HomeMy WebLinkAbout20061944.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE
CHAIR TO SIGN -YOUTH EMANCIPATION AND SERVICES, INC.
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a Child Protection Agreement for Services
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and Youth
Emancipation and Services, Inc.,commencing July 1,2006,and ending May 31,2007,with further
terms and conditions being as stated in said agreement, and
WHEREAS,after review,the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the Child Protection Agreement for
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and Youth
Emancipation and Services, Inc. be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 19th day of July, A.D., 2006, nunc pro tunc July 1, 2006.
BOARD OF OUNTY COMMISSIONERS
��`:► I /J \ WELD C TY, COLORADO
ATTEST: In 4/ ;�•- t1/411>♦�
. J. Geile, hair
Weld County Clerk to the =oar. Kc
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:< David E. Long, Pro-Tem
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Date of signature: -713i 10e
2006-1944
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DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY,CO. 80632
Website:www.co.weld.coms
'g Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
C.
COLORADO
MEMORANDUM
TO: M.J. Geile, Chair Date: July 17, 2006
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services `J a 1O
RE: Child Protection Agreement for Services Between the Weld County Department
of Social Services and Youth Emancipation & Services, Inc.
Enclosed for Board approval is a Child Protection Agreement for Services between the Weld
County Department of Social Services (Department) and Youth Emancipation & Services, Inc.
(Youth Emancipation). This Agreement was reviewed at the Board's Work Session of June 19,
2006.
The major provisions of the contract are as follows:
1. The term of the contract is July 1, 2006 through May 31, 2007.
2. The source of funding is Child Welfare Block Funding.
3. Youth Emancipation will provide anger management services for adolescents involved in
the child welfare system through individual, group, and family treatment
4. The Department agrees to pay according to Youth Emancipation's fee schedule,not to
exceed $2,500.
If you have any questions,please telephone me at extension 6510.
2006-1944
06-07-CPS-68
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND YOUTH EMANCIPATION& SERVICES,INC.
This Agreement, made and entered into the is'day of June 2006, by and between the Board of Weld
County Commissioners,sitting as the Board of Social Services,on behalf of the Weld County Department of Social
Services, hereinafter referred to as"Social Services,"and Youth Emancipation& Services, Inc.,hereinafter referred
to as "Y.E.S."
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Regular
Administration funding to Social Services for anger management and family conflict management services for
families, children,and adolescents; and
WHEREAS, Social Services requires the services of a therapeutic provider to assist the County to deliver
anger management and family conflict resolution services to youth in the child welfare system, and Y.E.S. is willing
and able to provide such services;and
WHEREAS,Y.E.S. is a Colorado non-profit corporation organized for the purpose of managing and
coordinating high quality,cost efficient,therapeutic services in the State of Colorado.
NOW THEREFORE,in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1,2006,upon proper execution of this Agreement and shall
expire May 31,2007, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Y.E.S. to any person(s)eligible for child protection services in compliance
with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule,"a copy of which is
attached hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from Child
Welfare Regular Administration funds during the duration of this Agreement.
b. Y.E.S. shall submit an itemized monthly bill to Social Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by
Social Services. Y.E.S. shall submit all itemized monthly billings to Social Services no later than
the twenty-fifth(25)day of the month following the month the cost was incurred.
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c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the
availability of Child Welfare Regular Administration funds to Social Services.
d. Social Services shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,Y.E.S. shall comply
with the administrative requirements,cost principles and other requirements set forth in the Financial
Management Manual adopted by the State of Colorado. The required annual audit of all funds expended
under Child Welfare Regular Administration funding must conform to the Single Audit Act of 1984 and
OMB Circular A-133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Y.E.S.shall provide proper monthly invoices and itemization of services performed for costs incurred
in the performance of the agreement.
b. Social Services may withhold any payment if Y.E.S. has failed to comply with the Financial
Management Requirements,program objectives, contractual terms,or reporting requirements. In
the event of a forfeiture of reimbursements,Y.E.S. may appeal such circumstance to the Director
of Social Services. The decision of the Director of Social Services shall be final.
