HomeMy WebLinkAbout20022040.tiff RESOLUTION
RE: APPROVE SEVENTEEN (17) 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 seventeen (17) 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 commencing
July 1, 2002, and ending June 30, 2003, with further terms and conditions being as stated in
said agreements:
1) Arapahoe House
2) El Pueblo Boys' and Girls' Ranch
3) Griffith Center
4) Kids Ark In Sterling
5) Kids Ark in New Raymer Ranch
6) Monarch Youth - Berthoud
7) Monarch Youth - Loveland
8) Monarch Youth - Berthoud, Bryon Grismore Treatment Center
9) Namaqua Center- 8th Street Loveland
10) Namaqua Center - 7th Street Loveland
11) Third Way Center- York
12) Third Way Center- Pontiac
13) Third Way Center- Lincoln
14) Turning Point Center for Youth - Prospect/Fort Collins
15) Turning Point Center for Youth - Mathews/Fort Collins
16) Turning Point Center for Youth - Shields/Fort Collins
17) The Mountain Star Center, 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 seventeen (17)
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.
2002-2040
CC' ` SS Cis) SS0029
RE: SEVENTEEN (17) 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 31st day of July, A.D., 2002, nunc pro tunc July 1, 2002.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: Lid /� \ �` EXCUSED DATE OF SIGNING (AYE)
Glerrr���///aad, Chair
Weld County Clerk to 86 0`;4�� 3 l ` Q
c(- )3/
David E. ng, Pro-Tem
BY:
Deputy Clerk to the � ✓ //-�
M. J. eile
A OV AST •
AEXCUSED DATE OF SIGNING (AYE)
illi m H. Jerke
ounty Attorny
Robert D. Masden
Date of signature: �r
2002-2040
SS0029
•
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
I
GREELEY,CO 80632
IWEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
/�
Q MEMORANDUM Child Support(870)352-6933
111 I
COLORADO TO: Glenn Vaad, Chair Date: July 25, 2002
Board of County Commissioners
CFR: Judy A. Griego, Director, Social Services ,�(ALA- : Cu`t
I v J
RE: Agreements to Purchase Residential Treatnibnt 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 Depar fluent of Social Services Operations Manual. These
Agreements were reviewed at the Board's Work Session of July 30, 2002.
The major provisions of the Agreements as follows:
1. The term is July 1, 2002 through June 30, 2003.
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. Arapahoe House: $26.45 per day.
B. El Pueblo Boys' and Girls' Ranch: $31.52 per day
C. Griffith Center: $28.58 per day
D. Kids Ark in Sterling: $26.56 per day
E. Kids Ark in New Reymer Ranch: $26.56 per day
F. Monarch Youth-Berthoud: $41.00 per day
G. Monarch Youth-Loveland: $41.00 per day
H. Monarch Youth—Berthoud: $41.00 per day
(Bryon Grismore Treatment Center)
I. Namaqua Center-8th Street Loveland: $29.89 per day
J. Namaqua Center—7th Street Loveland: $29.89 per day
K. Third Way Center-York: $40.00 per day
L. Third Way Center—Pontiac: $40.00 per day
M. Third Way Center-Lincoln: $40.00 per day
N. Turning Point Center—Prospect/Ft. Collins $32.20 per day
O. Turning Point Center—Mathews/Ft. Collins $32.20 per day
P. Turning Point Center—Shields/Ft. Collins $40.44 per day
Q. Mountain Star Center: $43.63 per day
If you have any questions,please telephone me at extension 6510.
2002-2040
Contact No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this 1St 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 Arapahoe House,
8801 Lipan St,Thornton, CO 80221, 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$26.45 per day for children placed within the Residential Treatment Center
identified as Provider ID#88692. 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#: 88692
Arapahoe House
8801 Lipan St
Thornton CO 80221
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. 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
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 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
Coii act 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: /'L�''` `� �� "
Weld County Cl ',� -' �+.� WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
1861
ps°�11
By: i, //� /, �O� Ft- �� By: Glenn a ir
Deputy Clerk to the Boar u gyp
APPROVED AS TO FORM:
CONTRACTOR
Co Attomey
Arapahoe House
8801 Lipan St
Thornton,
,,,��C,O`��8022221 80260
By: (/L//
Michael W. y,Jr. , Ph.D.
