HomeMy WebLinkAbout20052179.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR CORE SERVICES AND
AUTHORIZE CHAIR TO SIGN - SOUTHERN CORRECTIONS SYSTEMS, INC.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Child Protection Agreement for Core
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 Southern
Corrections Systems, Inc.,commencing June 1,2005,and ending May 31,2006,with further terms
and conditions being as stated in said agreement, and
WHEREAS,after review,the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County,Colorado,ex-officio Board of Social Services,that the Child Protection Agreement for Core
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 Southern
Corrections Systems, Inc. be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be,and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 3rd day of August, A.D., 2005, nunc pro tunc June 1, 2005.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
William H rke, Chair
Him II _ ' ;1j lerk to the -oard
WO
M. ile, ro-T
-
`�®f Clerk to the Board
id E. Long
APP AS TO FO
Robert D. Masden
/
County Attorney
Glenn Vaad
Date of signature:
2005-2179
SS0032
n Ss p8- /7-as-
jy? DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
1 Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
COLORADO MEMORANDUM
TO: William H. Jerke, Chair Date: July 28,2005
Board of County Commissioners )
FR: Judy A. Grego, Director, Social Services---2/�(,bJ C� C„1 -J
RE: Child Protection Agreement for Core Services between the Weld County
Department of Social Services and Southern Corrections System, Inc.
Enclosed for Board approval is a Child Protection Agreement for Core Services between the
Weld County Department of Social Services (Department) and Southern Corrections Systems,
Inc. This contract was reviewed at the Board's Work Session held on May 31, 2005.
The major provisions of the contract are as follows:
1. The term of the contract is June 1, 2005 through May 31, 2006.
2. The source of funding is Child Welfare Administration funding.
3. Southern Corrections System, Inc., will provide monitored sobriety services for families
and adolescents involved in the child welfare system.
4. The Department will reimburse Southern Corrections System, Inc., according to their
fee schedule for a total not to exceed$52,398.
If you have any questions,please telephone me at extension 6510.
7-1
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2005-2179
Contract Number. PY 05-06-CORE-53
CHILD PROTECTION AGREEMENT FOR CORE SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND SOUTHERN CORRECTIONS SYSTEMS, INC.
This Agreement,made and entered into the day of June 2005,by and between the Board of
Weld County Commissioners,on behalf of the Weld County Department of Social Services,hereinafter
referred to as"Social Services,"and Southern Corrections Systems, Inc.
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and
with appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Colorado Family
Preservation Act fund resources to Social Services for monitored sobriety services for families,children,
and adolescents;and
WHEREAS, Social Services requires the services of a substance abuse treatment provider to assist
the County to deliver monitored sobriety services to child welfare clients,and Southern Corrections
Systems,Inc. is willing and able to provide such services;and
WHEREAS, Southern Corrections Systems, Inc.is an Oklahoma for-profit corporation organized
for the purpose of managing and coordinating high quality,cost efficient,integrated chemical dependency
and related behavioral health care services in the State of Colorado.
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as
follows:
1. Term
This Agreement shall become effective on June 1,2005,upon proper execution of this Agreement
and shall expire May 31,2006,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Southern Corrections Systems, Inc.network providers to any
person(s)eligible for child protection services in compliance with Exhibit A"Scope of Services,"a
copy of which is attached by reference.
•
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"and Exhibit C,
"Core Services Fee Schedule,"copies of which are attached hereto and incorporated
herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Colorado Family Preservation Act funds during the duration of this Agreement.
Southern Corrections Systems, Inc.,in accordance with federal HIPAA regulations,has
adopted the standard transaction code set for all treatment services on or before October
16,2004. Even though this compliance has changed the service labels and groupings,the
net fees associated with those services have not changed.
b. Southern Corrections Systems, Inc.shall submit an itemized monthly bill to Social
Services for all costs incurred and services provided pursuant to Exhibit A of this
Agreement in accordance with criteria established by Social Services. The Contractor
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Contract Number. PY 05-06-CORE-53
shall submit all itemized monthly billings to Social Services no later than the twenty-fifth
(25)day of the month following the month the cost was incurred.
