Loading...
HomeMy WebLinkAbout20060523.tiff RESOLUTION RE: APPROVE ADDENDUM TO SIX AGREEMENTS TO PURCHASE CHILD PLACEMENT AGENCY SERVICES AND AUTHORIZE CHAIR TO SIGN 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 an Addendum to Six Agreements to Purchase Child Placement Agency 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 the following providers, commencing January 13,2006, and ending June 30, 2006, with further terms and conditions being as stated in said amendment, and 1. Savio House -#37330 2. Savio House -#5628 3. Savio House -#1517239 4. Savio House - #1534549 5. Savio House - #1536911 6. Maple Star WHEREAS,after review,the Board deems it advisable to approve said addendum, 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 Addendum to Six Agreements to Purchase Child PlacementAgency 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 and the following providers be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said amendment. 2006-0523 SS0033 C ea S53 O3 -fit- ki ADDENDUM TO SIX AGREEMENTS TO PURCHASE CHILD PLACEMENT AGENCY SERVICES AND AUTHORIZE CHAIR TO SIGN - VARIOUS PROVIDERS PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 22nd day o[ebruant A.D., 2006, nunc pro tunc January 13, 2006. i ♦4BOARD OF COUNTY COMMISSIONERS ` ELD COUN/Y, COLORADO ATTEST: at, .�; �_�, ��� /�f i6L J eile, Chair Weld County Clerk to the +►w ��i >1 l' d °e� V i r � " David E. Long, Pro-Tern BY: / _ D uty Cl 'k to the Bo( 11 : . ail Willi er 1��� �� APP VED M: l- I�WDeIUr� �� Robert C). Masden_/ Coun ttorney —� _� /I Glenn Vaad Date of signature: 3 w/ 10 p 2006-0523 SS0033 S DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 ' WebsIte:www.co.weld.co.us Administration and Public Assistance(970) 352-1551 Fax Number(970) 346-7691 O • COLORADO MEMORANDUM TO: M.J. Geile, Chair Date: February 14, 2006 Board of County Commissioners FR: Judy A. Griego, Director, Social Services �•,otH ( X C;� L RE: Addendums to Agreements to Purchase Child Placement Agency(CPA) and Group Center Services with Various Vendors Enclosed for Board approval are Addendums to Agreements to Purchase CPA Services between the Weld County Department of Social Services (Department) and various vendors. The Addendums were reviewed at the Board's Work Session held on February 13, 2006. Addendums have been entered into with those Vendors who are new providers that include the provision that rates will remain the same until June 30, 2006. The vendors include: Center Foster Care Rate Rate t. Savio House—Provider ID#37330 NA $130.95 per day 2. Savio House—Provider ID#5628 $78.50 per day N/A 3. Savio House—Provider ID#1517239 $103.34 per day N/A 4. Savio House—Provider ID#1534549 $78.50 per day N/A 5. Savio House—Provider ID#1536911 $105.21 per day* N/A 6. Maple Star Needs Based Formula *Offense specific placement would be$120.82 per day. If you have any questions,please telephone me at extension 6510. 2006-0523 WELD COUNTY ADDENDUM To that certain Agreement to Purchase Child Placement Agency Services ("Agreement") between Savio House and Weld County Department of Social Services for the period from January 13, 2006, through June 30, 2006. The following provisions, made this 20t1day of January , 2006, are added to the referenced Agreement. Except as modified hereby, all terms of the Agreement remain unchanged. 1. County agrees to purchase and Contractor, identified as Provider ID #37330, agrees to provide: A. Care and services, which are listed in this Agreement at a rate of$130.95 per day for children placed within the Multidimensional Treatment Foster Care Program. 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. 2. Add Paragraph 12 to Section I. The services purchased under this Agreement for CPA services may include, but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead, Service delivery Staff, which may include but are not limited to: Parent Training for Teens, Independent Living Training, Mentor/Advocate, and Supervised Visitation. 3. Add Paragraph 6 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) 350-8389. 