HomeMy WebLinkAbout20073312.tiff a
DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
WI I D O Fax Number(970)353-5215
COLORADO
• MEMORANDUM
TO: Judy Griego - Director
FROM: Lesley Cobb - Child Welfare Rate Negotiator
DATE: September 24, 2007
SUBJECT: Weld County Addendums to the Agreement to Purchase — State
SS-23A
Attached please find the Weld County Addendums to the Agreement to Purchase Child
Placement Agency Services for the following providers:
1) Adoption Alliance—Provider ID# 71259
2) Frontier Family Services—Provider ID#38041
3) Lost and Found Inc. —Provider ID#57351
4) Youth Ventures of Colorado—Provider ID#1529601
These contracts have been approved for consent by the Board of County Commissioners
however; I am requesting your signature along with the Boards to complete these contracts
for the FY 2007-2008. If you have any questions please call me at Ext. 6441.
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2007-3312
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Child Placement Agency Services
(the "Agreement") between Lost and Found Inc. and Weld County
Department of Social Services for the period from
July 1, 2007 through June 30, 2008.
The following provisions, made this / day of tT , 2007, are added to the referenced
Agreement. Except as modified hereby, all teams of the Agreement remain unchanged.
1. County and Contractor agree that a child specific Needs Based Care Assessment,
designated as Attachment B, shall be used to determine levels of care for each child
placed with Contractor.
2. County agrees to purchase and Contractor agrees to provide the care and services, which
are listed in this Agreement, based on the Needs Based Care Assessment levels
determined. The specific rate of payment will be paid for each level of service, as
indicated by the Needs Based Care Rate Table, designated as Attachment C, for children
placed within the CPA identified as Provider ID#57351. These services will be for
children who have been deemed eligible for social services under the statutes, rules and
regulations of the State of Colorado.
3. Section I, Paragraph 2. All bed hold authorizations and payments are subject to a 3 day
maximum for a child's temporary absence from a facility, including hospitalization. Bed
hold requests must have prior written authorization from the Department Administrator
before payment will be release to provider.
4. Add Paragraph 6 to Section I. A minimum of one polygraph test per Colorado fiscal
year, if needed by the child, will be furnished under this contract for facilities that
provide sex offender treatment.
5. Add Paragraph 7 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
which are not provided within the negotiated provider rate, will need to be authorized, in
writing by the County, prior to the service being performed. Any payment for specialized
services not authorized in writing will be denied.
6. Add Paragraph 5 to Section II. Contact by the Contractor with the County regarding
emergency medical, surgical or dental care will be made in person-to-person
communication, not through phone mail messages. During regular work hours, the
Contractor will make every effort to notify the assigned caseworker, supervisor, or intake
screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor
will contact the Emergency Duty Worker at the pager number(970) 304-2749.
7. Section III, Paragraph 5. Contractor additionally agrees to have appropriate personnel
available for staffing current placements with the Utilization Review Team. This review
team convenes every Monday morning, excluding holidays.
8. Add Paragraph 13 to Section IV. Agree to cooperate with any vendors hired by Weld
County Department of Social Services to shorten the duration of placement.
Weld County SS-23A Addendum
9. Add Paragraph 14 to Section IV. Agree to schedule physical examinations within 14
•
days after placement, dental examinations within 60 days after placement and forward all
appropriate information to the County.
10. Add Paragraph 15 to Section IV. A full evaluation of an Individualized Educational Plan
(IEP) for youth designated as a Special Education Student will be conducted every 3
years and reviewed every year. If the IEP is due while the child is in placement, the
Contractor will complete or obtain a completed IEP. A copy will then be forwarded to
the County.
11. Add Paragraph 16 to Section IV. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
11. Section V, Paragraph 5. Children in Psychiatric Residential Treatment Facilities,
Therapeutic Residential Child Care Facilities, Residential Child Care Facilities and Child
Placement Agencies are not eligible to receive clothing allowances as outlined in the
Weld County Department of Social Services Policy and Procedure Manual.
