HomeMy WebLinkAbout20022583.tiff RESOLUTION
RE: APPROVE SIX AGREEMENTS TO PURCHASE RESIDENTIAL TREATMENT CENTER
SERVICES WITH VARIOUS PROVIDERS 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 eleven Agreements to Purchase
Residential Treatment Center 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 service providers, with terms and conditions being as stated
in said agreements:
1) Colorado Christian Home
2) Colorado Christian Home
3) Trailhead Wilderness School
4) Synergy
5) Kathleen Painter Littler/North Range Behavioral Health
6) Cedar Springs Hospital, Inc., dba Cedar Springs Behavioral System, and
WHEREAS, after review, the Board deems it advisable to approve said agreements,
copies of which are 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 eleven Agreements to
Purchase Residential Treatment Center 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 above listed providers be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreements.
2002-2583
SS0029
(O0-4
RE: SIX AGREEMENTS TO PURCHASE RESIDENTIAL TREATMENT CENTER SERVICES
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 23rd day of September, A.D., 2002.
BOARD OF COUNTY COMMISSIONERS
�� E
!� WELD COUNTY, COLORADO
ATTEST: ,\ 1 mss°'r
Glenn Vaad, Chair
Weld County Clerk to th fi 9. F' '
C t "0 � 'l EXCUSED DATE OF SIGNING (AYE)
David E. L g, Pro-Tern
BY:
Deputy Clerk to the Bo?e``1 / Q..<✓
M. J. eile Iounty
AAS TO : EXCUSED DATE OF SIGNING (AYE)
•-7----' Iliam H. Jerke
Attamey� •
' WL
Robert D. Masden
jo/Date of signature:
2002-2583
SS0029
Contract No.: py 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this 1r`day of July,2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called"County" and Colorado Christian
Home, 2950 Tennyson St,Denver, CO 80212-3029,hereinafter called"Contractor".
WHEREAS, the Colorado State Department of Social Services,hereinafter called"State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services,and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS,County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE,it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of S34.75 per day Sr children placed within the Residential Treatment Center
identified as Provider ID#45205, 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. Contractor shall be reimbursed by Medicaid for services provided to County children placed with
Contractor. Medicaid reimbursement shall be based off of the State Vendor Rate for the approved Level of
Care. The assessment instrument used to determine the Level of Care will be the Colorado Client
Assessment Record (CCAR)as per outlined in the Department of Health Care policy and Finance, Staff
Manual Vol. 8, Section 8.765.30.
3. This Agreement shall be in force from July 1,2002,until August 31,2002; or until the child is removed
by the County; or if the child's behavior would cause harm to himself or other children, and Contractor
set approval from the County and the County agrees,in writing, to terminate this Agreement,whichever
event occurs first.
4. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. Tn addition to the termination provisions in
Paragraph 3 above, either party shall have the right to terminaw this contract by giving the other party thirty
(30)days notice by registered mail,return receipt requested. If notice is so given,this contract shall
terminate on the expiration of the thirty(30)days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for father performance of the tenors of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
5. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein describe&
Agreement to Purchase
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SECTION 1. DESCRIPTION OF SERVICES TO RE PURCHASED.
1. The services purchased under this Agreement as Room and Board costs for Residential Treatment Center
facility services,as outlined in the Department of Health Care policy and Finn.rP, StaffManual Vol. 8,
Section 8165.503 may include,but are not limited to:Basic 24-hour care and child maintenance(food,
shelter, clothing, educational supplies and allowance), Administration,Administrative Overhead, Support
Stag Support Overhead, and Sleep-over Staff.
2. The services reimbursable by Medicaid for treatment services under this Agreement, as outlined in the
Department of Health Care policy and Finance, Staff Manual Vol. 8, Section 8.765.502 may include,but
are not limited to: Evaluation Services(psychological, and/or neurological), Medication and follow-up,
Family Therapy,Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy,Polygraph,Plethysmograph,
Parent Training for Teens,Independent Living Training.Mentor/Advocate, Supervised Visitation,
Therapeutic Recreation,Direct Child Care,and Transportation.
3. Payment for a child's temporary absence from the facility,including absence due to hospitalization,will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
d. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child nuns away from the
Contractor's facility,the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
5. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
6. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contact shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
7. Contractor will provide the purchased care and services at
Facility Mt 45205
Colorado Christian Home
2950 Tennyson St
Denver CO 80212-3029
S. Contractor shall not charge any additional fees to children or families of r led to t referred by County for
services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
08/08/02 10:36 FAX 970 346 7691 _ WELD. CTY SOC SERVICES 2002
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Contract No.: PY 02/03-SS-23A-RTC
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,2.710.71, 2.710.72,
2/10.73, 2/10.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131),the contractor may obtain: 1)Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent_
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through Phone mail messages.
3. Between regular work hours,the Contractor will make every effort to nodfy the assigned caseworker,
supervisor, or Intake Sereener 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. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective,non-routine or non-emergency medical,surgical or dental services being provided.