WELD COUNTY DEPARTMENT Chief Executive Officer
OF SOCIAL SERVICES
By: cjr
+81A/(1)rct ;
Agreement to Purchase
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 1st 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 El Pueblo Boys' and
Girls' Ranch, One El Pueblo Ranch Way,Pueblo, CO 81006, 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$31.52 per day for children placed within the Residential Treatment Center
identified as Provider ID#45146. 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#: 45146
El Pueblo Boys' and Girls'Ranch
1591 Taos Rd.
Pueblo CO 81006
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. 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
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 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
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 el t. + Itfia,= J WELD COUNTY BOARD OF SOCIAL SERVICES,
to ,j �t ON BEHALF OF THE WELD COUNTY DEPARTMENT
' t+ OF SOCIAL SERVICE
ID4 't-001,09
L ' J T 1/41?
By. 4, By:
Deputy lerk to the Board Glenn V ha'r
APPROVED AS TO FORM:
•
!!! CONTRACTOR
ounty! [omey
El Pueblo Boys' and Girls'Ranch
One El Pueblo Ranch Way
Pueblo, CO 81006
By: 9 G' � ��
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: , �L
Die or
Agreement to Purchase
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 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 Griffith Center, 8745
W 14th Ave#230,Lakewood, CO 80215, 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, Coggty
Departments of Social Services, and ti
WHEREAS, County is authorized to purchase certain services for eligible children under State Dep4ment rules,
and -
-71
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center. 0.
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$28.58 per day for children placed within the Residential Treatment Center
identified as Provider ID#49547. 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
RTC Services 1 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#: 49547
Griffith Center
12163 S Perry Park Rd
Larkspur CO 80118
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. 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
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 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
•, 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 C e&p WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTMENT
• OF SOCIAL SERVICES
By: 1 b 4 By:
Deputy Clerk to the Bo d' J fnee S Glenna d,Chai
APPROVED AS TO FORM:
CONTRACTOR
o ty A omey
Griffith Center
8745 W 14th Ave#230
Lakewood, CO 80215
By '9-
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
ector
Agreement to Purchase
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 ls` day of July, 2002 between the Wealdl County Board of Social Services,on behalf of the Weld County Department of Social Services hereinafter call€al'Gililinty' ap!d r5dstrk In Sterling,
PO Box 1725,Sterling, CO 80751, 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 Diffiartment rules,
and �-
WHEREAS, County wishes to provide these services by purchasing them from Contractor, and, N
WHEREAS, Contractor is licensed as a Residential Treatment Center. -c
O0
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings Countyd 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$26.56 per day for children placed within the Residential Treatment Center
identified as Provider ID#34340. 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
Contraet 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#: 34340
Kidz Ark In Sterling
17282 CR 32
Sterling CO 80751
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. 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
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
• Contrach 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
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 C to tt `�n . a WELD COUNTY BOARD OF SOCIAL SERVICES,
pp. BEHALF IAL SOF TCES
� WELD COUNTY DEPARTMENT
OF
\-, ,, �� B
Deputy Clerk to the Boar. AV rt Glenn Vaad, C'C
APPROVED AS TO FORM:
CONTRACTOR
Coun ttomey
Kids Ark In Sterling
PO Box 1725
Sterling, CO 80751
By: k t(Ati
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
Ant-1
I„_.1,
�ector
Agreement to Purchase
RTC Services Rev 06/11/02
;Contrabi No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this 1st 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 Kids Ark In New
Reymer Ranch, PO Box 1725,Sterling, CO 80751,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$26.56 per day for children placed within the Residential Treatment Center
identified as Provider ID#34341. 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#: 34341