12. Add Paragraph 7 to Section VI. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of action
relating to such enforcement, shall be strictly reserved to the undersigned parties or their
assignees, and nothing contained in this Agreement shall give or allow any claim or right
of action whatsoever by any other person not included in this Agreement. It is the
express intention of the undersigned parties that any entity other than the undersigned
parties or their assignees receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
13. Add Paragraph 8 to Section VI. No portion of this Agreement shall be deemed to
constitute a waiver of any immunity the parties or their officers or employees may
posses, nor shall any portion of this Agreement be deemed to have created a duty of care
that did not previously exist with respect to any person not a party to this Agreement.
The parties hereto acknowledge and agree that no part of this Agreement is intended to
circumvent or replace such immunities.
2 Weld County SS-23A Addendum
14. Add Paragraph 9 to Section VI. The Director of Social Services or designee may
•
exercise the following remedial actions should s/he find the Contractor substantially
failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy
the scope of work shall be defined to mean incorrect or improper activities or inaction by
the Contractor. These remedial actions are as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
15. Add Paragraph 10 to Section VI. The contractor shall promptly notify Social Services in
the event in which it is a party defendant or respondent in a case, which involves services
provided under the agreement. The Contractor, within five (5) calendar days after being
served with a summons, complaint, or other pleading which has been filed in any federal
or state court or administrative agency, shall deliver copies of such document(s) to the
Social Services' Director. The term "litigation" includes an assignment for the benefit of
creditors, and filings in bankruptcy, reorganizations and/or foreclosure.
16. Add Section VII-ATTACHMENTS:
3 Weld County SS-23A Addendum
NORTHERN CONSORTIUM OF COUNTIES
NEEDS BASED CARE ASSESSMENT
• (Exhibit B)
IDENTIFYING INFORMATION
CHILD'S NAME STATE ID# ISEX F [TRAILS CASE ID 1DOB
WORKER COMPLETING ASSESSMENT HH# I IRATE OF ASSESSMENT
AGENCY NAME PROVIDER NAME PROVIDER TRAILS ID
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT
• For each question below,please select the response which most closely applies to this child.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does the child require transportation by the foster care provider for the following: Therapy; Medical Treatment;
Family Visitation; Extraordinary Educational Needs; etc.,as outlined in the treatment plan?
❑Basic Maint.)Less than one round trip a week El)One round trip a week ❑l'/)2 round trips a week
O2)3-4 round trips a week. O2%)5 round trips a week O3)6 round trips a week
❑3%) 7 round trips or more
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
❑ Basic Maint.)No participation required 01)Once a month ❑1%)Two times month
O2)Three times a month O2%)Once a week ❑3)Two times a week
O3%)Three times a week or more
P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular o
special education plan?
O Basic Maint.)No educational requirements 01)Less than a %z hour per day ❑1%) %I hour a day
O2) 1 hour a day O2 %z) 1'h-2 hours per day O3)2'/2-3 hours per day
O3%)More that 3 hours per day
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time
and/or activities and/or crisis management?
❑Basic Maint.)No special involvement needed ❑1)Less than 5 hours per week 01%) 5 to 7 hours per week
❑2) 8 to 10 hours per week O2%) 11 to 14 hours per week
0 3)Constant basis during awake hours O3%)Nighttime hours
P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feedil
bathing,grooming,physical, and/or occupational therapy?
❑Basic Maint.)0-2 hours per week ❑1)3 to 4 hours per week ❑1/)5 to 7 hours per week
❑2)8 to 10 hours per week O2%) 11 to 15 hours per week ❑3) 16 to 20 per week
❑3%)21 or more hours per week
A 1. How often is CPA/County case management required?(Does not include therapy)
❑Basic Maint.)Face-to-face contact one time per month with child and no crisis intervention.
(i.e.mutual care placements.)
❑1)Face-to-face contact one time per month with child and minimal crisis intervention.
❑l%)Face-to-face contact one time per month with child and occasional crisis intervention.
O2)Face-to-face contact two times per month with child and occasional crisis intervention.
O2%)Face-to-face contact three times per month with child and occasional crisis intervention.
O3)Face-to-face contact weekly with child and occasional crisis intervention.
❑3%)Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination
of multiple services.
**Please Note: The Case Management level may be assessed on a combined basis if a sibling group,or more than one
County foster child is with the same provider.