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s)should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County,the
parent(s)must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical,surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening,Diagnosis
and Treatment Program,
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor,including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence front the facility of over seven(7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure,where possible,permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,which comes to their attention.
Agreement to Purchase
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Contract No.: PY 02/03-SS-23A-RTC
SECTION TEL REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child,
3. County and Contractor agree and understand that the psychological (mental and behavioral)or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan distil be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5_ At no longer than thirty-day(30)inteavals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation,education progress,significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
L Conform with and abide by all rules and regulations of the Colorado Department of Social Services,the
State of Colorado and any federal laws and regulations,as such,which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964. Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
1. Maintain during the term of this Agreement a liability insurance policy of at least 5400,000 for property
damage liability, $150,000 for injury and/or damage to any one person,and$400,000 for total injuries
arising from any one accident.
2. Maintain during the terms of this Agreement a fidelity bond of at least$25,000 or two(2)months gross
receipts,whichever is greater,covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts,omissions, or any other defalcations of the Contactor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury,including death,to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby,or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
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7. Maintain service program records,fiscal records,documentation and other records,which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection,review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered,using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process,for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement at RTC level.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(MP)for youth designated as a Special Education
Students will be conducted every 3 years and reviewed every year. If the I)rP is due while the child is in
placement,the Contractor will complete or obtain a completed MP, A copy will then be forwarded to the
County.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services,
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein,when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal mles and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual,Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
Agreement to Purchase
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SECTION vL GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent,or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and subcontractors during the performance of this Agreement.
2. Payment pursuant to this Agreement,if in State of Colorado or federal funds, whether in whole or in pail,
is subject to and contingent upon the continuing availability of State of Colorado and federal fonds for the
purpose thereof
3. It is agreed that if, after investigation,it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition,deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation,renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
6. In the event this contract is tenanted, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error,fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contactor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
7. 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 Ageement. It is the express intention of the
undersigned parties that any entity other than the undersigned panics or their assignees receiving services
or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees maypossess,nor shalt any portion of this Agreement be deemed to have ersated a
duty of care which 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.
Agreement to Purchase
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Contract No.: PT 02/03-S5-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,month, and year
first above written.
ATTEST: �"�" 1
Weld County etic to the Board) WELD COUNTY BOARD OP SOCIAL SERVICES,
ON BEHALF OF TEE WELD COUNTY DEPARTMENT
� OF SOCIAL SERVICES
`1
By: <�/ � �e��a�s: � 8y:
Deputy Clerk to the Bo Nit Glenn Vaad,Chair
AV (91a31aocr)
APPROVED AS TO FORM:
cr; CONTRACTOR
County
Colorado Christian Home
2950 Tennyson St
D er, CO 80212- 029
By ErP/4
WELD COUNTY DEPARTMENT 5 6 oR
OF SOCIAL SERVYCF.S
By: c_distij
Dti
Agreement to Purchase
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AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this 1"day of July,2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called"County" and Colorado Christian
Home, 2950 Tennyson St, Denver, CO 80212-3029,hereinafter called"Contractor".
WHEREAS,the Colorado State Department of Social Services,hereinafter called"State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS,Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE,it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of$36.50 per day for children placed within the Residential Treatment Center
identified as Provider]D#45205. 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. Contractor cha11 be reimbursed by Medicaid for services provided to County children placed with
Contractor. Medicaid reimbursement shall be based off of the State Vendor Rate for the approved Level of
Care. The assessment instrument used to determine the Level of Care will be the Colorado Client
Assessment Record(CCAR)as per outlined in the Department of Health Care policy and Finance, Staff
Manual Vol. 8, Section 8/65.30.
3. This Agreement shall be in force from September 1,2002,until the end of the Colorado fiscal year,
June 30,2003; or until the child is removed by the County; or if the child's behavior would cause harm to
himself or other children, and Contractor seeks approval from the County and the County agrees, in
writing,to terminate this Agreement,whichever event occurs first.
4. This Agreement may be rend i only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 3 above, either party shall have the tight to terminate this contract by giving the other party thirty
(30)days notice by registered mail,rearm receipt requested. If notice is so given,this contract shall
terminate on the expiration of the thirty(30)days or until the eligible child can be placed elsewhere,
whichever occurs earlier,and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
5. This Agreement is in lieu.of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreeing=to Purchase
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SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement as Room and Board costs for Residential Treatment Center
facility services, as outlined in the Department of Health Care policy and Finance,Staff Manual Vol. 8,
Section 8.765.503 may include,but are not limited to:Basic 24-hour care and child maintenance(food,
shelter, clothing, educational supplies and allowance), Administration,Administrative Overhead, Support
Staff, Support Overhead,and Sleep-over Stag
2. The services reimbursable by Medicaid for treatment services under this Agreement,as outlined in the
Department of Health Care policy and Finance, Staff Manual VoL 8,Section 8.765.502 may include,but
are not limited to: Evaluation Services(psychological,and/or neurological), Medication and follow-up,
Family Therapy,Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy,Polygraph,Plethysmograpb,
Parent Training for Teens, Independent Living Training,Mentor/Advocate, Supervised Visitation,
Therapeutic Recreation.Direct Child Care,and Transportation.