Failure to submit monthly billings in accordance with the terms of this agreement may
result in Southern Corrections Systems, Inc.'s forfeiture of all rights to be reimbursed for
such expenses. In the event of a forfeiture of reimbursement, Southern Corrections
Systems, Inc.may appeal such circumstance to the Director of Social Services. The
decision of the Director of Social Services shall be final.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the
availability of Colorado Family Preservation Act funds to Social Services.
d. Social Services shall not be billed for,and reimbursement shall not be made for time
involved in activities outside of those defined in Exhibit A or in the"Weld County
Guidelines." Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
e. Social Services shall pay or appeal the monthly billing within 60 days of receipt of the
billing.Any billing not appealed within 60 days shall be conclusively deemed to be
accepted as to its validity and accuracy. All amounts due on any billing not paid or
appealed within 60 days of receipt shall bear interest from the date due until paid at the
rate of 10%per annum.Receipt of the billing as used herein shall mean the date three(3)
days following the date of mailing of the billing by Southern Corrections Systems,Inc.
f. Social Services may dispute any billing by appeal within 60 days and request a rebilling.
Social Services will submit payment in full within 30 days after receipt of the rebill
submitted by Southern Corrections.Amounts not paid within such time will bear interest
as provided in Paragraph 3 (e).
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,the
Contractor shall comply with the administrative requirements,cost principles and other
requirements set forth in the Financial Management Manual adopted by the State of Colorado.
The required annual audit of all funds expended under Child Welfare Services and the Family and
Children's Program must conform to the Single Audit Act of 1984 and OMB Circular A-133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Southern Corrections Systems,Inc.shall provide proper monthly invoices and verification of
services performed for costs incurred in the performance of the agreement.
b. Social Services may withhold any payment if Southern Corrections Systems, Inc.has
failed to comply with the Financial Management Requirements,program objectives,
contractual terms,or reporting requirements. In the event of a forfeiture of
reimbursements, Southern Corrections Systems,Inc.may appeal such circumstance to the
Director of Social Services. The decision of the Director of Social Services shall be final.
c. Social Services will submit payment for all services rendered by Southern Corrections
Systems, Inc.,pursuant to referrals made by the Social Services' caseworker. Services
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Contract Number. PY 05-06-CORE-53
rendered under referrals made by the Social Services' caseworker shall not be subject to
challenge on the basis that the referral was not authorized unless Southern Corrections is
notified before performance of the services. The referral will be subject to challenge by
Social Services if Southern Corrections Systems, Inc.,does not have documentation that a
referral was received from Social Services prior to services being rendered.
6. Assurances
Southern Corrections Systems,Inc.shall abide by all assurances as set forth in the attached Exhibit D,
which is attached hereto and incorporated herein by reference.
7. Compliance with Applicable I aws
At all times during the performance of this contract, Southern Corrections Systems, Inc. shall
strictly adhere to all applicable federal and state laws,orders,and all applicable standards,
regulations,interpretations or guidelines issued pursuant thereto. This includes the protection of
the confidentiality of all applicant/recipient records,papers,documents,tapes and any other
materials that have been or may hereafter be established which relate to the Contract. Southern
Corrections Systems, Inc.acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d —1 et. seq- and its
implementing regulation,45 C.F.R. Part 80 et.Geri•and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
national origin,and,sex,religion and handicap,including Acquired Immune Deficiency Syndrome
(AIDS)or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,
as amended,cited above. If necessary, Southern Corrections Systems,Inc.and Social Services
will resist in judicial proceedings any efforts to obtain access to client records except as permitted
by 42 CFR Part 2. Social Services and Southern Corrections Systems, Inc.shall sign a Qualified
Service Organization Agreement in compliance with 42 CFR Part 2(Exhibit E).
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to
assure that small and minority businesses are utilized,when possible,as sources of supplies,
equipment,construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint
either with the Colorado Department of Human Services or with the U.S. Department of Health
and Human Services,Office for Civil Rights.
8. Certifications
Southern Corrections Systems, Inc.certifies that,at the time of entering into this Contract, it has
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Contract Number. PY 05-06-CORE-53
currently in effect all necessary licenses,approvals, insurance, etc.required to properly provide the
services and/or supplies covered by this contract.
9. Monitoring and Fvalnation
Southern Corrections Systems, Inc. and Social Services agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by Southern Corrections Systems, Inc.and
Social Services. The results of the monitoring and evaluation shall be provided to the Board of
Weld County Commissioners and Southern Corrections Systems, Inc..