4. Section V, Paragraph 5. Children in Residential Treatment 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. 15. ' 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. 6. 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. Weld County SS-23A Addendum 7. 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. 8. Add Paragraph 16 to Section IV. Assure and certify that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, 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. 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 immunities the parties or their officers or employees may possess, 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. 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; 2 Weld County SS-23A Addendum 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 that the Contractor learns of any actual litigation in which it is a party defendant 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. 3 Weld County SS-23A Addendum IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above written. ATTEST: 4.0 `t0 4 Weld County Clerk to the Board }%, \ WELD COUNTY BOARD OF t ictr - SOCIAL SERVICES, ON BEHALF Isar ) � OF THE WELD COUNTY hi, DEPARTMENT OF SOCIAL is SERVICES By: \. �� CZ.Gt (t' :C I By: Deput/ lerk to the Baa d .J. Geile, Chair J v FEB 2 2 2008 CONTRACTOR Savio House 325 King Street Denver, CO 80219 ✓By: ZIP/a WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Director' 4 Weld County SS-23A Addendum ;,lore-05°73 WELD COUNTY ADDENDUM To that certain Agreement to Purchase Group Center Care Services ("Agreement") between Savio House and Weld County Department of Social Services for the period from January 13, 2006, through June 30, 2006. The following provisions, made this 20th day of January , 2006, are added to the referenced Agreement. Except as modified hereby, all terms of the Agreement remain unchanged. 1. County agrees to purchase and Contractor, identified as Provider ID #5628, agrees to provide: A. Care and services, which are listed in this Agreement at a rate of$78.50 per day for children placed within the Group Home/Center. 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. 2. Add Paragraph 12 to Section I. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead, Service delivery Staff, which may include but are not limited to: Parent Training for Teens, Independent Living Training, Mentor/Advocate, and Supervised Visitation. 3. Add Paragraph 6 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) 350-8389. 4. Section V, Paragraph 5. Children in Residential Treatment 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. 5. 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. 6. 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. 7. Add Paragraph 15 to Section IV. A full evaluation of an Individualized Educational Plan j Weld County S5-23A Addendum a�Gl�6- �J�� (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. 8. Add Paragraph 16 to Section IV. Assure and certify that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, 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. 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 immunities the parties or their officers or employees may possess, 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. 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 2 Weld County SS-23A Addendum 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 that the Contractor learns of any actual litigation in which it is a party defendant 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. 3 Weld County SS-23A Addendum IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above l' written. ATTEST: J "< i!/. "-" Weld County Clerk to the Board t E La WELD COUNTY BOARD OF ?, SOCIAL SERVICES, ON BEHALF 53 , OF THE WELD COUNTY 1161 h �' DEPARTMENT OF SOCIAL „„P.A. SERVICES By: " 9 �1�ll. � lC . 