3. Payment for a child's temporary absence from the facility,including absence due to hospitalization,will be
made in accordance with State Department rules in Staff Manual Volume VU, 7.406.1 (F).
4. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed If the child runs away from the
Contractor's facility,the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
5. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement However,
provisions for payment of other transportation maybe provided for in the treatment/case plan.
6. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
7. Contractor will provide the purchased care and services at:
Facility ID#; 45205
Colorado Christian Home
2950 Tennyson St
Denver CO 80212-3029
8. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
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SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies(2.710.70, 2310.71,2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131),the contractor may obtain: 1)Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contactor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between 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. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective,non-routine or non-emergency medical,surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County,the
parent(s)must be contacted for authorization.
6. The Contactor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor_
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening,Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7)days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure,where possible,permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status,which comes to their attention.
Agreement to heehaw 3 Rev 06/11/02
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con actNo: PY 02/03-SS-23A-RTC
SECTION ILL REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form.This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion.Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3_ County and Contractor agree and understand that the psychological(mental and behavioral)or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30)intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions,and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Cara Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL;
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services,the
State of Colorado and any federal laws and regulations, as such,which may be amended front time to time,
and shall be binding on Contractor and control any disputes in this Agreement
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information congaing the child and the child's family.
1. Maintain during the term of this Agreement a liability insurance policy of at least$400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and$400,000 for total injuries
arising from any one accident.
2. Maintain during the terms of this Agreement a fidelity bond of at least$25,000 or two (2)months gross
receipts,whichever is greater, covering the activities of any of its officers,agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts,omissions, or any other defalcations of the Contractor.
6_ Indemnify County,the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or wising out of damage or injury,including death,to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute,ordinance, or regulation and the
defense of any such claims or actions.
•
Agreement to Purcbase Rev 06/11/02
RTC Services
VI/IT'd WdLE:20 z0, e0 one
08/bs/o'L 10:42 FAIL ale :foe real nar.0 tail NJ,- a&nri O_
Contract Igo: PY 02103SS-23A-RTC
7. Maintain service program records,fiscal records, documentation and other records,which Will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement The above shall be subject at all reasonable times to inspection,review or audit by federal,
State Department or county persommel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered,using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received,payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2)weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held,participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement at RTC level
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP)for youth designated as a Special Education
Students 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.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual,Volume VII,and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
Agreement to Purchase 5 Rev 06/11/02
RTC Services
bSi2L'd Wd8E:20 20, 80 Sflj
ueida,uz su:4z rws aiv 440 /Oil ,IL• .. ..al .s. .. •1f.av'...
ContractNo.: PY07/03-SS-23A-ATC
SECTION VL GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them,contemplated
pll Contractor shall be
is that of employer-independent conhactor. No agent, employee, servant
deemed
to be an employee,agent,or servant of Cotmty. Contractor will be solely and entirely responsible for its
acts or of any agent employee,servants and sub-contractors during the performance of this Agreement
2. Payment pursuant to this Agreemer t,if in State of Colorado or federal funds,whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof
3. It is agreed that if,after investigation,it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition,deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation,renewal,addition,deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contact shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports,on-site visits where applicable and
other contacts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
6. In the event this contract is terminated,final payment to the Contractor may be withheld at their discretion
of the County until final audit Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado,Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms arid 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.
8. 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 which 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.
Agfeemcat to Purchase 6 Rev owl vo2
RTC Services
bT/ET'd Wd8S:20 20. 80 and
V Vy ovi Vi 1u.40 Mal DI V 440 I ODl nL141 U11 JU%. JLATLio.C4 IQJ V1J
CouaactNo.: PY 02J03-SS-23A-RTC
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
weld county[ rte, ,� � WELD COUNTY BOARD OP SOCIAL SF -VICES,
1 ON BEHALF OF TAE WELD COUNTY DEPARTMENT
eel / 1 OF SOCIAL SERVICES
�S�'-
By: '` �� r / � By: _j2S ,r_lkte.))
Deputy C1edr to the Board Glenn Valid,
Chair
(9/ 3IQco
APPROVED AS TO FORM:
CONTRACTOR
County A y
Colorado Christian Home
2950 Tennyson St
Den r, CO S0212-30
By
WELD COUNTY DEPARTMENT 9i fr/Off.