Southern Corrections Systems, Inc. shall permit Social Services,and any other duly authorized
agent or governmental agency,to monitor all activities conducted by the contractor pursuant to the
terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or
appropriate,such program data,special analyses, on-site checking,formal audit examinations,or
any other reasonable procedures. All such monitoring shall be performed in a manner that will not
unduly interfere with agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Social Services or designee may exercise the following remedial actions should
s/he fmd Southern Corrections Systems, Inc. substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by Southern Corrections Systems, Inc. These remedial
actions are as follows:
a. Withhold payment of Southern Corrections Systems, Inc. until the necessary services or
corrections in performance are satisfactorily completed;
Deny payment or recover reimbursement for those services or deliverables,which have
not been performed and which due to circumstances caused by Southern Corrections
Systems, Inc.cannot be performed or if performed would be of no value to the Social
Services. Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Social Services;
b. Incorrect payment to Southern Corrections Systems, Inc. due to omission, error, fraud,
and/or defalcation shall be recovered from Contractor by deduction from subsequent
payments under this Agreement or other agreements between Social Services and Southern
Corrections Systems, Inc., or by Social Services as a debt due to Social Services or
otherwise as provided by law.
12. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated
representatives of the respective parties. Either party may from time to time designate in writing a
new or substitute representative(s):
For Social Services:
Gloria Romansik Social Services Administrator
Name Title
For Southern Corrections Systems,Inc.:
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Contract Number. PY 05-06-CORE-53
lames Safile President
Name Title
13.Notice
All notices required to be given by the parties hereunder shall be given by certified or registered
mail to the individuals at the addresses set forth below. Either party may from time to time
designate in writing a substitute person(s)or address to whom such notices shall be sent:
To: Social Services To: Southern Corrections Systems,Inc.
Judy A Griegn,Director lames Raffle,President
P O Box A 7650 N Washington
Greeley,CO R0612 Denver CO R0779
14. Litig to inn
Southern Corrections Systems,Inc.shall promptly notify Social Services in the event that Southern
Corrections Systems,Inc.learns of any actual litigation in which it is a party defendant in a case
that involves services provided under this Agreement. Southern Corrections Systems, Inc.,within
five(5)calendar days after being served with a summons,complaint,or other pleading which has
been filed in any federal or state court or administrative agency,shall deliver copies of such
document(s)to the Social Services Director. The term"litigation" includes an assignment for the
benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty (30) days written notice
and is subject to the availability of funding. Southern Corrections Systems, Inc. reserves the right to
suspend services to clients if funding is no longer available. Social Services acknowledges financial
responsibility for services authorized before the effective date of termination.
16. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between
the parties with respect to the subject matter hereof,and may not be changed or modified except as
stated in Paragraph 10 herein.
17. In the absence of any formal agreement beyond the term of this agreement,Southern Corrections
Systems,Inc.agrees to continue providing treatment,under the terms of this agreement,for clients
that are in treatment or referred by Social Services for treatment. This is with the further
understanding that service delivery and payment are subject to the terms under"Termination"
(section 15).
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year
first above written.
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Contract Number.PY 05-06-CORE-53
first above written.
ATTEST: LISS/
a ' COUNTY BOARD OF COUNTY
I!�"''�r• THE BOARD COMMISSIONERS WELD
/4* COUNTY,COLORADO
t 1861 „�, ,,��' '' ';chat , " _ - William x.lance,Chair AUG 0 3 2005
t
0 j+Pier SO CORRECT! NS SYSTEMS,INC.
®,�art\ i _. BY 7-0-v n
ilt
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
BY. 7/2n/of
• Direct
EXHIBIT A
SCOPE OF SERVICES
Special r onditions:
A. Southern Corrections Systems,Inc.with each UA will follow their UA policy,herein described below
under"Northern UA Collection Procedure Example."
B. Southern Cmrections Systems, Inc.will only conduct monitored sobriety for Social Service clients at
their Day Reporting Center.
C. Southern Corrections Systems,Inc.will have enough staff available to meet Social Service clients'
needs. Southern Corrections Systems,Inc.will not turn a client away,or have them wait more than
fifteen(15)minutes to provide a sample.
