HomeMy WebLinkAbout20041632.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR DAY
TREATMENT PROGRAM AND AUTHORIZE CHAIR TO SIGN - NORTH COLORADO
MEDICAL CENTER -YOUTH PASSAGES
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 Notification of Financial Assistance Award
for the Day Treatment Program 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 North Colorado Medical Center- Youth Passages, commencing June 1, 2004, and ending
May 31, 2005, with further terms and conditions being as stated in said award, and
WHEREAS, after review, the Board deems it advisable to approve said award, 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 Notification of Financial Assistance
Award for the above listed program 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 North Colorado Medical Center be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said award.
The above and foregoing Resolution was,on motion duly made and seconded, adopted by
the following vote on the 16th day of June, A.D., 2004, nunc pro tunc June 1, 2004.
P '%, BOARD OF COUNTY COMMISSIONERS
= /q // WE`�1\p COUNTY, COLORADO
' 1661 I: 1�� .,�1 /,��',�,/e 1)G�l t ^�II,1W
" ' ' ♦ Robert D. Masden, Chair
'kr. 1p""" � o�erk to the Board
� •�°, • William H. erke, Pro-Tem
BY: &
Deputy Clerk t the Board
M. eile
A E AS • (-3 �
Davi . Long
unty Attgrney x
/ Glenn Vaad
Date of signature: to- -� 3 ty
2004-1632
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DEPARTMENT OF SOCIAL SERVICES
P.O.BOX A
GREELEY,CO. 80632
' Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
•
COLORADO
MEMORANDUM
TO: Robert D.Masden, Chair Date: June 14, 2004
Board of County Commissioners �`
FR: Judy A. Griego,Director, Social Services a
tter
RE: Notification of Financial Assistance Award lit
Designed
ed
Programs with Various Providers
Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAAs) for
County Designed Programs between the Weld County Department of Social Services and various
providers. The NOFAAs are based upon the provider's Request for Proposal, which has been
reviewed and approved by the Families,Youth and Children(FYC) Commission. The NOFAAs
were reviewed at the Board's Work Session of June 14, 2004.
The major provisions of the NOFAA are as follows:
1. The teen period is from June 1,2004 through May 31,2005.
2. The Department agrees to reimburse providers under Core Services funding according to
the NOFAA and their respective bid proposal for County Designed Programs. These
services are for children,youth, and families receiving child welfare services. Generally,
County Designed Programs are innovative and/or otherwise unavailable services that
meet the goals of the Core Services Program.
3. Providers will be reimbursed according to various rates as provided below:
�\ Vendor Name Rate
�l A. North Colorado Medical Center—Youth Passages $21.00 per hour
Adolescent Partial Hospitalization
B. Lutheran Family Services $350.00 per hour(group rate)
Foster Parent Consultation $90.00 per hour(individual rate)
C. Ackerman and Associates P.C. $350.00 per hour(group rate)
Foster Parent Consultation $90.00 per hour(individual rate)
2004-1632
D. Lori Kochevar $350 per hour(group rate)
Foster Parent Consultation $90.00 per hour(individual rate)
E. Transitions Psychology Group,LLC $350 per hour(group rate)
Foster Parent Consultation $90.00 per hour(individual rate)
If you have any questions,please contact me at extension 6510.
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission (Core)Funds
Type of Action Contract Award No.
X Initial Award FY04-PAC-10000
Revision (RFP-FYC-04006)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2004 and North Colorado Medical Center-Youth Passages
Ending 05/31/2005 Day Treatment Program
1801 16th Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Adolescent Partial Hospitalization is a program designed Assistance Award is based upon your Request for
to address the multifaceted needs of adolescents Proposal (RFP). The RFP specifies the scope of
experiencing significant emotional,behavioral, services and conditions of award. Except where it is
educational, interpersonal, familial problems, and in conflict with this NOFAA in which case the
adolescents suffering from a wide range of psychiatric NOFAA governs, the RFP upon which this award is
disorders and chemical dependency. 96 adolescents (10- based is an integral part of the action.
18 years)per year, and/or(range of 5-18 years), 7
monthly average capacity, 37.5 average hours per week, Special conditions
for 6-10 weeks. Average hours in intensive outpatient
program per week is12. Day program is conducted in 1) Reimbursement for the Unit of Services will be based
English while family sessions can be conducted in on an hourly rate per child or per family.
Spanish through a Bilingual therapist. Transportation for 2) The hourly rate will be paid for only direct face to
South County families provided through Weld BOCES face contact with the child and/or family, as specified
and RE-8. in the unit of costs computation.
3) Unit of service costs cannot exceed the hourly and
Cost Per Unit of Service yearly cost per child and/or family.
4) Payment will only be remitted on cases open with,
Hourly Rate Per Unit of Service $21.00 and referrals made by the Weld County Department
of Social Services.
Based on Approved Plan 5) Requests for payment must be an original submitted
to the Weld County Department of Social Services
Enclosures: by the end of the 25th calendar day following the end
X Signed RFP:Exhibit A of the month of service. The provider must submit
X Supplemental Narrative to RFP: Exhibit B requests for payment on forms approved by Weld
X Recommendation(s) County Department of Social Services.