6t1 By: DeputyClerk to the B6 rd .J. Geile, Chair FEB 2 2 2006 CONTRACTOR Savio House 325 King Street Denver, CO 80219 By: //>//1%'`_' (Z WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: tibtio. re t 3r 4 Weld County SS-23A Addendum &IY6 -1-'543 WELD COUNTY ADDENDUM • ' - To that certain Agreement to Purchase Group Center Care Services ("Agreement") between Savio House and Weld County Department of Social Services for the period from January 13, 2006, through June 30, 2006. The following provisions, made this 20thday of January , 2006, are added to the referenced Agreement. Except as modified hereby, all terms of the Agreement remain unchanged. 1. County agrees to purchase and Contractor, identified as Provider ID #1517239, agrees to provide: A. Care and services, which are listed in this Agreement at a rate of$103.34 per day for children placed within the Group Home/Center. 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. 2. Add Paragraph 12 to Section I. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead, Service delivery Staff, which may include but are not limited to: Parent Training for Teens, Independent Living Training, Mentor/Advocate, and Supervised Visitation. 3. Add Paragraph 6 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) 350-8389. 4. Section V, Paragraph 5. Children in Residential Treatment 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. 5. 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. 6. 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. 7. Add Paragraph 15 to Section IV. A full evaluation of an Individualized Educational Plan 1 Weld County SS-23A Addendum tW -CS.�2 (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. 8. Add Paragraph 16 to Section IV. Assure and certify that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, 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. 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 immunities the parties or their officers or employees may possess, 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. 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 2 Weld County SS-23A Addendum 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 that the Contractor learns of any actual litigation in which it is a party defendant 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. 3 Weld County SS-23A Addendum IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above written. aja14,44 ATTEST: Weld County Clerk to the Board WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF �e ; , OF THE WELD COUNTY t�t �I Y tDEPARTMENT OF SOCIAL '*, SERVICES 1 �, By: I26 1 i �2 By: eput Clerk to the B a d M.J. Geile, Chair FEB 2 2 2006 CONTRACTOR Savio House 325 King Street Denver, �C/O�8021199 By: L:l/��/�G e%rf- c - WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: O irecto 4 Weld County SS-23A Addendum 0?CCE: —CSC WELD COUNTY ADDENDUM To that certain Agreement to Purchase Group Center Care Services ("Agreement") between Savio House and Weld County Department of Social Services for the period from January 13, 2006, through June 30, 2006. The following provisions, made this 20thday of January , 2006, are added to the referenced Agreement. Except as modified hereby, all terms of the Agreement remain unchanged. 1. County agrees to purchase and Contractor, identified as Provider ID #1534549, agrees to provide: A. Care and services, which are listed in this Agreement at a rate of$78.50 per day for children placed within the Group Home/Center. 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. 2. Add Paragraph 12 to Section I. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead, Service delivery Staff, which may include but are not limited to: Parent Training for Teens, Independent Living Training, Mentor/Advocate, and Supervised Visitation. 3. Add Paragraph 6 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) 350-8389. 4. Section V, Paragraph 5. Children in Residential Treatment 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. 5. 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. 6. 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. 7. Add Paragraph 15 to Section IV. A full evaluation of an Individualized Educational Plan 1 Weld County SS-23A Addendum (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. 8. Add Paragraph 16 to Section IV. Assure and certify that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, 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. 