D. Southern Corrections Systems,Inc.will confirm any positive monitored sobriety result within 24
hours through a fax and a phone call to the Social Services caseworker
E. Southern Corrections Systems,Inc.will provide court testimony at no additional charge.
NORCUEM UA COLLECTION FEES
Standard Five-Panel UA,with GM/MS confirmation on positive results,
(screens for THC,Cocaine,Meth/Amphetamines,Opiates,and Barbiturates) $15.00
Automatic GC/MS confirmation on positive UA screens at madditinnaLcost
If a UA screen tests positive,and it is confirmed positive by GC/MS,the client may pay to have the
specimen re-screened by GC/MS confirmation............................................... $20.00
SalivaTests $15.00
Breathtesting $2.00
Other illicit substances can be screened at an additional cost.Please contact Contractor for fees.
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was-a/7y
Contract Number.PY 05-06-CORE-53
NORCHEM UA COLLECTION PROCEDURE EXAMPLE
A. Important Point
The collector and the donor shall keep the urine in view at all times prior to its being sealed with a
tamper-evident sealing label.
B. Prior to Collection
1. The collection facilities must be clean,well lighted,and dedicated solely to urine
collection during the collection process.
2. The toilet water must not be available to the donor for specimen adulteration:
• Regular Flushing Toilets: Bluing agent(or dye)should be placed in the toilet
bowl and tank,and secure the tank cover with tamperproof tape.
• Pressure flushing toilets: Bluing tablets(or dye)should be placed in the toilet
bowl after each flush or before the next donor.
3. No other source of water should be accessible to the donor during the collection process.
C. Collection.
1. Collector must positively identify the donor. If the collector is not the caseworker for the
donor,the collector must ask the donor for photo identification. The only other form of
acceptable identification is for the donor's identity to be verified by their caseworker,or
supervisor,in person.
2. Collector must assure that all applicable information on the Chain-of-Custody(COC)
form is complete.
3. Collector must ask the donor to remove all items from their pockets,and pull their
pockets inside out.
4. All personal belongings, such as purse or briefcase,are to remain outside the collection
location(with outer garments.)
5. Collector instructs donor to wash and dry hands.(Do not use soap. Use water only.)
6. Collector instructs donor to fill the specimen collection bottle.
7. Donor enters the toilet stall,if an observed collection,collector accompanies the donor.
D. I Ipon Receiving Specimen from Donor
1. Collector visually checks the specimen for signs of contamination or adulteration
(discoloration,precipitation,etc.)and notes all observations in the Test Request space
provided on the Chain-of-Custody form.
2. In the presence of the donor, collector notes the temperature of the specimen using the
temperature strip provided on the container within four(4)minutes from the time of
urination.The acceptable sample temperature range is 90-100 degrees Fahrenheit.
3. Record the temperature on the Chain-of-Custody form.
4. If tamper proof tape was used on the toilet tank,check that the tape was not tampered
with.
5. Collector and donor shall keep the specimen in view at all times prior to the specimen
being sealed with tamper evident tape.
6. Make sure the bottle is tightly capped.
7. Seal the specimen by placing the tamper evident tape over the lid of the bottle with the
ends of the tape coming down the sides of the bottle.
8. Have the donor place their initials in the space provided on the security seal. This is to
certify that the specimen has been sealed with a tamper-evident sealing label in the
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Contract Number. PY 05-06-CORE-53
donor's presence,and that the donor gave the specimen.
9. Using a ballpoint pen,donor and collector sign the appropriate area on the Chain-of-
Custody form.
10. Collector encourages donor to wash hands.
E. Specimen Rejection Criteria.
You should reject the specimen if one of the following occur:
1. If the specimen is not within the acceptable temperature rang-.(90-100 degrees
Fahrenheit),discard the specimen and request another specimen from the donor.
2. If the specimen shows signs of discoloration from the addition of bluing agent/dye.,clearly
state this fact on the Chain-of-Custody form,and send specimen to laboratory.
3. If there is the distinctive odor of bleach in the specimen collection area,or on the donor,
clearly state this fact on the Chain-of-Custody form,and send specimen to the laboratory.
4. If there is insufficient volume of specimen to perform the required analysis discard the
specimen and request another from the donor. Insufficient volume here means that the
specimen level must be above the level of the temperature strip on the collection bottle.