X Conditions of Approval 6) The Contractor will notify the Department of any
change in staff at the time of the change.
Approvals: 140 Program Official:
By �X By
Robert D. Masden, Chair Jud e ,Direc r
Board atrel 1 go Commissioners Well nt of Social Services
Date: JUiv 1 Date:
SIGNED RFP-EXHIBIT A
INVITATION TO BID
OFF SYSTEM BID B001-04(04005-04011 AND 006-00)
DATE: February 11, 2004 BID NO: RFP-FYC-04006
I
I RETURN BID TO: Pat Persichino, Director of General Services
1 915 10th Street, P.O.Box 758, Greeley, CO 80632
I SUMMARY
Request for Proposal (RFP-FYC-04006) for:Colorado Family Preservation Act--Day Treatment Prograni'
Emergency Assistance Program
Deadline: March 5, 2004, Friday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of
Weld County Commissioners authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101) and
Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S.
26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run froth
June 1, 2004, through May 31, 2005, at specific rates for different types of service, the county will authorize
approved vendors and rates for services only. The Day Treatment Program Category must provide a
comprehensive, highly structured program alternative to placement or more restrictive placement that
provides therapy and education for children. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Jon Sewell
TYPED OR PRINTED SIGNATURE
VENDOR North Colorado Medical Center '''--
(Name) Handwritten Signature By Authorized
Officer or Agent of Vendor
ADDRESS 1801 16th Street TITLE Chief Executive Officer
Greeley, CO 80631
DATE 2, - Z 7,
PHONE # 352-4121
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 31
' * ' Off-System Bid B001-04 (RFP-FYC-04006) Attached A
DAY TREATMENT PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING
EMERGENCY ASSISTANCE PROGRAM
2004/2005 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2004-2005
OFF-SYSTEM BID B001-04 (04006)
NAME OF AGENCY: North Colorado Medical Center - Youth Passages
ADDRESS: 1801 16th St , Greeley, CO 80631
PHONE: (970 ) 352-1056
CONTACT PERSON: Karen Nicholson TITLE: Behavioral Health Therapist I7
DESCRIPTION OF EMERGENCY ASSISTANCE PROGRAM CATEGORY: The Day Treatment Program Category must
provide a comprehensive,highly structured program alternative to placement that provides therapy and education for children.
12-Month approximate Project Dates: 12-month contract with actual time lines of: .
Start June 1, 2004 Start June 1 , 2004
End May 31, 2005 End May ii , 2005
TITLEOFPROJECT: Youth Passages
David Rastatter �t'' r( ' • 2/27/04
Name and Signature of Person Prep ' g Document Date
Jon Sewell __ 2 _ Z7 _
Name and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Posposal
for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2003-
2004 to Program Fund year 2004-2005.
Indicate No Change from FY 2003-2004
_ Project Description x
Target/Eligibility Populations x
Types of services Provided x
Measurable Outcomes x
Service Objectives x
Workload Standards x
Staff Qualifications x
XUnit of Service Rate Computation
Program Capacity per'Month x
_ Certificate of Insurance x
Provider Number for State Child Care Licensing We are licensed by JC.AHO.Division of Mental Health and
A DAD as a Partial Hospitalization Program.This level of care
is considered more intensive than day treatment so we do not
possess a license for this less intensive treatment modality.
Page 25 of 31
Off-System Bid B001-04 (RFP-FYC-04006) Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD Supervisor:
/
r+vF�s s ? `!EgQS l ay
69-‘,„/"A • ,4 ) [�ls/ �j/ 3 /r7 "2-3-;
/
;el z/��y
Name and Signature of Su .sor Date
•
Page 26 of 31
I ,
Off-System Bid B001-04 (RFP-FYC-04006) Attached A
Program Category Day Treatment Program Bid Category
Project Title Youth Passages
Vendor NCMC
Please list your provider number as given to you from the State Child Care Licensing s e e note on p . 2; Of 3
PROJECT DESCRIPTION
Provide a brief one-page description of the project.
II. TARGET/ELIGIBILITY POPULATIONS
Provide a one page brief description of the proposed target/eligibility populations. At a minimum
your description must address:
A. Total number of clients to be served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. The monthly maximum program capacity.
G. The monthly average capacity.
H. Average stay in the program(weeks).
I. Average hours per week in the program.
III. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Please address if your project
will provide the service minimums as follows:
A. Site based services (The Bidder must state that a minimum of site based services of 5 hours
per day, ages eight through twenty-one (21) and two and one-fourth hours minimum per day
for children ages three to seven) will be provided.
B. Community collaboration efforts. The Bidder must describe its community collaborative
efforts with:
1. The Department of Social Services.
2. The Department of Mental Health.
3. The Department of Education.
4. Others (Please Describe).
C. Program components. The Bidder must describe the program components of:
1. Educational
2. Therapeutic
Behavioral
4. Recreational
D. Parental/Caretaker involvement in all program components as indicated in the case plan and
as required.