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 immunities the parties or their officers or employees may possess, 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. 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 2 Weld County SS-23A Addendum 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 that the Contractor learns of any actual litigation in which it is a party defendant 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. 3 Weld County SS-23A Addendum IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above written. ATTEST: �� "e'^'1 /��!/YGf r�i% Weld County Clerk to the Board R, WELD COUNTY BOARD OF �' t: - SOCIAL SERVICES, ON BEHALF : { OF THE WELD COUNTY m DEPARTMENT OF SOCIAL SERVICES tppS 7/ By: y^�i"l /zip L-O(70 1'I By: 77/71,07,2‘..c„, Deput Clerk to the 1§jiard M.J. Geile, Chair FEB 2 2 2006 CONTRACTOR Savio House 325 King Street Denver, CO 80219 800219 Byi&i//�4/ I() WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: Ok Director Pkt 4 Weld County SS-23A Addendum ohle6 -c..5a3 WELD COUNTY ADDENDUM To that certain Agreement to Purchase Group Center Care Services • ("Agreement") between Savio House and Weld County Department of Social -' Services for the period from ` „) January 13, 2006, through June 30, 2006. The following provisions, made this 90rhday of January , 2006, are added to the referenced Agreement. Except as modified hereby, all terms of the Agreement remain unchanged. 1. County agrees to purchase and Contractor, identified as Provider ID #1536911, agrees to provide: A. Care and services, which are listed in this Agreement at a rate of $120.82 per day for Offense Specific placements, all other placement will be at rate of $105.21 for children placed within the Group Home/Center. 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. 2. Add Paragraph 12 to Section I. The services purchased under this Agreement for Group Home/Center services may include,but are not limited to: Basic 24-hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), Direct Child Care, Transportation, Administrative Overhead, Support Overhead, Service delivery Staff, which may include but are not limited to: Parent Training for Teens, Independent Living Training, Mentor/Advocate, and Supervised Visitation. 3. Add Paragraph 6 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) 350-8389. 4. Section V, Paragraph 5. Children in Residential Treatment 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. 5. 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. 6. 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. ] Weld County SS-23A Addendum 7. 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. 8. Add Paragraph 16 to Section IV. Assure and certify that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, 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. 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 immunities the parties or their officers or employees may possess, 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. 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; 2 Weld County SS-23A Addendum 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 that the Contractor learns of any actual litigation in which it is a party defendant 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. 3 Weld County SS-23A Addendum IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above written. ATTEST: ' '•G�f.11 4 Weld County Clerk to the Board 1 tt WELD COUNTY BOARD OF i,7 SOCIAL SERVICES, ON BEHALF -. OF THE WELD COUNTY ��I a�I 4a DEPARTMENT OF SOCIAL (fAr '',SERVICES By: �� , / , � By: 4 Depulerk to the yard M.J. Geile, Chair V FEB 2 2 2006 CONTRACTOR Savio House 325 King Street Denver,�CO�880221199 By: ��.e'///i�Gi� L_A WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: hector 4 Weld County SS-23A Addendum WELD COUNTY ADDENDUM To that certain Agreement to Purchase Child Placement Agency Services (the "Agreement") between Maple Star Colorado and Weld County Department of Social Services for the period from October 1, 2005, through June 30, 2006. The following provisions, made this day of , 2005, are added to the referenced Agreement. Except as modified hereby, all terms 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#90967. 