F. Prepare Specimen for Shipment to laboratory.
1. Collector removes copy of Chain-of-Custody form,and keeps for records.
2. Place the top copy of Chain of custody form in the front pouch of specimen bag.
3. Place the capped,sealed specimen bottle in the bag(with absorbent pad)and seal
specimen bag by removing adhesive strip.
4. Place the sealed bag into proper mailing product.If specimens are shipped via courier,
prepare according to courier's instructions.
5. Specimens should be shipped as soon as possible(within seven days of collection.)Keep
specimens in a secure area until shipped.
G. Notes:
1. Specimens left at room temperature longer than seven(7)days may produce unreliable
results.
2. Minimize the number of people handling specimens.
3. Ensure that all necessary areas of the Chain-of-Command form are filled out.
4. Make sure the specimen is tightly and properly sealed.
5. Ensure the specimen is sealed/labeled.
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Social Services agrees to reimburse to Southern Corrections Systems, Inc. in consideration for the
work and Services performed,a total amount not to exceed Fifty-Two Thousand,Three Hundred
Ninety-Eight Dollars($52,398.00)under Child Welfare Services and Family and Children's
Program Funding.
Expenses incurred by Southern Corrections Systems, Inc., in association with said project prior to
the term of this agreement,are not eligible Social Services expenditures and shall not be
reimbursed by Social Services.
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Contract Number.PY 05-06-CORE-53
Payment pursuant to this Contract, if Colorado Family Preservation Act funds,whether in whole or
in part, is subject to and contingent upon the continuing availability of Colorado Family
Preservation Act funds for the purposes hereof. In the event that said funds,or any part thereof,
become unavailable as determined by Social Services,Social Services may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services—as shown on the attached Exhibit A"Core Services Fee Schedule"
Social Service referrals will not be sent to collections by Southern Corrections Systems,Inc. for
default of co-pay/fees. Services will be performed regardless of client's refusal or inability to pay
co-pay.
3. Submittal of Vouchers
Southern Corrections Systems,Inc.shall prepare and submit monthly the itemized voucher
according to the criteria listed under"Standards of Responsibility"in Exhibit D,and certify that
the services authorized were provided on the date indicated and the charges made were pursuant to
the terms and conditions of Exhibit A.
EXHIBIT C
ASSURANCES
1. Southern Corrections Systems,Inc.agrees it is an independent contractor and that its officers and
employees do not become employees of Weld County,nor are they entitled to any employee
benefits as Weld County employees,as the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,
shall not be held liable for injuries or damages caused by any negligent acts or omissions of
Southern Corrections Systems,Inc.-contracted providers or its employees,volunteers,or agents
while performing duties as described in this Agreement. Southern Corrections Systems, Inc.shall
indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld
County, its employees,volunteers,and agents. Southern Corrections Systems, Inc. shall provide
adequate liability and worker's compensation insurance for all its employees,volunteers,and
agents engaged in the performance of the Agreement upon request, Southern Corrections Systems,
Inc.shall provide Social Services with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or
their officers or employees may possess,not shall any portion of this Agreement be deemed to
have treated a duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of
Weld, State of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsections,paragraph, sentence,clause,or phrase of this Contract is for any reason
held or decided to be unconstitutional, such decision shall not affect the validity of the remaining
portions. The parties hereto declare that they would have entered into this Contract and each and
every section, subsection,paragraph,sentence,clause,and phrase thereof
irrespective of the fact that any one or more sections, subsections,paragraphs,sentences,clauses,
or phrases might be declared to be unconstitutional or invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall
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Contract Number.PY 05-06-CORE-53
have any pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. Southern Corrections Systems, Inc.assures that they will comply with the Title VI of the Civil
Rights Act of 1986 and that no person shall,on the grounds of race,creed,color,sex,or national
origin,be excluded from participation in,be denied the benefits of,or be otherwise subjected to
discrimination under this approved Contract.
8. Southern Corrections Systems,Inc.assures that sufficient,auditable,and otherwise adequate
records that will provide accurate,current, separate,and complete disclosure of the status of the
funds received under the Contract are maintained for three(3)years or the completion and
resolution of an audit. Such records shall be sufficient to allow authorized local, Federal,and State
auditors and representatives to audit and monitor Southern Corrections Systems, Inc..