OF SOCIAL SERVICES
By:
Dice 91112
Agreement to Pea-chase
ServicesRev 06/11/02
bTi4L'd Wd8S:20 20. 80 snu
Contract No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVI
THIS AGREEMENT made this 1s' day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and fitt jbead Wilderness
School, PO Box 797, Georgetown, CO 80444, hereinafter called "Contractor". 0
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is authorized
to provide social services to individuals and families of individuals through its agents, County Departments of
Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of$24.80 per day for children placed within the Residential Treatment Center
identified as Provider ID#104890. 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. Contractor shall be reimbursed by Medicaid for services provided to County children placed with
Contractor. Medicaid reimbursement shall be based off of the State Vendor Rate for the approved Level of
Care. The assessment instrument used to determine the Level of Care will be the Colorado Client
Assessment Record (CCAR) as per outlined in the Department of Health Care policy and Finance, Staff
Manual Vol. 8, Section 8.765.30.
3. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30, 2003;
or until the child is removed by the County; or if the child's behavior would cause harm to himself or other
children, and Contractor seeks approval from the County and the County agrees, in writing, to terminate
this Agreement, whichever event occurs first.
4. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 3 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
5. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
ContractNo.: PY 02/03-SS-23A-RTC
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement as Room and Board costs for Residential Treatment Center
facility services, as outlined in the Department of Health Care policy and Finance, Staff Manual Vol. 8,
Section 8.765.503 may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Administration, Administrative Overhead, Support
Staff, Support Overhead, and Sleep-over Staff.
2. The services reimbursable by Medicaid for treatment services under this Agreement, as outlined in the
Department of Health Care policy and Finance, Staff Manual Vol. 8, Section 8.765.502 may include, but are
not limited to: Evaluation Services (psychological, and/or neurological), Medication and follow-up,
Family Therapy, Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, Supervised Visitation,
Therapeutic Recreation, Direct Child Care, and Transportation.
3. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
4. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
5. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
6. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
7. Contractor will provide the purchased care and services at:
Facility ID#: 104890
Trailhead Wilderness School
212 E 7th St
Leadville CO 80461
8. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
Contract No.: PY 02/03-SS-23A-RTC
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between 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. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services provided
and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care of
the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social activities
of Contractor, including supervised off grounds excursions and extended trips within the State, provided
that Contractor has written permission from County and legal custodian for any trips out of Colorado for
any reason and any planned absence from the facility of over seven(7) days within a consecutive 30-day
period. Such written permission may be in the treatment/case plan. Further, Contractor and County will
also secure, where possible, permission from parents or guardians of the child placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Aereement to Purchase
Contract No.: PY 02/03-SS-23A-RTC
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and shall
include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological(mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
1. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
2. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to persons
or property caused or sustained in connection with the performance of this contract or by conditions created
thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such
claims or actions.
Agreement to Purchase
Contract No.: PY 02/03-SS-23A-RTC
7 Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement at RTC level.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan(IEP) for youth designated as a Special Education
Students 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.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
Agreement to Purchase
ContractNo.: PY 02/03-SS-23A-RTC
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is
that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed to
be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its acts
or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part, is
subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
6. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
7. 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.
8. 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 which 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.
Agreement to Purchase
Contrast No.: PY 02/03-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
Weld County Clerk to sin107:Ititip WELD COUNTY BOARD OF SOCIAL SERVICES,
,,T leatA\ ON BEHALF
OF SOCIAL SERV CES F THE WELD COUNTY DEPARTMENT
r,86,
By: c�d.,_ ���(i � .1 :144\ Nil By:
Deputy Clerk to the Board% b i 4 A �, Glenn Vaad,Chair
I), (9/23/2aA
APPROVED AS TO FORM:
_ CONTRACTOR
(aunty A orney
Trailhead Wilderness School f'
PO Box 797
Cetown, CO 80444
By: y c
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: d
ector
Aereement to Purchase
VV/ V✓VG 1V-JJ tits JIV JIU 1UJl RLLY L11 JUL JL1111LLJ WIUUe
`Contract No: PY 02103-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this I" day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and`Synergy, 3738 W
Princeton Cir,Denver; CO 80236, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of$38.40 per day for children placed within the Residential Treatment Center
identified as Provider ID#49488. 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- Contractor shall be reimbursed by Medicaid for services provided to County children placed with -
Contractor. Medicaid reimbursement shall be based off of the State Vendor Rate for the approved Level of
Care. The assessment instrument used to determine the Level of Care will be the Colorado Client
Assessment Record (CCAR) as per outlined in the Department of Health Care policy and Finance, Staff
Manual Vol- 8, Section 8.765.30.
3. This Agreement shall be in force from July 1, 2002,until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
4. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 3 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
5. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
'The Regents of the University of Colorado on behalf of the Health Sciences Center
Agreement to Purchase
a
RTr .-rvjr,-c C Rev 06/11/02
08/02/02 10:39 FAX 970 346 7691 {VELD CTY S0C SERVICES 2 003
Contract No.: PY 02/03-SS-23A-RTC
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement as Room and Board costs for Residential Treatment Center
facility services, as outlined in the Department of Health Care policy and Finance, Staff Manual Vol. 8,
Section 8.765.503 may include, but are not limited to: Basic 24-hour care and child maintenance(food,
shelter, clothing, educational supplies and allowance), Administration, Administrative Overhead, Support
Staff, Support Overhead, and Sleep-over Staff.