Kidz Ark New Raymer Ranch
Kidz Ark New Raymer Ranch
New Raymer CO 80742
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. 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
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 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
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
-Conttatt 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 ff to WELD WELD COUNTY BOARD OF SOCIAL SERVICES,
cy ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 '"''' l=; OF SOCIAL SERVICES
r
By: . .iii �.,4�� ° r �A By: 1/64
Deputy Clerk to the Boar Net Glenn Vaadreluur
APPROVED AS TO FORM:
CONTRACTOR
ount A omey
Kids Ark In New Reymer Ranch
PO Box 1725
Sterling, CO 80751 ��
By: m t. E Ct 2git_
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: Lt11111( k
Director
Agreement to Purchase
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 lm 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 Monarch Youth, PO
Box K,Berthoud, CO 80513, 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 Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate o er day for children placed within the Residential Treatment Center
identified as Provider ID#38462. 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, 7.406A (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#: 38462
Blue Mountian Ranch
2100 Blue Mountian Dr
Berthoud CO 80513
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. 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
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 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
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: "' �� �" .1
Weld County Cl- elEog�% WELD COUNTY BOARD OF SOCIAL SERVICES,
4• ON BEHALF OF THE WELD COUNTY DEPARTMENT
OF SOCIAL
/SERVICES
1861 ,e) qv
� ///dl n
� Fej �1X/.f'C//.l'.�.l.t-1
By: . _,Art �O: opzat : F� y�, By:
Deputy Clerk to the B,ekdr 7 ` , Glenn VaglIMITaii
Nvt
APPROVED AS TO FORM:
CONTRACTOR
County A orney
Monarch Youth
PC-Bun Kits w.3ja %wo%2b�
B ;(
�� t� 4 b4l?Af<<(1S C.0-S0513 LoV A, cb(y031
By: j 9 ).
•
WELD COUNTY DEPARTMENT �✓
OF SOCIAL SERVICES
By: Ji'e A
j Director
Agreement to Purchase
RTC Services Rev 06/11/02
Contfact No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
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 Monarch Youth, PO
Box K,Berthoud, CO 80513, 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$41.0eper day for children placed within the Residential Treatment Center
identified as Provider ID#1500261. 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 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#: 1500261
Fox Drive Treatment Center
3400 Fox Dr
Loveland CO 80537
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. 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
RTC Services Rev 06/11/02
Contiact 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
Confract 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
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 Cl o thW! rt`ta WELD COUNTY BOARD OF SOCIAL SERVICES,
rryoi. ,` ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 '``I' ;')IN OF SOCIAL SERVICES
4t(u
r≤� 1
By: ._,i ,_ �,.�.��(i�p �� By
Deputy Clerk to the Board�' C N°� Glenn Vaa ,
APPROVED AS TO FORM:
CONTRACTOR
County ttorney
Monarch Youth �� p
PO-Box lv2-(oSf W ��S llat l- 19 bg
Berthoud, CO 80513 Loakhoice ans31.
By: �P
WELD COUNTY DEPARTMENT C` 0Qlk-it
OF SOCIAL SERVICES
By: ,k-e1, CtAikete0
Director
J y
Agreement to Purchase
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 lst 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 Monarch Youth, PO
Box K,Berthoud, CO 80513, 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$41.0Dper day for children placed within the Residential Treatment Center
identified as Provider ID#1503010. 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#: 1503010
-B+yFeultizmore Treatment Center IyoU G1 t-sten -..
204 WCR 10E
Berthoud CO 80513
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. 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
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 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
' 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.
I A
ATTEST:
Weld County C to Y' °3' ` WELD COUNTY BOARD OF SOCIAL SERVICES,
t ON BEHALF OF THE WELD COUNTY DEPARTMENT
1861 t�
OF SOCIAL SERVICES
Lf'"-Y_�' am
By: . _/ z. e � � I By: Li�G�
Deputy Clerk to the Board ���� Glenn Vaad,L
APPROVED AS TO FORM:
CONTRACTOR
Coun Attorney
Monarch Youth p
PO BeX K Otpc1s to, Ittio - p id
B c' 805-1-3 Lc'>:l1%)(.o 8 n-
By: t
WELD COUNTY DEPARTMENT 0 lien.- 4; tsa‘fclicios .