9. All such records, documents,communications,and other materials shall be the property of Social
Services and shall be maintained by Southern Corrections Systems, Inc.,in a central location and
custodian,in behalf of Social Services,for a period of four(4)years from the date of final payment
under this Contract,or for such further period as may be necessary to resolve any matters which
may be pending,or until an audit has been completed with the following qualifications: If an audit
by or on behalf of the federal and/or state government has begun but is not completed at the end of
the four(4)year period,or if audit findings have not been resolved after a four(4)year period,the
materials shall be retained until the resolution of the audit finding.
10. Southern Corrections Systems, Inc.assures that authorized local,federal and state auditors and
representatives shall,during business hours,have access to inspect any copy records, and shall be
allowed to monitor and review through on-site visits,all contract activities,supported with funds
under this Contract to ensure compliance with the terms of this Agreement. Contracting parties
agree that monitoring and evaluation of the performance of the Agreement shall be conducted by
appropriate funding sources. The results of the monitoring and evaluation activities shall be
provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,
and assigns. Southern Corrections Systems, Inc.or Social Services may not assign any of its rights
or obligations hereunder without the prior written consent of both parties.
12. Southern Corrections Systems, Inc.certifies that federal appropriated funds have not been paid or
will be paid, by or on behalf of Southern Corrections Systems, Inc.,to any person for influencing
or attempting to influence an officer or employee of an agency,a Member of Congress,an officer
or employee of Congress,or an employee of a Member of Congress in connection with the
awarding of any Federal contract,the making of any federal grant,the making of any federal loan,
the entering into of any cooperative agreement,and the extension,continuation,renewal,
amendment,or modification of any Federal contract,loan,grant,or cooperative agreement.
13. Southern Corrections Systems, Inc.assures that it will fully comply with all other applicable
federal and state laws. Southern Corrections Systems, Inc./Southern Corrections Systems,Inc.
understands that the source of funds to be used under this Contract is:Colorado Family
Preservation Act funds.
14. Southern Corrections Systems, Inc.assures and certifies that is and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or
voluntarily excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period of preceding this Agreement,been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal offense
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Contract Number. PY 05-06-CORE-53
in connection with obtaining,attempting to obtain,or performing a public(federal, state,
or local)transaction or contract under a public transaction;violation of federal or state
antitrust statutes or commission of embezzlement,theft,forgery,bribery,falsification or
destruction of records,making false statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government
entity(federal,state,or local)with commission of any of the
offenses enumerated in paragraph 11(b)of this certification;and
d. Have not within a three-year period preceding this Contract,had one or more public
transactions(federal,state,and local)terminated for cause or default.
The Appearance of Conflict of Interest applies to the relationship of a contractor with Social
Services when Southern Corrections Systems, Inc. also maintains a relationship with a third party
and the two relationships are in opposition. In order to create the appearance of a conflict of
interest, it is not necessary for the contractor to gain from knowledge of these opposing interests.
It is only necessary that the contractor know that the two relationships are in opposition. During the
term of the Contract, Southern Corrections Systems,Inc. shall not enter any third party relationship
that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,Southern Corrections Systems, Inc.shall submit to
Social Services,a full disclosure statement setting forth the details that create the appearance of a
conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for Social Services'termination,for cause,of its contract with Southern
Corrections Systems, Inc..
15. Southern Corrections Systems, Inc.shall protect the confidentiality of all applicant records and
other materials that are maintained in accordance with this Contract. Except for purposes directly
connected the administration of the Child Protection,no information about or obtained from any
applicant/recipient in possession of Southern Corrections Systems, Inc. shall be disclosed in a form
identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with
Southern Corrections Systems,Inc.written policies governing access to,duplication and
dissemination of,all such information. Southern Corrections Systems, Inc. shall advise its
employees,agents,and subcontractors,if any,that they are subject to these confidentiality
requirements. Southern Corrections Systems, Inc.shall provide its employees,agents,and
subcontractors,if any,with a copy or written explanation of these confidentiality requirements
before access to confidential data is permitted.
16. Proprietary information for the purposes of this contract is information relating to a party's
research,development,trade secrets,business affairs, internal operations and management
procedures and those of its customers,clients or affiliates,but does not include information(1)
lawfully obtained from third parties,(2)that which is in the public domain,or(3)that which is
developed independently. Neither party shall use or disclose directly or indirectly without prior
written authorization any proprietary information concerning the other party obtained as a result of
this Contract. Any proprietary information removed from the State's site by Southern Corrections
Systems, Inc. in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by Southern Corrections Systems, Inc.for similar information in
the course of its own business.