2. The services reimbursable by Medicaid for treatment services under this Agreement, as outlined in the
Department of Health Care policy and Finance, Staff Manual Vol. 8, Section 8.765.502 may include, but
are not limited to: Evaluation Services (psychological, and/or neurological), Medication and follow-up,
Family Therapy, Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training,Mentor/Advocate, Supervised Visitation,
Therapeutic Recreation, Direct Child Care, and Transportation.
3. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
4. Transportation shall be furnished by County between the child's residence and Contractors facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
5. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plait
6. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
7. Contractor will provide the purchased care and services at:
Facility ID#: 49488
Synergy
3660-80 W Princeton Cir
Denver CO 80236
8. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
T1 Tr Srrvirrt 2 Rev 06/11/02
08/02/02 10:40 FAX 970 346 7691 WELD CTY SOC SERVICES Z004
at Contract PY 02/03-SS-23A-RTC
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between 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. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s)must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will.provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plait Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase
3
RTC Services Rev 06/11/02
• Contract No.: PY 02/03-SS-23A-RTC
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological(mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services,the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family_
1. Maintain during the term of this Agreement a liability insurance policyrf at lead$dnrl,n00 for piQpPrp,
damage liability, 5150,000 for injury and/or damage to any one person, and 5400,000 for total injuries
arising from any one accident. equal to damages under teh Colorado Governmental Impunity Act
2. L Maintain during the tens of this Agreement a fidelity bond of at lust 525,000 or two (2)months gross
' receipts,wbicbevrr is Beater, covering the activities of any of its officers, agents or employees.rPaponsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
arts, nmiccinns, nr any nther drfalratinnc of the r nntrnrtnr.
tl To the extent permitted under the Colorado Governmental Immunity Act
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death,to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
RTC Services Rev 06/11/02
U`S/UZ/UZ 1U:41 FAA 97U 346 7691 WELD CFI SUC SERVICES 4 006
Contratt No.: PY 02/03-SS-23A-RTC
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement at RTC level.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (1EP) for youth designated as a Special Education
Students 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.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child wider this Agreement for placement and medical coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein,when
Provider Rosters are submitted as described in Section IV,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
Agreement to Purchase
5
RTC Services Rev 06/11/02
08/02/02 10:42 FAA 970 746 7691 WELD CTY SOC SERVICES 41007
Contract No.: PY 02/03-SS-23A-RTC
SECTION VI. GENERAL, PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
6. in the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall riot be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
7. 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.
8. 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 which 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.
Agreement to Purchase
DTr e.,.,,:,.,.� Rev 06/11/02
Contract No.: PY 02/03-SS•23A-RTC
• TN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: ' d✓ =�
Weld County C1 WELD COUNTY BOARD OF SOCIAL SERVICES,
`fJ` ON BEHALF OF THE WELD COUNTY DEPARTMENT
{, ` OF SOCIAL SERVICES
I86I 't�%•ll.1A
0 cc, ig
$y: 7/..�A. e By:
Dcputy Clerk to the Boat C(0 acF' Glenn Vaad,C
� .
(q T)/a3hcn
APPROVED AS TO FORM:
CONTRACTOR
County Afro nay Univ. of Colo. Hlth. Sci. Ctr. dba
Synergy
3738 W Princeton Cir
Denver, CO 80236
KA...±0,flAgr
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES Kristin O.
Manager Pre-Award°yer
Grants and
Contracts
By:
D ector
Agreement to Purchase 7
RTC Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this 15`day of July, 2002 between the Weld County Board'at'iq .Ial Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and KathleetfliaigAer
Littler/North Range Behavioral Health, 2350 3rd St Rd, Greeley, CO 80631, hereinafter called "Contractor"): aa. jo
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of$31.34 per day for children placed within the Residential Treatment Center
identified as Provider ID#6220. 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. Contractor shall be reimbursed by Medicaid for services provided to County children placed with
Contractor. Medicaid reimbursement shall be based off of the State Vendor Rate for the approved Level of
Care. The assessment instrument used to determine the Level of Care will be the Colorado Client
Assessment Record (CCAR) as per outlined in the Department of Health Care policy and Finance, Staff
Manual Vol. 8, Section 8.765.30.
3. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
4. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 3 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
5. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
RTC Services
Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement as Room and Board costs for Residential Treatment Center
facility services, as outlined in the Department of Health Care policy and Finance, Staff Manual Vol. 8,
Section 8.765.503 may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Administration, Administrative Overhead, Support
Staff, Support Overhead, and Sleep-over Staff.
2. The services reimbursable by Medicaid for treatment services under this Agreement, as outlined in the
Department of Health Care policy and Finance, Staff Manual Vol. 8, Section 8.765.502 may include, but
are not limited to: Evaluation Services (psychological, and/or neurological), Medication and follow-up,
Family Therapy, Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, Supervised Visitation,
Therapeutic Recreation, Direct Child Care, and Transportation.
3. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
4. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
5. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
6. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
7. Contractor will provide the purchased care and services at:
Facility ID#: 6220
Kathleen Painter Littler/North Range Behavioral Health
2350 3rd St Rd
Greeley CO 80631
8. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
2
RTC Services
Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
SECTION II. MEDICAL CARE
1. hi accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between 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. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven (7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence affecting educational status, which comes to their attention.
Agreement to Purchase
3
RTC Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
1. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
2. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
RTC Services
Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement at RTC level.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education
Students 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.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section W,Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
Agreement to Purchase
5
RTC Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
6. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
7. 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.
8. 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 which 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.
Agreement to Purchase
6
RTC Services
Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
Weld County Cler th :.ar<< 4% WELD COUNTY BOARD OF SOCIAL SERVICES,
t a ON BEHALF OF THE WELD COUNTY DEPARTMENT
• 1861 J� ' OF SOCIAL SERVICES
O tip
By: D 1� JJg �p 4 , By:
Deputy Clerk to the Board � `�' FV U Glenn Vaad, Chair
141Q 3P4.1)
APPROVED AS TO FORM:
CONTRACTOR
ttomey
Kathleen Painter Littler/North Range
Behavioral Health
2350 3rd St
Greeley, CO 80631 ry ���
By: 14 drne el
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
ector
Agreement to Purchase
7
RTC Services
Rev 06/11/02
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Reasons for purchasing services for this child are:
REASON (If Other please Explain)
II. Please mark services already utilized.
❑ In home services O Kinship Care ❑ Receiving Home
❑ Shelter Care O Placement with Relative
O County Foster Care O County Critical Care Foster Care
❑ CPA O Group Home O CORE Services O Independent Living
❑ Day Treatment O Substance Abuse Treatment ❑ Other(Explain)
III. Please mark most appropriate services needed within the Initial Treatment Plan.
Appropriate Setting:
O Therapeutic(Behavior Modification) O Secure ❑ Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender O AggressiveNiolent O Substance Abuse O Truancy
O Victim Behavior O Depression O Self-destructive O Delinquency
O Special Medical Needs O Behavior Modification O Anger Management O Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring O Independent Living Training
❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30, 2003, or before.
IV. CCAR Level of Care: (for RTC Placements Only) (Level) (copy to Business Office)
O This child is in need of rehabilitative services. (Mark if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) n Yes n No (copy to Business Office)
V. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned, Contractor agrees to meet with the County to
revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Address
Greeley CO 80632 City, State,Zip
Caseworker's Name and Date
Provider Info:
(If applicable) Foster Care Provider
Provider Address
Caseworker Signature City, State,Zip
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Completed Referral Distribution: E-mail completed form to Business Office(Cynthia and Lesley)and D&N cases only to Legal(Mary and Sally)
Print 2 copies for Administrator to sign and mail to Facility.
• Contract No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this ls` day of July, 2002 between the Weld County Board of Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and*Cedar Springs
Behavioral System, 2135 Southgate Rd,Colorado Springs, CO 80906-2605, hereinafter called "Contractor".
*Cedar Springs Hospital, Inc. dba
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State Department" is 4"'L
authorized to provide social services to individuals and families of individuals through its agents, County
Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules,
and
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings County and Contractor
agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of$32.88 per day for children placed within the Residential Treatment Center
identified as Provider ID#70716. 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. Contractor shall be reimbursed by Medicaid for services provided to County children placed with
Contractor. Medicaid reimbursement shall be based off of the StateVendor Rate for the approved Level of
Care. The assessment instrument used to determine the Level of Care will be the Colorado Client
Assessment Record (CCAR) as per outlined in the Department of Health Care policy and Finance, Staff
Manual Vol. 8, Section 8.765.30.
3. This Agreement shall be in force from July 1, 2002, until the end of the Colorado fiscal year, June 30,
2003; or until the child is removed by the County; or if the child's behavior would cause harm to himself or
other children, and Contractor seeks approval from the County and the County agrees, in writing, to
terminate this Agreement, whichever event occurs first.
4. This Agreement may be renewed only by entering into a new written Agreement, such as this Agreement,
signed by the authorized representatives of the parties. In addition to the termination provisions in
Paragraph 3 above, either party shall have the right to terminate this contract by giving the other party thirty
(30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall
terminate on the expiration of the thirty(30) days or until the eligible child can be placed elsewhere,
whichever occurs earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty to perform their
obligations up to the date of termination.
5. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to
the care and services herein described.
Agreement to Purchase
1
RTC Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement as Room and Board costs for Residential Treatment Center
facility services, as outlined in the Department of Health Care policy and Finance, Staff Manual Vol. 8,
Section 8.765.503 may include, but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Administration, Administrative Overhead, Support
Staff, Support Overhead, and Sleep-over Staff.