OF SOCIAL SERVICES
By: �� �� 1;►n
D' ,ctor
Agreement to Purchase
RTC Services Rev 06/11/02
Contract'No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES -1
THIS AGREEMENT made this 1st day of July, 2002 between the Weld County Board oi'%%ial Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Nama( uu Center,
1327 W Eisenhower Blvd,Loveland, CO 80537, hereinafter called "Contractor". .)s
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$29.89 per day for children placed within the Residential Treatment Center
identified as Provider ID#45142. 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#: 45142
Namaqua Center
549 E 8th St
Loveland CO 80537
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
ContractNo.: PY 02/03-SS-23A-RTC
SECTION IL 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
RTC Services Rev 06/11/02
Contracf 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 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
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: 4,,m4/4.4
Weld County WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: ,' . \ r.% By: �i� /id
Deputy Clerk to e.‘.0",;1.„,',,,:t; ,r t A / Glenn .•., ,it
!!j7
APPROVED AS TO FORM:
CONTRACTOR
ounty ttorney
Namaqua Center
1327 W Eisenhower Blvd
oveland, C 0537
By: HILL p
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: 1f
Die or
Agreement to Purchase
RTC Services Rev 06/11/02
contract No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICESr
f
THIS AGREEMENT made this 15`day of July, 2002 between the Weld County Board of S't1¢ial Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Namag4Center,
1327 W Eisenhower Blvd,Loveland, CO 80537, hereinafter called "Contractor".
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$29.89 per day for children placed within the Residential Treatment Center
identified as Provider ID#100889. 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#: 100889
Namaqua Center
404 E 7th St
Loveland CO 80537
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. 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
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 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
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
ContractNo.: 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 ►P.t, ,t1I : WELD COUNTY BOARD OF SOCIAL SERVICES,
rr ` ON BEHALF OF THE WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
IS61: ; ,.x cij,By: Ca�4 yy I By: �W�CO-ut4(dad
Deputy Clerk to the :.. ,211 y Glenn hai
P ty °�'I
APPROVED AS TO FORM:
CONTRACTOR
ttomey
Namaqua Center
1327 W Eisenhower Blvd
Aoveland,, CO1534)
By: lithi
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: �/ � lei +th73
Direcr
V
Agreement to Purchase 7
RTC Services Rev 06/11/02
07/15/02 14: 47 FAX 970 346 7691 WELD CTY S0C SERVICES 016/022
Contract No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this 19t 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 Third Way Center,
PO Box 61385, Denver, CO 80206, 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:
•
i. County agrees to purchase and Contractor agrees to provide Room and Board services which are listed in
this Agreement at a rate of$40.00 per day for children placed within the Residential Treatment Center
identified as Provider TD#49487. 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.
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
07/15/02 14: 47 FAX 970 346 7691 WELD CTY S0C SERVICES 017/022
Contact 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#: 49487
Third Way Center- York •
1295 York St
Denver CO 80206
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
07/15/02 14: 47 FAX 970 346 7691 WELD CTY SOC SERVICES f7;01S/022
' 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 worlcing 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
R:I C Services Rev 06/11/02
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Contract No.: PY 02/03-SS-23A-RTC
SECTION DI. 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 Depattnlent 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 S400,000 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 Rev Scrviccs 06/11/02
07/15/02 14: 48 FAX 970 346 7691 WELD CTY S0C SERVICES Z026/022
• 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 (MP) 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 treabnent/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
RTC Services 5 Rev 06/11/02
07/15/02 14: 48 FAX 970 346 7691 WELD CTY SOC SERVICES 021/022
' Contact No.: PY 02/03-SS-23A-RTC
SECTION VI. GENERAL PROVISIONS.
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.