T 1. How often are therapy services needed to address child's individual needs per NBC assessment?
❑0)Not needed or provided by another source(i.e.Medicaid) ❑1)Less than 4 hours per month
O2)4-8 hours per month O3)9-12 hours per month
4 Weld County SS-23A Addend
•
WELD COUNTY DSS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Y+,�jS1`S.�+�:A� C.--,,,t,':;,' 'xr y ti _C. p 6bP �' '! '�ihk '�'TC a k .
':%%.114,,,,4,1,p%.4,4'° +� rt3 f i.a{ .. E e# d f *a_ .. .` ,,,$ 0 3 ;,„'tiia 3 s '`.
� � �1 8 L 1 41 A�1£ i A { it ii ( ffiy P T..c�3�
.... ' (�� 'HAP A �w, q'1�._�� ;�t°� ' E .rac r :. .;.-.44:4„. "LIZ.' 4" *` -h�':'Px...c��i'
.r ..�. ...rze rz_rz •.mxn m. m�� .� Y 4 i1P...: .:v .. .'�i ..^�R'i-.m Ani.�� .u:
Aggression/Cruelty to Animals
El El ❑ El
Verbal or Physical Threatening
❑ ❑ ❑ El
Destructive of Property/Fire
Setting 0 0 0 0
Stealing
❑ ❑ 0 0
Self-injurious Behavior
❑ El ❑ ❑
Substance Abuse
O 0 0 0
Presence of Psychiatric
Symptoms/Conditions III ❑ ❑ ❑
Enuresis/Encopresis
O 0 0 0
Runaway
❑ ❑ 0 ❑
Sexual Offenses
O 0 0 0
5 Weld County SS-23A Addend
BEHAVIOR ASSESSMENT CONTINUED
•
(Exhibit B)
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
.{genisso 'tsxset e ��:3�,.�c!'5. Jo {: n7{ t rte t t ! "tersisvire ,
xx s l r L ;h. - ItlFlr ilj v
,{,{ !'� i l •b y:Fib
gst SLi �.a sa a {Icy il15Sl!lr• r,T t a":41.40,6+
Tif Y't 'm" ,. U. 3 !1. V ! wad b ! t 4 L !E d }I! !1 4 ,!4.k.3, u4' , 1 .. .1-3k�_'S_ ;v swab
.a.,4 ....,n.„4
.� `s`} �$!fr s. - s ?. x. . . ,.__._ .uv � .,m..ax
Inappropriate Sexual Behavior
❑ 0 0 0
Disruptive Behavior
❑ ❑ 0 ❑
Delinquent Behavior
❑ ❑ 0 0
Depressive-like Behavior
❑ ❑ 0 ❑
Medical Needs
(If condition is rated"severe",please complete ❑ ❑ ❑ ❑
the Medically fragile NBC)
Emancipation
❑ ❑ 0 ❑
Eating Problems
❑ o 0 0
Boundary Issues
❑ ❑ 0 0
Requires Night Care
❑ ❑ 0 0
Education
❑ ❑ 0 0
Involvement with Child's Family
❑ 0 0 0
CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT:
(check level of need) El0 ❑ 1 2 3
6 Weld County SS-23A Addend
•
' WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
•
NEEDS BASED CARE
RATE TABLE
(Exhibit C)
S""' e u a 1: e cr x a gri,1r ' "� '+.ar�"g'` r s, °°"_114. 4'�`c�'°s§S 'arr § x '5 {.. �u ,
'i7k�p ?q'�` e a 2 I ``:.. ' 1e a.�$.e. 'a ailr a4aa `'a.y°�" i�' z 'V^v ` 'iiSi ate.