2. The services reimbursable by Medicaid for treatment services under this Agreement, as outlined in the
Department of Health Care policy and Finance, Staff Manual Vol. 8, Section 8.765.502 may include, but
are not limited to: Evaluation Services (psychological, and/or neurological), Medication and follow-up,
Family Therapy, Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy, Polygraph, Plethysmograph,
Parent Training for Teens, Independent Living Training, Mentor/Advocate, Supervised Visitation,
Therapeutic Recreation, Direct Child Care, and Transportation.
3. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be
made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1 (F).
4. Transportation shall be furnished by County between the child's residence and Contractor's facility for the
initial placement and return after the treatment plan is completed. If the child runs away from the
Contractor's facility, the County shall provide transportation to either return the child to the facility or to
other care as arranged by the County. The County will make the decision to return the child to the facility,
with input from the Contractor.
5. All other transportation associated with the Contractor's proposed services will be provided by Contractor.
Any transportation costs not covered or contemplated in the original treatment plan must be negotiated
between County and Contractor and are not subject to reimbursement under this Agreement. However,
provisions for payment of other transportation may be provided for in the treatment/case plan.
6. Any transportation costs to be incurred on behalf of this child which are to be borne by persons or agencies
which are not a party to this contract shall be specified in the treatment/case plan, and those persons shall
acknowledge their responsibility by signing the treatment/case plan.
7. Contractor will provide the purchased care and services at:
Facility ID#: 70716
Cedar Springs Behavioral System
2135 Southgate Rd
Colorado Springs CO 80906-2605
8. Contractor shall not charge any additional fees to children or families of children referred by County for
services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any sub-contracts
without the express written approval of the Executive Director of the Colorado Department of Social
Services or his appointed designee.
Agreement to Purchase
2
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Rev 06/11/02
• Contract No.: PY 02/03-SS-23A-RTC
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70, 2.710.71, 2.710.72,
2.710.73, 2.710.74) and Colorado Department of Human Services Child Care Licensing Division policy
(7.714.131), the contractor may obtain: 1) Ordinary medical care, and 2) Emergency medical, surgical or
dental care for said child after making reasonable efforts to contact the County to obtain consent.
Emergency care is defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or dental care will not be
made through phone mail messages.
3. Between 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. The County will be notified by the facility no later than the following working day of any administration of
emergency medical, surgical or dental services provided under this authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services being provided,
authorization must be obtained from the assigned caseworker or supervisor. If parental rights are intact,
authorization or attempts to obtain authorization from the parent(s) should also be documented. If the
placement is made through a voluntary placement agreement between the parent(s) and the County, the
parent(s) must be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental services
provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the time of submittal
of each progress report, including the discharge report at the time of the child's termination from the care
of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic Screening, Diagnosis
and Treatment Program.
9. It is agreed and permission is granted for the child to participate in planned recreational and social
activities of Contractor, including supervised off grounds excursions and extended trips within the State,
provided that Contractor has written permission from County and legal custodian for any trips out of
Colorado for any reason and any planned absence from the facility of over seven(7) days within a
consecutive 30-day period. Such written permission may be in the treatment/case plan. Further,
Contractor and County will also secure, where possible, permission from parents or guardians of the child
placed with the Contractor.
10. County and Contractor shall inform each other and the local school district of any changes in parental
residence'affecting educational status, which comes to their attention.
Agreement to Purchase
3
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Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be child specific and
shall include the initial Treatment Plan that shall be goal oriented and time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated educational
arrangement for the child upon completion. Also included will be the anticipated date for discharge from
treatment purchased as well as provisions concerning the involvement of the child's family in treatment of
the child.
3. County and Contractor agree and understand that the psychological (mental and behavioral) or physical
problems which necessitate purchasing services for this child are specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and Contractor and shall be
reflected in the Attachment A.
5. At no longer than thirty-day(30) intervals after placement, Contractor shall provide County with written
reports which address changes to the child's physical or psychological condition, changes in the child's
family situation, education progress, significant incidents or disciplinary actions, and progress made to
achieve goals specified in the Treatment Plan. Contractor shall participate in all Foster Care Reviews
as scheduled by the County and insure the attendance of the child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Social Services, the
State of Colorado and any federal laws and regulations, as such, which may be amended from time to time,
and shall be binding on Contractor and control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State law.
3. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504
of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide
confidentiality of information concerning the child and the child's family.
1. Maintain during the term of this Agreement a liability insurance policy of at least $400,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $400,000 for total injuries
arising from any one accident.
2. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2)months gross
receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible
for the implementation and/or administration of this contract in order to make reparations for any wrongful
acts, omissions, or any other defalcations of the Contractor.
6. Indemnify County, the Colorado Department of Social Services and the State of Colorado against any and
loss against all claims and actions based upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this contract or by
conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the
defense of any such claims or actions.