Aorcement to Purchase
6 Rev 06/11/02
RTC Services
07/15/02 14: 48 FAX 970 340 7691 WELD CTY S0C SERVICES Z022/022
Contra.ct 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 Cl o �;!!s-a WELD COUNTY BOARD OF SOCIAL SERVICES,
4:'4 ' SERVICES
ON BEHALFOF
THE
WELD COUNTY DEPARTMENT
0.1 OF
186 Vigo,cdct9
k By:
By: Deputy Clerk to the Boar• , &HI Glenn aad, Chair
APPROVED AS TO FORM:
CONTRACTOR
County norney
Third Way Center
PO Box 61385
Den r, CO 0 6
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
DirerfiLLID
Agreement to Purchase
7 Rev 06/11/02
RTC Scrcice9
07/15/02 14: 46 FAX 970 346 7691 WELD CTY SOC SERVICES C 009/022
Contract No. PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESLDENTIAL 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 Third Way Center,
PO Box 61385, Denver, CO 80206,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$40.00 per day for children placed within the Residential Treatment Center
identified as Provider ID#65346. 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 Rev 06/11/02
RTC Services
07/15/02 14: 46 FAX 970 348 7691 WELD CTY SOC SERVICES 2010/022
Contract No.: PY 02/03-SS-23A-RTC
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
I. 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#: 65346
Third Way Center- Pontiac
1735 Pontiac St
Denver CO 80220
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
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Contract Na.: 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
RTC Services Rcv 06/11/02
07/15/02 14:46 FAX 970 346 7691 WELD CTY S0C SERVICES Z012/022
Contact No_: PY 02103-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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Contract No.: P1 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 TEP 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 Rev 06/11/02
07/15/02 14: 47 FAX 970 346 7691 WELD CTP SOC SERVICES 0 014/022
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 finds 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 terns 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 riot 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 5 Rev 06/11/02
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ContractNo 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�i. . 4 ,/
Weld County f k t. . *-4 i WELD COUNTY BOARD OF SOCIAL SERVICES,
r 1861 ,i �� ON BEHALF OF THE WELD COUNTY DEPARTMENT
t I _.',. ,' OF SOCIAL SERVICES
1V �t?yi`�J'
By: �. I, _�� ��� By:
Deputy Clerk to the Board Glenn Vaad, Chair
APPROVED AS TO FORM:
CONTRACTOR
ounty A orncy
Third Way Center
PO Box 61385
�ver, C 206
•
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: l
r clot
Agrccmcnt to Purchase
RTC Se.rvi;ec 7 Rev 06/11/02
07.15.02 14: 45 FAX 970 346 7691 WELD CTY SOC SERVICES 002/022
.Contra0No_: PY02/03-SS-23A-RTC •
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
20
THIS AGREEMENT made this 1" day of July, 2002 between the Weld County Bood/gf Social Services,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Thirr'V1 y Center, •
PO Box 61385, Denver, CO 80206, hereinafter called "Contractor". `' 29
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$40.00 per day for children placed within the Residential Treatment Center
identified as Provider ID#77810. 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.
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
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Contact No.: PY 02/03-SS-23A-RTC
SECTION I. 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#: 77810
Third Way Center- Lincoln
1133 Lincoln
Denver CO 80203
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 RevRcv 06/11/02 •
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.Contract No.: PY 02/03-SS-23A-RTC
SECTION U. 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 maybe 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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.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
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.ContractNo.: 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 1EP 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.
S. 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
07/15702 14: 45 FAX 970 346 7691 WELD CTY SOC SERVICES x'007/022
-Contract No.: PY 02/03-SS-23A-RTC
SECTION VI. GENERAL PROVISIONS.
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 set-vices 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
07/15/02 14 : 46 FAX 970 346 7691 WELD CT? S0C SERVICES 2008/022
Contract No.: PY 02/03-SS-23A-RTC
LN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
Weld County y to 4hf' q r .;b WELD COUNTY BOARD OF SOCIAL SERVICES,
'•; ON BEHALF OF THE WELD COUNTY DEPARTMENT
- 42 OF SOCIAL SERVICES
I 86 P a^9
By: CP--ce .z.c� CC" C . ;,,,715 4 By
Deputy Clerk to the ip�--2..psi` , Glc
t,i `E' l
APPROVED AS TO FORM:
CONTRACTOR
un A rney
Third Way Center
PO Box 61385
Dior, CO
By: it,.." `��
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: L a (xtu_0(1)Ictor
V
Agreement to Purchase
RFC Services Rev 06/11/02
Contract No.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this l5t day of July, 2002 between the Weld County Board of Social'S vices,
on behalf of the Weld County Department of Social Services hereinafter called "County" and Turning Po S,!)-vices,
Center
for Youth, 1644 South College Ave,Fort Collins, CO 80525, hereinafter called "Contractor".
cfp
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$32.20 per day for children placed within the Residential Treatment Center
identified as Provider ID#45178. 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#: 45178
Turning Point For Drugsttndal eh.,.l.