17. The Contractor certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring
criminal background record checks for all employees,contractors,and sub-contractors.
EXHIBIT D
Standards of Responsibility
Page 11 of 17
Contract Number. PY 05-06-CORE-53
Southern Corrections Systems,Inc. agrees to:
1. Report expenditures and case disbursement at agreed upon times.
2. Submit monthly FYC completed billing forms to Ms. Elaine Furister,CPS/CAP,Core Services
Specialist,within twenty-five(25)calendar days of the month following service in order to receive
payment. Billing forms will not be accepted by the Department for processing after the 25th day
following the service month. All items submitted after this date will he returned to Southern
Corrections Systems, Inc unpaid Further,the Department will not consider payments that were
originally reviewed as deficient in documentation for further reimbursement.
3. In the event no service fees are incurred during the service month,an Authorization for Contractual
Services stating no services were provided for that service month shall be submitted within twenty-
five(25)calendar days following the month of service.
4. A complete and timely billing form is identified by and must include the following elements.
a. The billing must be an original billing signed by the provider and/or designee.
b. The billing must include all forms designed for Child Welfare Regular Administration
funds reimbursement and approved by Social Services;Contractual Services
Authorization of Funds, Project Report,Update Report,for each client served during the
billing period.
c. Each client who has a current referral,both receiving services and not receiving services
during the service month,must be listed on the billing form.A service summary must be
provided by the provider for clients who have active referrals during the billing month in
order to direct issues to the caseworker and court.
I) Core Services Authorization forms must be submitted completely filled in with an
original signature from the provider and/or designee.
2) Project reports must include the client's full name,Weld County household
number, suffix number,referral number,if applicable,hours served,hourly rate,
and total billed for the month the service was provided.
3) Requests for payment must be date stamped by the Department of Social Services
by the 25th day of the month following the service month.Requests for payment
received after the 25th of the month following service will not be honored.
d. Additionally, Southern Corrections Systems, Inc.agrees to provide Social Services
monitoring results(UA,BA,patch,tox trap)by faxing said results to Social Services at
970.346.7698 no later than 72 hours after the day of service. Southern Corrections
Systems,Inc.agrees to provide service summaries for clients with active referrals during
the billing month in order to direct issues to the caseworker and court.
e. The Department will determine pilled services not elig hle for payment by identifying
conflicts in the following-
I) Details provided in client referrals,including types of service,approved hours
and/or units of service,begin and end dates of service,client name,or other client
identifying information.
2) Details in supporting documentation provided by Southern Corrections Systems,
Page 12 of 17
Contract Number. PY 05-06-CORE-53
Inc.and submitted with the original bill,including,but not limited to,original
signed client verifications,receipt of monitoring results,times of service,units or
hours of service provided,and names of clients receiving the services.
3) Details provided in the current approved contract and Notification of Financial
Assistance, including,but not limited to unit of service,cost per unit of service,
and special conditions and/or revisions to said contract.
The above items,4 d, 1,2,and 3,will supersede all requests from Southern Corrections
Systems, Inc. for review of billing errors. Items submitted for billing will be processed
according to the criteria established by the above documentation.
5. Will meet with Social Services FPP Supervisor quarterly(more if needed)to review progress
usage and effectiveness to discuss necessary improvements to better serve families or increase
referrals;
6. Be available to meet with DSS staff to explain program,time lines of response to referrals and
answer questions to enhance program.
7. Be available for the Families,Youth and Children Commission review and attendance at the FYC
meetings.
5310.213(2/79)
COLORADO STATE DEPARTMENT OF SOCIAL SERVICES
AIITHORI7AT1ON FOR CONTRACTIIRAI.SERVICFS
1. WFI DCOI MTV DATE:
2.
Name of Provider
3.
Address
4.
City, State, Zip
THE DESCRIBED SERVICE IS AUTHORIZED FOR THE CLIENT INDICATED:
5.
Name of Client Household# Cat. Cat.Grp.
6.