Agreement to Purchase
4
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Rev 06/11/02
' Contract No.: PY 02/03-SS-23A-RTC
7. Maintain service program records, fiscal records, documentation and other records, which will sufficiently
and properly reflect all direct and indirect costs of any nature incurred in the performance of this
Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal,
State Department or county personnel, and other persons authorized in writing by the Executive Director,
Colorado Department of Social Services.
8. Bill the County for services rendered, using the required Division of Child Welfare Provider Roster. This
roster is to be mailed to the County department by the last day of the month of care. If Provider Rosters are
not received, payments will be held until the required paperwork is received.
9. Attend and participate in Foster Care Reviews for children in placement longer than 60 days, and any
subsequent appeal process, for children in placement with the Contractor pursuant to two (2) weeks written
notice by the County. If the facility is in a different part of the state from the county in which the review is
held, participation may be by teleconference.
10. Agree to cooperate with any vendors hired by Weld County Department of Social Services to shorten the
duration of placement at RTC level.
11. Obtain physical examinations within 14 days of placement and forward all appropriate information to the
County.
12. Obtain Dental examinations within 60 days of placement and forward all appropriate information to the
County.
13. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education
Students 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.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Social
Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for
services purchased under this Agreement in accordance with the established rate specified herein, when
Provider Rosters are submitted as described in Section IV, Number 8.
4. Abide by all the rules and regulations of the Colorado Department of Social Services, federal rules and
regulations and the laws of the State of Colorado, any of which may be amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements of State
Department Staff Manual, Volume VII, and provide consultation and/or technical assistance to Contractor
in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the Discrete Case Plan at
time of placement or as soon as completed and when updated or revised.
Agreement to Purchase
5
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Rev 06/11/02
' Contract No.: PY 02/03-SS-23A-RTC
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement
is that of employer-independent contractor. No agent, employee, or servant of Contractor shall be deemed
to be an employee, agent, or servant of County. Contractor will be solely and entirely responsible for its
acts or of any agent, employee, servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado and federal funds for the
purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect
personal items brought to Contractor by the Child, Contractor will be released from responsibility for loss
or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever,
unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services to monitor the service program,
fiscal books and other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned child through program reports, on-site visits where applicable and
other contracts as deemed necessary. The Contractor understands that the Colorado Department of Social
Services will provide consultation and technical assistance to Contractor to assure satisfactory performance
in the provision of purchased services under this Agreement.
6. In the event this contract is terminated, final payment to the Contractor may be withheld at their discretion
of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or
misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments
under this contract or other contracts between the County and the Contractor or by the County, as a debt
due to both the State of Colorado, Colorado Department of Social Services and the County. The waiver of
any violation shall not be construed as a waiver of any other or subsequent violation of this contract or
appropriate statutes and regulations.
7. 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.
8. 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 which 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.
Agreement to Purchase
6
RTC Services
Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: I `{II_,
Weld County Cler f e t?:: � ,a WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 '�p�1 OF SOCIAL SERVICES
ASV
By: �o ,c_ — �(;'S By:
Deputy Clerk to the Board � lty ll Glenn Vaad, Chair
(q la3la Lu)
APPROVED AS TO FORM:
�- CONTRACTOR
County ttomey Cedar Springs Hospital, Inc.
dba Cedar Springs Behavioral System
2135 Southgate Rd
Colorado Springs, CO 80906-2605
By:
Mary Wilk s
WELD COUNTY DEPARTMENT VP, Corp rate Controller
OF SOCIAL SERVICES
By: lJl 7
ector
Agreement to Purchase
RTC Services Rev 06/11/02
•
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
1119 C MEMORANDUM Child Support(970)352.6933
COLORADO�O: Glenn Vaad, Chair Date: September 18,2002
Board of County Commissioners
FR: Judy A. Griego,Director, Social Services_ Cya Cry
RE: Agreements to Purchase Residential Trea ent Center(RTC) Services
Between Weld County Department of Social Services with Various
Vendors
Enclosed for Board approval are Agreements to Purchase Residential Treatment Center(RTC)
Services between the Weld County Department of Social Services with various vendors. These
yearly Agreements are in accordance with Board approved policies of Sections 2.320 and
2.902.22 of the Weld County Department of Social Services Operations Manual. These
Agreements were reviewed at the Board's Work Session of September 18, 2002.
The major provisions of the Agreements are as follows:
1. The term is July 1, 2002 through June 30, 2003, or as indicated below.
2. The Department agrees to reimburse vendors at rates including room and board costs and
excluding Medicaid treatment costs. The rates are as follows:
A. Colorado Christian Home: $34.75 per day
(Period of July 1 through August 30,2002)
B. Colorado Christian Home: $36.50 per day
(Period of September 1, 2002,through June 30, 2003)
C. Trailhead Wilderness School: $24.80 per day
D. Synergy: $38.40 per day
E. Kathleen Painter Littler/North Range Behavioral $31.34 per day
Health:
F. Cedar Springs Hospital, Inc. dba Cedar Springs $32.88 per day
Behavioral System:
If you have any questions,please telephone me at extension 6510.
2002-2583
Hello