6. Assurances
Y.E.S.shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,Y.E.S. shall strictly adhere to all applicable federal
and state laws,orders,and all applicable standards, regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers, documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. Y.E.S. acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 a seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
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Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency
Syndrome(AIDS)or AIDS related conditions, covered under Section 504 of the Rehabilitation
Act of 1973,as amended,cited above. If necessary,Y.E.S. and Social Services will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42 CFR
Part 2.
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Certifications
Y.E.S. certifies that,at the time of entering into this Contract, it has currently in effect all necessary
licenses,approvals, insurance, etc. required to properly provide the services and/or supplies covered by this
contract.
9. Monitoring and Evaluation
Y.E.S. and Social Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by Y.E.S. and Social Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and Y.E.S.
Y.E.S. shall permit Social Services, and any other duly authorized agent or governmental agency,to
monitor all activities conducted by Y.E.S. pursuant to the terms of this Agreement. As the monitoring
agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on-
site checking, formal audit examinations,or any other reasonable procedures. All such monitoring shall be
performed in a manner that will not unduly interfere with agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Social Services or designee may exercise the following remedial actions should s/he find
Y.E.S. 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 Y.E.S.
These remedial actions are as follows:
a. Withhold payment to Y.E.S. until the necessary services or corrections in performance are
satisfactorily completed;
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b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by Y.E.S.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. Incorrect payment to Y.E.S.due to omission,error,fraud,and/or defalcation shall be recovered from
Y.E.S.by deduction from subsequent payments under this Agreement or other agreements between
Social Services and Y.E.S.,or by Social Services as a debt due to Social Services or otherwise as
provided by law.
12. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives
of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Social Services:
Gloria Romansik Social Services Administrator
Name Title
For Y.E.S.:
James P.Nelson Executive Director
Name Title
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: Social Services To: Youth Emancipation&Services,Inc.
Judy A.Griego,Director James P.Nelson
P.O.Box A 3400 16`"Street,Bldg,6,Suite MM
Greeley,CO 80632 Greeley,CO 80634
14. Litigation
Y.E.S. shall promptly notify Social Services in the event that Y.E.S. learns of any actual litigation in which
it is a party defendant in a case that involves services provided under this Agreement. Y.E.S.,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,reorganization and/or foreclosure.
15. Termination
This Agreement maybe terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. Y.E.S.reserves the right to suspend services to clients if funding is no
longer available.
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16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written. ���
ATTEST: £4
WELD COUNTY %4 OF COUNTY
CLERK TO THE BOARD 4* e 1. ISSIONERS WE D
1161 tk4 �.�O CC
•
�, OyLO
De. ty Cler' O � M.J. eile,Chair JUL 1 9 2006
APP TO FORM: YOUTH EMANCIPATION& SERVICES, Inc.
BY
County A ey s P.Nelson,Executive Director
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: _ l
Ju A.Grieg ,Director
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EXHIBIT A
SCOPE OF SERVICES
Overall Project Description
Y.E.S. shall provide services to Social Services clients,specifically adolescents,having issues with anger
management. These services will include individual,group,and family treatment.
2. Eligible Population for Services
Social Services will refer to Y.E.S.youth ages twelve to nineteen and who have an open child welfare case
or at imminent risk of out of home placement due to their substance abuse.
3. Types of Services to be Provided
A. Treatment Options
Group Therapy/Support Groups:
1. Anger Management and Conflict Resolution Groups will concentrate on discovering the
underlying feelings antecedent to anger outbursts,the irrational thoughts and fears that
contribute to the intensity of anger,and will retain individuals and families in the
understanding and diffusing of their personal anger cycles.
2. A licensed master's level therapist who has experience in group therapy with this
challenging yet rewarding population will facilitate groups.
Family Conflict Management:
I. Family Conflict Management will teach dispute resolution skills to reduce stress and
foster an atmosphere of cooperation rather than contention when internal conflicts arise
that reduces the family's ability to work together to achieve common goals and interests.
The degree of conflict within the family will be measured using an assessment devise at
the initiation of services and at the termination of services.