Description Sv.Code
6. APPROVAL:
Caseworker Date Co.Director or Supervisor
8.TO BE COMPLETED BY PROVIDER
DATE OF SERVICE
CHARGES$
Page 13 of 17
Contract Number.PY 05-06-CORE-53
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED AND THE CHARGES ARE MADE
PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE COUNTY DEPARTMENT OF SOCIAL SERVICES
INDICATED.
Provider Signature Date
Prepare in Triplicate,Original and One copy to Provider,One Copy for Pending File.
Completed Provider's Forms-Original to County Finance Office-Copy to Case Record.
WELD COUNTY CORE SERVICES PROGRAM MONTHLY REQUEST FOR REIMBURSEMENT
Remit to:Elaine Furister,PS/CAP,Core Service Specialist
Name of Program Month of Service Weld County Department of Social Services
Notice to Providers:List all clients currently enrolled in your program. P.O.Box A,315 B N I1 Avenue,Greeley,CO 80632
Enter 0 if no services were provided during billing month Telephone:970.352.1551,extension 6295
FAX:970.346.7698
Client Name HH# Referral# Approved Approved Service Actual Maximum Hours Rate per Monthly
Entry Date Exit Date Date Hrs/Service Period Sessions/Service Unit Total
Period
Social Service Codes:CE-Computation Error;NR-No Referral;EED-Exceeds End Date;EMH-Exceeds Maximum Hours;EMS-
Exceeds Maximum Sessions;NP-Not Payable;
PD-Payment Delayed;SPD;Submitted Past Deadline;NDC-No Face to Face Contact;NV-No Client Verification;ICMP-Initial Case
Management Plan Needed;PR-Progress Report Needed
WFI D COUNTY CORE CFRVIf FS PROGRAM PROTECT REPORT
Remit to:Elaine Furister,
CPS,Core Service Specialist
Weld County Department
of Social Services
Program Month of Service P.O.Box A,315 BN II
Avenue,Greeley,CO 80632
Telephone:970.352.1551,
Ext.6295 FAX:970.346.7698
Page 14 of 17
Contract Number. PY 05-06-CORE-53
#Households Referred During #of Households Enrolled #of Households Served During #of Households Discharged
Month During Month Month During Month
Termination Reason Codes:SEP-Successfully Ended Program;M-Moved;UL-Unable to Locate;RCCF-Entered a Residential
Facility;FCR-Foster Care Review;OT-Explain,TM-Transferred to Mother Program More Restrictive;FC-Entered Foster Care;NT-
Terminated;Unable to Work with Client;RH-Returning to Relative
Child's Name Direct Service Date Service Termination Client Caseworker Provider Initial Case Mont
Date Ended Reasons Survey Survey Survey Management Repoi
Plan(Date)
•
Funding Source: M-Medicaid;CI-Client Insurance;0-Other
EXHIBIT E
SOUTHERN CORRECTIONS SYSTEMS,INC.CORRECTIONAL SERVICES, INC.,
ON BEHALF OF THE VILLA AT GREELEY,LLC
QUALIFIED SERVICE ORGANIZATION AGREEMENT
Southern Corrections Systems, Inc.and Weld County Department of Human Services(County)hereby
enter into a Qualified Service Organization Agreement whereby Southern Corrections Systems, Inc.,agrees
to accept and serve Counties' clients substance abuse treatment needs. In light of the relationship between
County and Southern Corrections Systems, Inc.,County requires client identifying information and data
and information related to the services furnished to the clients. County and Southern Corrections Systems,
Inc.,will have this relationship from June 1,2004 to June 30,2005,thus the QSOA will be in effect during
this period of time.
Furthermore,the County:
1. acknowledges that in receiving,storing,processing,or otherwise dealing with any
information from Southern Corrections Systems, Inc.,about the clients in the Villa at
Greeley,LLC's program, it is fully bound by the provisions of the federal regulations
governing confidentiality of Alcohol and Drug Abuse Patient Records,42 CFR Part 2;
and
Page 15 of 17
Contract Number.PY 05-06-CORE-53
a. agrees to undertake in resisting judicial proceedings in any effort to obtain access to
information pertaining to clients otherwise than as expressly provided for in the federal
confidentiality regulations,42 CFR Part 2.
Executed this 2 g day of Aoh 200/5
'4OC
James L. Sallie,President Ju +A.Gri o,Dir r 1
Southern Corrections Systems,Inc. Weld CodDepa nt of octal Services
Page 16 of 17
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