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. Add Paragraph 14 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. 4. Add Paragraph 6 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) 350-8389. 5. Section V, Paragraph 5. Children in Residential Treatment 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. 6. 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. 7. 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. 8. 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. ;?ot 6 1 mein r h,cc_nn Addpnn,,.., 9. Add Paragraph 16 to Section IV. Assure and certify that it and its principals: A. Are not presently debarred, suspended, proposed for debarment, 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. 10. 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. 11. Add Paragraph 8 to Section VI. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their officers or employees may possess, 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. 12. 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; 2 Weld(nine.,CC_91A Addendum • 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. 13. Add Paragraph 10 to Section VI. The contractor shall promptly notify Social Services in the event that the Contractor learns of any actual litigation in which it is a party defendant in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being sewed 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. 14. Add Section VII-ATTACHMENTS: 3 WnlA rnnnh,CC-11A ',Hon/biro WELD COUNTY DSS NEEDS BASED CARE ASSESSMENT (ATTACHMENT B) IDENTIFYING INFORMATION CHILD'S NAME STATE ID# SEX Trails Case ID IDOB Sex WORKER COMPLETING ASSESSMENT IHH# 1DATE OF ASSESSMEI AGENCY NAME ROVIDER NAME PROVIDER CWEST ID ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT FOR CHILDREN AGES 1 DAY THROUGH 18 YEARS OLD. • For each question below,please select the response which most closely applies to this child. • Please check the number for that response in the corresponding box below. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does this child require transportation by the provider for one of the following: therapeutic or medical treatment,emotional or social counseling,etc.,as outlined in the treatment plan or approved by the caseworker? O0)one trip a week or less ❑1)2-3 trips a week ❑2)4-5 trips a week O3)6 or more trips a week P 2. How often is the provider required to participate in child's therapy or counseling sessions? O0)one a month ❑l)twice a month O2)once a week ❑3)2 or more times a week 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 or special education plan? ❑0)less than a'h hour per day ❑1)'A hour a day O2)more than %hour per day,up to 2 hours per day O3)more than 2 hours per day P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitorin of time and/or activities and/or crisis management? 00)less than 5 hours per week ❑1)5 to 10 hours per week ❑2)at least daily O3)on a constant basis P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feeding,bathing,grooming,physical,and/or occupational therapy? O0)less than 5 hours per week ❑l)5 to 10 hours per week O2) II to 20 hours per week O3)21 or more hours per week A 1. How often is CPA case management required? ❑0) Minimal CPA involvement per month and/or no crisis intervention ❑1) 2-3 contacts per month and/or minimal crisis intervention O2) 1 face to face contact per month and/or occasional crisis intervention O3) Face to face contact 1-2 times per week and/or ongoing crisis intervention T 1. How often are therapy services needed to address child's individual needs per NBC assessment? O0)not needed or Provided by another source(i.e.Medicaid) ❑l)less than 4 hours per month ❑2)4-8 hours per month ❑3)8-12 hours per month RATING OF SERVICE AREAS Initial Assessment Date: SERVICE AREAS 0 1 2 3 P 1 Transportation ❑ 0 ❑ 0 P 2 Therapy/Counseling ❑ ❑ ❑ ❑ P 3 Educational Intervention ❑ 0 0 0 P 4 Behavior Management ❑ ❑ 0 ❑ P 5 Personal Care 0 ❑ ❑ ❑ A 1 Case Management ❑ 0 0 0 T 1 Therapeutic Services ❑ 0 0 ❑ 4 wain rn.,nt,,cc-na Aadennnm WELD COUNTY DSS NEEDS BASED CARE ASSESSMENT (CONT.) RATE THE BEHAVIOR CONDITIONS WHICH CREATE THE NEED FOR SERVICES THAT APPLY TO THIS CHILD THAT ARE SIGNIFICANT IN TERMS OF DURATION AND INTENSITY. Assessment Period: ❑Initial Assessment ❑Re-Determination -Months in Care THE BEHAVIOR ASSESSMENT IS USED ONLY TO IDENTIFY CHILD NEEDS AND ASSIST IN TREATMENT PLANNING. L, e r r ..a trr :: ;;...».»