$� per. t�,�Se� '*�{
% "s F .i,.�,., J 4yi`!•`„a v'C+2.° '`i;e §'°} a�'° t + tY: "if. 3 ,c4
ti..,"ale le l,a _ i. a 12N. yr,. ,
'i Age 0-10...$16.32($496) Basic Maint $4.93 day/$150mo V Level 0 $0
in Age 11-14...$18.05 .5% Therapy not needed or provided .i,i-
County 11'"y
Basic ($549) • No crisis intervention, Minimal CPA by 11:1,,, Level 0...$0
Maint. it p, Age 15-21...$19.27 t (None)
($586) involvement,one face-to-face visit " another source,i.e.mental health. ,T
+$.66 Respite Care ,_ `'
1)!.Ti-
„Er:9,
($20) 1 with child per month. .a` ler
I
IA
_� • Level 1 $4.93/$150 mop$19.73 Level 1 •$8.22 day/$250 mo ,:n
;-. +$.66 Respite Care Minimal crisis interention as needed, r., Regularly scheduled therapy, •k_
1 a,y Level 1 ...$2.99
3 one face-to-face visit per month with
3 sir, ($20.39 day/$620 mo) child, lrij. up to 4 hours/month.
=IA; iy' ;y
2-3 contacts per month
T $23.01 'ar= akl:,
1 1/2 r +$.66 Respite Care Level 1 1/2 $9.86 day/$300 mo _�aa iiE
z' ($23.67 day/$720 mo) -
P Y r ..
47
Ni, $26.30 Level 2 $11.51 day/$350 mo a v Level 2 $9.86/$300 mo
'.
10 +$.66 Respite Care : Occasional crisis intervention as needed, Weekly scheduled therapy,
2 — - Level 2..$4.47
gD, ($26.96 day/$820 mo) two face-to-face visits with child, S�`. 5-8 hours a month with 4 hours of n.
2-3 contacts per month ,; group therapy. 4
,Tai_. $29.59 1e.
2 1/2 4.66 Respite Care Level 2 1/2 $13.15 day/$400 mo F�`=
,;• ($30.25 day/$920 mo) �`- el
:
gi
=i $32.88 •
: Level 3 $14.79 day/$450 mo IN Level 3 $14.79/$450 mo
_ OR
+$.66 Respite Care Ongoing crisis intervention as needed, V. Regularly scheduled weekly 1
3 qs' multiple sessions,can include y Level 3..$6.02
weekly face-to-face visits with child e_ more r
($33.54day/$1020 mo) 'E s
and intensive coordination of _;s than 1 person,i.e.family therapy,
gi` multiple services. ''„' for 9-12 hours/monthly.
"itc.` $36.16 :L,
3 1/2 _, l +$.66 Respite Care Level 3 1/2.........$16.44 day/$500 mo urgr"', :0
f_
Pt; ($36.82 day/$1,120 mo) : _ ; '';
$39.45 Level 4 $18.08 day/$550 mo 1 _. Level 4 $14.79/$450 mo iHt.
` . +$.66 Respite Care Ongoing crisis intervention as needed, Regularly scheduled
P 9 99 Y weekly
4 i3'3 av4 multiple sessions,can include r
RTC T: which includes high level of case '- more Level 4....Neg.
Drop '
Down *, ($40.77 day/$1220 mo) management and CPA involvement with than 1 person,i.e.family therapy,
is"_ • child and provider and 2-3 face-to-face Irro for 9-12 hours/monthly.
lit
contacts .er week minimum. -
Assess 4 -0 =sue:
$26.96 day/$820 mo - ?:
Rate 4: (Includes Respite) ' t� $11Jai• .51 day/$350 mo , , .'
_y�ji iiu' ' ''-i,'
Admin.Overhead Rate: As of 7/01/07
$6.25 day/$190.00 month
7 Weld County SS-23A Addend
•
' ' IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
,) i,," n 7)//f /1
ATTEST: ) Jct...4,// [/(/! Y=.
Weld County Clerk to the Board
, `~ WELD COUNTY BOARD OF
,� ' .,, SOCIAL SERVICES, ON BEHALF
'� (- 4 °� N OF THE WELD COUNTY
Also} ;' ` ,;9 ;— DEPARTMENT OF SOCIAL
a SERVICES
By: (1-eld�c By:
c)(
Deput Clerk to the oard David E. Long, Chair
OC 2 2 2001
CONTRACTOR
Lost and Found Inc.
6700 44th Ave
Wheatridge, CO 80033
By: ,levi.LG (��
M5 n/ ,/.41,'o'6
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By Ctit ctor
8 Weld County SS-23A Addendum
4002
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