640 W Prospect St.
Fort Collins CO 80524
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
RTC Services 2 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
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 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
RTC Services 5
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
RTC Services 6
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: k/ 4 "_,1�, ..:,e
Weld County Cle o oag a WELD COUNTY BOARD OF SOCIAL SERVICES,
f s•-,�e r'j ON BEHALF OF THE WELD COUNTY DEPARTMENT
asi tS , ,r OF SOCIAL SERVICES
Z O .gip,
By: Co .7,z j -,;.:ao By:
Deputy Clerk to the Board !A•` Glenn as , hair
APPROVED AS TO FORM:
CONTRACTOR
ounty A orney
Turning Point Center for Youth
1644 South College Ave
Fort Collins, CO 80525
•
WELD COUNTY DEPARTMENT Styr A-, , ≤7(rc' 6F eAke
OF SOCIAL SERVICES
By: 1,
Dire r
Agreement to Purchase
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 1st 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 Turning Point Center
for Youth, 1644 South College Ave,Fort Collins, CO 80525, 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$32.20 per day for children placed within the Residential Treatment Center
identified as Provider ID#45179. 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#: 45179
Turning Point Mathews St
614 S Mathews St
Fort Collins CO 80521
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. 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
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 maybe 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
RTC Services Rev 06/11/02
Contract 11o. 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 Na.: 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.
jeu/
ATTEST: ___
Weld County t WELD COUNTY BOARD OF SOCIAL SERVICES,
CS ON BEHALF OF THE WELD COUNTY DEPARTMENT
isbi tb Cg � OF SOCIAL SERVICES LeiBy: & '—s ,e1, By:
Deputy Clerk to the Boa i a//,' L' ( Glenn Vaad, Chair
=1—
APPROVED AS TO FORM:
CONTRACTOR
County Attorney
Turning Point Center for Youth
1644 South College Ave
Fort Collins, C 80525
By:
WELD COUNTY DEPARTMENT C-x-e^e-' arum
OF SOCIAL SERVICES
By: ALL CAAL°P
Di ector
Agreement to Purchase
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 1st 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 Turning Point Center
for Youth, 1644 South College Ave,Fort Collins, CO 80525, 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$40.44 per day for children placed within the Residential Treatment Center
identified as Provider ID#100441. 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#: 100441
Turning Point Center for Youth and Family
801 S Shields St
Fort Collins CO 80524
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. 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
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 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
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.
Mill
ATTEST:
Weld County C r' to 4, WELD COUNTY BOARD OF SOCIAL SERVICES,
.13' ON BEHALF OF THE WELD COUNTY DEPARTMENT
' 1861
OF SOCIAL SERVICES
o `er
By: / " � Tl"Y ,r,k By:
Deputy Clerk to the Board �j Glenn a , it
APPROVED AS TO FORM:
CONTRACTOR
ounty ttorney
Turning Point Center for Youth
1644 South College Ave
Fort Collins, CO 80525
By: K
WELD COUNTY DEPARTMENT Ti-get-e.... Cam"-' thus-e-
OF SOCIAL SERVICES By: ( Dir oT r
V
v
Agreement to Purchase
RTC Services Rev 06/11/02
ContrachNn.: PY 02/03-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES (f!?;+
THIS AGREEMENT made this 1St day of July, 2002 between the Weld County Board of So�al,xServices,
on behalf of the Weld County Department of Social Services hereinafter called "County" and The Mount* Star
Center, 3520 W Oxford Ave,Denver, CO 80236, hereinafter called "Contractor". O
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$43.63 per day for children placed within the Residential Treatment Center
identified as Provider ID#13363. 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
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#: 13363
The Mountian Star Center(At Ft. Logan)
4177 S Knox Ct -Fl
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
2
RTC Services 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
RTC Services Rev 06/11/02
ontract•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 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
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 Cl- r �`� WELD COUNTY BOARD OF SOCIAL SERVICES,
Ir �, ON BEHALF OF THE WELD COUNTY DEPARTMENT
¢86 f`� OF SOCIAL SERVIC
■By: ��: i y •a By: A Deputy Clerk to the B6WM( * � . ;n_`L Glenn , it
APPROVED AS TO FORM:
CONTRACTOR
County A mey
The Mountian Star Center
3520 W Oxford Ave
Denver, CO 80 36
By: ,-_tGf_ ! �/
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
D ctor
Agreement to Purchase
RTC Services Rev 06/11/02
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