....., s.» :.. i E s - ..... : ...... .......... .,,...» .......zu:. .......�'i.fsiz.5,.s........e.e.('r;..�.• £E. i.ls;..er. .ek..,..L i�:'e.�.Y'i.; .»... ,�i�, ...₹:: r:sii₹.i...i..t3..:r...=:�:..e•₹•i......» ... •:i:i{:::::..�::£�.•�ti .. ::�!•�.:.:::.�...: ........... .. ... .r£, e.:aE .e f Ee::...ess..mr"». ::W,�.• ..o .. .y ..,z:::s s :::. .._...._. a₹ee...S.:...E,fe. u:d ,e.. ₹.. E i..i.S e•. S:s Ei u,., ..rsi::::::i:::>^ :s: .. n_i i.,a₹...r..i i.5...Ep.n k. _: .L.4..I..n E E .8 .E. »Yi... . �.. ..........•............: c•. a: ..., .rs. I..I e..e..re.�.'�... i.₹ ..i...� s� .e:::�£:�' `�r�ti;i ::�:::::• :::::::::::: ::.. . ... .. Re ... e.r...e,»�"x�rr ., y...a C...i.,i... ...� ;i Eli.y.»EeE�.: :...::E ::;Ee.: ........... ..... ..... ._ .. ... .i..sirs!₹e..=.=E:.;r�Tp.=y,yz.i.;�.Efl I E,..__�.,rsL..J....e.e.€.yF 5i... i .zss � ..................................................... e..•-.....s .. i..:.;w ;: y.....E...............1₹ _..e:Fr::;:.�:::.5i:::�:::::::::.e:E.:::::...e:e:::::::;:::.._..:,,.. r..il.5e = f . __: ::£.:..eeE.F..:.».�...�»_.£6e �F fi_>i'�ii a`:r:£ :. .:....:.w:..₹:....4...E...s3...c:h �s i..e...e.......i...».....»,.,».................................—...xx e ::rye: : �� .•s.......�:: r:�...... �:r::e::.::::;..., .. .......:.........e...= »._..r1.. ...........»., r t. _: r ..... ,,:•�lR ....., o.............::..:::_;:.it:.`,i"::: l :.^::::y:•:a,:t,,,::.ti: .i:i;:: .�:.::::.•r:::!;₹iy:.₹..;uE.x.7:::::....e£::r::::!£:.......rs.».�µµ....g „. ..;;. i....i.i.,i r....₹i£r�:� :»�5. .k:•e...:₹................. 5.:=::::4:;e� ............:.::�::r :. ..... rsrs.f ....i....i.....�,....... 1:...rr_•₹;^... r... .,.��, .i:......:•:::••₹..:45£s1�..S:= sl...s:.......•......... ...........i:�i�:::s........................................................ ..����e::�:�::.'.::..,..:�::� �:r�:�:: ......e...»r........... ................ ...»..»..». .o..i.:.:.s..... .s5T,.,i .;;.Eir:₹s;i;..i₹.;₹;;�.•..,�.i r ».�.._.. ......... ....... ....... .........;,:r:«?:: E::::£:£:e:aK n=s,..::e::i »u.n......, y e .fe...... aa;;.—; ._.... =5.:. F: i;ie,s :.....:.................. �.;.;... ....,..e�.::.;....4._..._E.:rs::r::�:�:?r....e M�ggr ii.. � � �}}tt +i it:.�yIy.�i`•.E.i�»..y:.•::ern:::�... ............... '•£��i£i�?��..............::::::::::::::�=£:r:i::::=:::£:: ... _. .......,...».:»»r .............re......T..o..i a ... �....£₹£i.=�..F.:zJ₹.i₹.4{..�.::�:..:.............................:.:: _ ........................................... ............................ue:r:::z...................................».t..............e......i:xa:::e:as:yr•�ui:::e::G. ..Per:....r��,•»^^..�:.._ ... ..... ,..•, .......r...c:::•.a..�.:. ;.6....:::S:S:C......... .... ...�.......�... ............ .......,.....,.,.,.i....."'i:tt•:ra».... .,.....,.,Fie... F .. ....,.r..i..r. ..S₹a=::::?e??:s£::e:rz:_r::::�c£i₹:::iii :£^ .s...s.... _.: re:. ::.:.::::::.::: ...... ................ a ..:c»c::"uS EF•:k�•, i 'F ..r.:......:.e .₹..:............ _ - . ... .....:.: : ... : rf££ �.t:ft4:E....... ��- ..u:::,-:.n:,: •..•.. ••:• ..:::..�..i. ,...:4±£?:t:;Y::Si::i.₹,.;:... f£,:•, a...:�ItilO�.04.M::,.r':::::.MIlilta£t?t::a':"IRK att..r. ' .:... ,•......_...._ ........5 e:.r � �:=h{iI I£'ip£EJi.r�»: R`d.,.._,., ..�..,,₹�..y is- ...... ..:.........:•r::c*.z:,iii•_:a . _ _.: .. .:...:�.�..•.e.I Er r E...E..a�.... ..r.,..., .;;..,....... ............................... 1;::₹;i:,:₹s:;::v ........... . . i i.i....e.,s...E+S..i ....:.-E5 .1.�����... a e..e.LL....E..» .r»... ::r..•efE₹qr.. ...:.;:".D,:::•....... r... i.a ...,a.r�n...r�s.i se.�.. E.E.�. . ...,,.»,.. ;,..,:........... ...... ,i,i,.?