B. Reporting
Y.E.S. will provide monthly reports to Social Services concerning the status of each participant
including both monthly aggregate and client progress reports. All client progress reports
submitted by Y.E.S. will be substantive, clearly written,and signed by the clinician, therapist, or
evaluator. Y.E.S. will utilize the monthly progress report form created by Social Services. Y.E.S.
will incorporate into each youth treatment plan the child welfare objective as identified by the
Social Services caseworker. These objectives are derived from the Social Services' caseworker's
assessment and state what must be done to undertake behavioral changes,to mitigate safety
concerns,to resolve risks and to result in family continuity and/or permanency. These reports will
be provided to Social Services by the twenty-fifth day of each month.
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4. Fee Schedule for Services
Y.E.S.'s fee schedule for services is as follows:
Anger Assessment(up to 4 hours) $35.00 per hour
Individual, Group, and Family Therapy $45.00 per hour
5. Measurable Outcomes and Objectives
Y.E.S. shall abide by Social Services outcome indicators of Safety, Permanency and Child and Family
Well-Being, which are provided under Adoption and Safe Families Act (ASFA), 1997;Colorado Child and
Family Services Plan 2000—2004; and ACF Reviews(Reference: Federal Register, Volume 65,Number
16: 45 CRF Parts 1355, 1356, and I357), March 25,2000.
a. Client Objectives
The Social Services caseworker will identify three child welfare objectives to be addressed within
each client's treatment plan. Y.E.S. shall develop action steps to reach the identified child welfare
objectives. Y.E.S. shall report monthly on each client's progress in meeting the three identified
objectives. Each objective will be measured via a percentage Likert Scale to determine progress.
b. Overall Program Objectives
Y.E.S. and Social Services agree to monitor the ability of the substance abuse program offered by
Y.E.S. to achieve objectives as follows:
I) Increase level of functioning currently impaired by anger issues.
2) Decrease in aggressive behaviors at home and/or school and in the community.
3) Develop the capacity to ask for help and assistance with out resorting back to aggressive
behavior.
4) Youth will demonstrate increased verbal skills,empathy and accountability
5) Youth will develop problem-solving skills when confronted with a relapse trigger
6) Youth will address past/current victimization issues that interfere with their ability to
manage their anger.
7) Improve Parent-child functioning to lower the risk of out of home placement
8) Family member will identify and implement opportunities to support the youth in their
recovery.
6. Workload Standards
Y.E.S. will meet the following workload standards:
a. Serve up to eight youth per month in anger management treatment;
b. Should there not be enough clients to begin a group, Y.E.S. will work with the youth on an
individual basis until they can be transitioned to a group.
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7. Staff Qualifications
Y.E.S. staff members who will provide services to Social Services will have credentials and/or
certifications as required by the Colorado Department of Human Services,Alcohol and Drug Abuse
Division.
a. CACII; A CACII level counselor will be utilized when it appears that the primary issue is
substance abuse with underlying home/social factors.
b. LPC/LCSW; A LPC/LCSW will be utilized when the clients' substance abuse issues are a direct
result of home/social factors.
c. Case Manager; A Y.E.S. case manager will be assigned to every Social Services client that is
referred for substance abuse services.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Social Services agrees to reimburse Y.E.S. in consideration for the work and services performed,a total
amount not to exceed Two Thousand Five Hundred Dollars ($2,500) under Child Welfare Regular
Administration funding.
Expenses incurred by Y.E.S., in association with said project prior to the term of this agreement, are not
eligible Social Services expenditures and shall not be reimbursed by Social Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof,become unavailable as
determined by Social Services, Social Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Anger Assessment(up to 4 hours) $35.00 per hour
Individual, Group, and Family Therapy $45.00 per hour
Social Services referrals will not be sent to collections by Y.E.S. for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
3. Submittal of Vouchers
Y.E.S. shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility"in Exhibit D, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
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EXHIBIT C
ASSURANCES
1. Y.E.S. agrees it is an independent contractor and that its officers and employees do not become employees
of Weld County,nor are they entitled to any employee benefits as Weld County employees, as the result of
the execution of this Agreement.
2. Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not
be held liable for injuries or damages caused by any negligent acts or omissions of Y.E.S.-contracted,
Y.E.S. or its employees,volunteers,or agents while performing duties as described in this Agreement.
Y.E.S. shall indemnify,defend, and hold harmless Weld County,the Board of County Commissioners of
Weld County, its employees,volunteers,and agents. Y.E.S. shall provide adequate liability and worker's
compensation insurance for all its employees,volunteers,and agents engaged in the performance of the
Agreement upon request, Y.E.S. shall provide Social Services with the acceptable evidence that such
coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections,paragraph, sentence, clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. Y.E.S. assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person
shall,on the grounds of race,creed,color, sex, or national origin,be excluded from participation in,be
denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. Y.E.S. assures that sufficient,auditable, and otherwise adequate records that will provide accurate,current,
separate,and complete disclosure of the status of the funds received under the Contract are maintained for
three(3)years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors, and representatives to audit and monitor Y.E.S..
9. All such records,documents,communications,and other materials shall be the property of Social Services
and shall be maintained by Y.E.S., in a central location and custodian, in behalf of Social Services, for a
period of four(4)years from the date of final payment under this Contract, or for such further period as
may be necessary to resolve any matters which may be pending,or until an audit has been completed with
the following qualifications: If an audit by or on behalf of the federal and/or state government has begun
but is not completed at the end of the four(4)year period,or if audit findings have not been resolved after
a four(4)year period,the materials shall be retained until the resolution of the audit finding.
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10. Y.E.S. assures that authorized local, federal, and state auditors and representatives shall, during business
hours,have access to inspect any copy records, and shall be allowed to monitor and review through on-site
visits,all contract activities,supported with funds under this Contract to ensure compliance with the terms
of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the
Agreement shall be conducted by appropriate funding sources. The results of the monitoring and
evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors, heirs, legal representatives,and
assigns. Y.E.S. or Social Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. Y.E.S. certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of
Y.E.S.,to any person for influencing or attempting to influence an officer or employee of an agency,a
Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any federal grant,the making of any
federal loan,the entering into of any cooperative agreement, and the extension,continuation,renewal,
amendment,or modification of any Federal contract, loan,grant,or cooperative agreement.
13. Y.E.S. assures that it will fully comply with all other applicable federal and state laws. Y.E.S. understands
that the source of funds to be used under this Contract is Child Welfare Regular Administration funds.
14. Y.E.S. assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment, declared ineligible,or voluntarily
excluded from covered transaction by a federal department of 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 11(b)of
this certification; and
d. Have not within a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with Social Services when
the contractor also maintains a relationship with a third party and the two relationships are in opposition.
In order to create the appearance of a conflict of interest, it is not necessary for the contractor to gain from
knowledge of these opposing interests. It is only necessary that the contractor know that the two
relationships are in opposition. During the term of the Contract,Y.E.S. shall not enter any third party
relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation, Y.E.S. shall submit to Social Services,a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Social Services'
termination, for cause, of its contract with Y.E.S.
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16. Y.E.S. shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. Except for purposes directly connected with the administration of Child
Protection, no information about or obtained from any applicant/recipient in possession of Y.E.S. shall be
disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with Y.E.S. written policies governing access to,duplication and dissemination of, all such
information. Y.E.S. shall advise its employees,agents, and subcontractor,if any,that they are subject to
these confidentiality requirements. Y.E.S. shall provide its employees,agents,and subcontractors, if any,
with a copy or written explanation of these confidentiality requirements before access to confidential data
is permitted.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of
its customers, clients or affiliates, but does not include information(1) lawfully obtained from third parties,
(2)that which is in the public domain, or(3)that which is developed independently. Neither party
shall use or disclose directly or indirectly without prior written authorization any proprietary information
concerning the other party obtained as a result of this Contract. Any proprietary information removed from
the State's site by Y.E.S. in the course of providing services under this Contract will be accorded at least
the same precautions as are employed by Y.E.S. for similar information in the course of its own business.
18. The Contractor certifies it will abide by Colorado Revised Statute(C.R.S.) 26-6-104,requiring criminal
background record checks for all employees, contractors, and sub-contractors.