����ri tti;11':::'' ...,•e,i7, e..e E3€ i.r.,i....£....,:.₹i a€ siHe .e i 8...»....:. ..... Aggression/Cruelty to Animals ❑ O O ❑ Verbal or Physical Threatening ❑ ❑ O O Destructive of Property/Fire Setting O O ❑ ❑ Stealing ❑ ❑ ❑ O Self-injurious Behavior O ❑ ❑ ❑ Substance Abuse ❑ ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions ❑ ❑ O ❑ Enuresis/Encopresis ❑ ❑ El ❑ Runaway ❑ O O ❑ Inappropriate Sexual Behavior ❑ O O ❑ Disruptive Behavior O O O O Delinquent Behavior El ❑ ❑ ❑ Depressive-like Behavior ❑ ❑ ❑ ❑ Medical Needs O ❑ ❑ ❑ Emancipation ❑ ❑ ❑ ❑ Education ❑ ❑ ❑ ❑ Involvement with Child's Family ❑ Cl ❑ ❑ CHILD'S OVERALL LEVEL OF NEED: AVERAGE LEVEL: (check level of need) ❑ o ❑ 1 O 2 O 3 5 Weld Co,,nty CC-)1A A&lilend°m WELD COUNTY DSS NEEDS BASED CARE ASSESSMENT (ATTACHMENT B) SUMMARY-Please identify all specific requirements and expectations which support Level of Care. EVEL OF PROVIDER SERVICES NEEDED (Average of PI through P5) ERIOD 1: LEVEL# omments: EVEL OF CASE MANAGEMENT SERVICES NEEDED(Al) EVEL # omments: EVEL OF THERAPY SERVICES NEEDED(TI) EVEL # omments: SPECIAL MEDICAL NEEDS: (Medically Fragile Children Only) EVEL # omments: EXT SCHEDULED RATE REVIEW: Initial Date: maximum of 6 month intervals) • 6 Weld County SS-23A Addendum • WELD COUNTY DEPARTMENT OF SOCIAL SERVICES NEEDS BASED CARE RATE TABLE Calculated as Daily Rates (Attachment C) LEVEL OF RECOMMENDED RECOMMENDER AGENCY RATE INTERVENTION RATE MEDICAL NEEDS SERVICE PROVIDER RATE 3 :4: ! Al . -. .- . TI! ADDENDUM Pt,,p Level 'Rate Adnlht °yprtle-Ad COSe Management Therapy.: .( (d i .Maim) ; (Admin.,Main€) (Adr#tin.Services) 0 Age 0-10...$11.47 Level 0...$4.56 '. Level 0 $4.93 Level 0 $0 ! Level 0......$0 0 Age 11-14...$12.89 (Therapy not needed or provided (None) (Minimal CPA involvement, no by another source,i.e.mental 0 Age 15-21...$13.91 crisis intervention.Only doing health.) what is necessary to maintain ` +$.66 Respite Care monthly responsibility.) Level 1 $8.22 Level l $4.93 1 $19.07 Level 1 $2.99 +$.66 Respite Care Level 1...$4.56 (Low level of case management ', (Regularly scheduled therapy, ($19.73) ir. minimal crisis intervention,2-3 4 hours/month.) r. contacts/month,minimal crisis intervention, 2-3 contacts/month.) s Level2 $11.51 Level2 $9.86 2 $25.64 (Moderate level of case (Weekly scheduled therapy, Level 2 $4.47 +$.66 Respite Care Level 2...$4.56 Management including ! 4-8 hours a month with 4 hours of ($26.30) Weekly support services, Group therapy.) Occasional crisis intervention, Face to face contact 1 time Per month.) ' Level $14.79 Level 3 $14.79 $32 22 :;(High level of case management (Regularly scheduled weekly 3 +$.66 Respite Care Level 3...$4.56 '- and CPA involvement with child multiple sessions,can include Level 3 $6.02 ($32.88) and provider including ongoing more than 1 person,i.e.family crisis intervention and face to therapy,for 8-12 hours/monthly.) face contactl-2 time per week minimum.) t.', Level 4 $18.08 Level 4 $14.79 i 4 $38.79 f. (High level of case management Z (Regularly scheduled weekly Level 4 Neg. RTC +$.66 Respite Care Level 4...$4 56 and CPA involvement with child multiple sessions,can include Drop ($39 45) . and provider,including on-going more than 1 person,i.e.family Down crisis intervention and face to therapy,for 8-12 hours/monthly.) face contact 2-3 times per week minimum.) Assess. :�+1 Assessment 'i Assessment Assessment Period Period $26.30 period $4.56 Period $11.51 '' Assessment Period $0 (Includes Respite) Effective 10/01/01 7 Weld County SS-23A Addendum IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above written. a t e It War ATTEST: Weld County Clerk to the Board : if b •q WELD COUNTY BOARD OF ,';'t ▪ .1 SOCIAL SERVICES, ON BEHALF c:Ael''`` ,9- '• \OF THE WELD COUNTY 185' it a 0.`l- itl-'9r x-,DEPARTMENT OF SOCIAL -1 x SERVICES el (cery, 7 i By {° (� 1 al 1.( (L. �J h r te By eputy lerk to the and M. J. Geile, CHair 02/22/2006 CONTRACTOR Maple Star Colorado 2785 Speer Blvd, Suite 340 Denver, CO 80211 By: _bYlC LU WELD COUNTY DEPARTMENT OF SOCIAL SERVICES By: hector 8 Weld County SS-23A Addendum cee - v 3 Hello