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EXHIBIT D
CHILD WELFARE SERVICES
Y.E.S. agrees to:
Provide a written report to the Social Services caseworker within 25 calendar days of the month following
service.
2. Report to Social Services a monthly brief report on the status of the program as prescribed by Social
Services.
3. Report expenditures and case disbursement at agreed upon times.
4. Submit monthly-completed billing forms to Ms. Andrea Shay,Core Services Caseworker,by the 10th day
of the month following service provision. If the billing is not submitted within twenty-five(25)calendar
days of the month following service, it may result in forfeiture of payment.
5. Submit in the event no service fees are incurred during the service month,an Authorization for Contractual
Services stating no services were provided for that service month shall be submitted within twenty-five
(25)calendar days following the month of service.
6. Submit an original Request for Reimbursement in complete form to re-bill for services previously denied
by Social Services. If in the resolution process,the provider will not re-bill for payment unless the
provider can justify payment by documentation. Social Services will not consider payments that were
originally reviewed as deficient in documentation without new documentation to justify payment. Social
Services shall receive the Request for Reimbursement no later than five business days from receipt of a
certified letter from Social Services documenting such denials of payment.
7. Work with family to prepare to pay for services beyond established time frame.
A complete and timely billing form is identified by and must include the following elements.
a. The billing must be an original billing signed by the provider and/or designee.
b. The billing must include all forms designed for Child Welfare Administration funding
reimbursement and approved by the Department of Social Services including Colorado State
Department of Social Services Authorization for Contractual Services form and Weld County
Monthly Request for Reimbursement under Child Welfare Regular Administration Funding.
c. A re-bill must include all forms designed for re-billing of Requests for Reimbursement under
Child Welfare Regular Administration funds, and approved by the Department of Social
Services. This includes a signed original Authorization for Contractual Services and Weld
County Program Re-bill under Child Welfare Regular Administration funds and Additional
Request for Reimbursement form.
1. Authorization for Contractual Services forms must be submitted completely filled in
with an original signature from the provider and/or designee.
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06-07-CPS-68
2. Request for Reimbursement forms must include the client's full name; Weld County
household number, suffix number, and referral number, if applicable; units provided,
service date, unit rate,and total billed for the service date.
3. Requests for payment must be date stamped by the Department of Social Services by
the 25th day of the month following the service month. Requests for payment
received after the 25th of the month following service will not be honored.
4. Re-bills for services must include only those items Island Grove can justify with
documentation and include a signed original Authorization for Contractual Services
form and Weld County Program Re-bill under Child Welfare Regular
Administration funds and Additional Request for Reimbursement form.The Weld
County Rebill under Child Welfare Regular Administration funding form must
include the client's name;household number and suffix number, if applicable; month
of billed service,re-bill amount, the approved entry date and exit dates,the actual
units re-billed,the rate per unit, and the re-bill total for the line item.
8. Will develop and utilize evaluation tools(pre and post assessment test instruments)to
collect necessary data in cooperation with Social Services staff to monitor effectiveness
of program.
9. Will meet with Social Services FPP Supervisor and/or Core Services Caseworker
quarterly(more if needed)to review program usage and effectiveness to discuss
necessary improvements to better serve families or increase referrals.
10. Be available to meet with Social Services staff to explain program, time lines of response
to referrals and answer questions to enhance program, and to participate in Core Review
Team, if necessary.
11. Be available for the Families,Youth and Children Commission review and attendance at
the FYC meetings.
Page 2 of 2
06-07-CPS-68
WELD COUNTY
AUTHORIZATION FOR CONTRACTUAL SERVICES
Date:
Provider: Billing Contact:
Phone #:
Address:
Description of Services:
Service Month / Year Charges: $
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED AND
THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND
THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES.
Printed Name of Signer Provider Signature Date
(Original signature required—no faxes)
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
Approvals:
Core Caseworker Date Director Date
AMOUNT PAYABLE: $
ANY CHANGES LISTED BELOW:
Client/ID/HH# Billed Amt Denied Paid Reason
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