Page 27 of 31
FYC PROPOSAL
1. STATEMENT OF NEED
Youth Passages Adolescent Partial Hospitalization Program has been designed to address the
multifaceted needs of adolescents experiencing significant emotional,behavioral, educational,
interpersonal, and familial problems. As such, it serves adolescents with a wide range of
psychiatric disorders and chemical dependency issues. Youth Passages can intensively treat these
adolescents while simultaneously minimizing the disruption and stigma often associated with
inpatient treatment or other restrictive settings. Youth Passages offers programming options of
day treatment (Monday through Thursday, 8:00 AM—3:30 PM and Friday 8:30 AM- 1:30 PM),
intensive outpatient (Monday through Friday 8:30 AM— 11:30 AM and in the evening on
Monday from 4:15 PM—7:00 PM,Tuesday from 6:00 PM- 8:00 PM and Wednesday from 4:15
PM -7:00 PM). Psychiatric evaluations and ongoing care are provided on a weekly basis by a
board certified child and adolescent psychiatrist. In addition, a Colorado licensed master's level
affective needs special education teacher is on staff to addresses academic and behavioral issues
in the classroom.
Until the opening of Youth Passages, adolescents needing a more intensive treatment modality
than outpatient therapy were necessarily treated outside of our community and/or separated from
family. Indeed, in order to assure the adolescent's safety, they were often hospitalized because
there were no intermediate levels of care available. Youth Passages is currently the sole
community provider of medical model adolescent partial hospitalization services. Given the level
of utilization of our PAC program since June '93, Youth Passages appears to be meeting a vital
need within our community. We believe that the therapeutic scope and intensity of our program
is well suited to successfully intervene with children that are at risk for being placed outside of
their homes. By utilizing a partial orb hospitalization model specific therapeutic interventions
can be implemented with the a iry system or wish the ehildispr h.,___ le }eha dor while they-T
continue to reside at home.
Youth Passages steps children down into less intensive services as soon as they become
stabilized. Criterion of stabilization includes,but is not limited to: 1))ignificant reduction of
behavioral acting out achieving a sustained period of abstinence from drugs and alcohol®a
reduction in family conflict; and 4fja decrease of psychiatric symptoms (e.g. level of depression).
Stepping down a level of service is achieved by returning a youth to his or her home school while
continuing treatment at our facility. Examples of how we accomplish this include: 1)youth
attends school in the afternoon and Youth Passages in the morning; and 2)youth atY rids Youth
Passages all day on Monday, Wednesday and Friday and school all day on Tuesday and
Thursday. We also offer a continuing care group to successful program graduates, free of charge,
one hour per week (Tuesdays from 3:30 P.M. to 4:30 P.M.). As a new service this year, Youth
Passages has included an Intensive Outpatient Evening Program, which meets Mondays 4:15-
7:00 PM, Tuesdays 6:00-8:00 PM and Wednesdays 4:15-7:00 PM.
X 12 Mo Program •
Name of Day Treatment Project: Youth Passages Vendor: North Colorado PsychCare
Yes/No (Be Specific)
Explain How This Item Will Be Met
2.TARGET ELIGIBILITY POPULATIONS
QUANTITATIVE MEASURES
A. 96 Total number of clients to be served in the 8 youth/month for 12 months
12-month program
B. 96 Total individual clients who are ages 10 through 18;and/or All Youth Passages participants are from 10 to 18 years old
(Range is 5 years to 18 years)
C.96 Total family units as described as follows:
Immediate family and/or foster family
D. 0 Sub-total of individuals who will receive bicultural/ Youth Passages employs a bilingual therapist.The day and intensive outpatient programs
bilingual services are conducted in English while family sessions may be conducted in Spanish.
E. 0*Sub-total of individuals who will receive services in *Youth Passages does not prohibit south Weld County residents
South Weld County from attending. Daily transportation to Greeley has been
prohibitive in the past. We have worked with Weld BOCES and
RE-8 to provide transportation for 4 children in thepast year
and are hopeful this trend will continue into '03 & '04. ]— VV VbY' Y k~
F. 12 The monthly maximum program capacity
G. 7 The monthly average capacity
H. 6-10 Average stay in the program(weeks)*
I. 37.5 Average hours per week in the program for day M-F to 8:00 AM-3:30 PM
treatment
12 Average hours per week in the program for intensive Various combinations of days/evenings are possible to meet individual needs.
outpatient program
*Length of time is estimated for each program component.
Children participating in both day treatment and intensive
outpatient services will have length of stay up to 20 weeks.
2
Yes/No (Be Specific)
Explain How This Item
Will Be Met
3.TYPE OF SERVICE TO BE PROVIDED:
Will your project provide services as follows:
A.Site based services with a minimum of 5 hrs.per day? Yes M-F 8:00 a.m.-4:00 p.m.
M-F 12:00 p.m.-4:00 p.m.
B.Community collaboration efforts among:
1)The Department of Social Services? Yes 1)Continue collaboration with MD referrals from DSS.
2)The Department of Mental Health? Yes 2)Continue collaboration with MD and referrals to-from
3)The Department of Education? Yes NRBH
4)Others(Please Describe)? 3)Youth Passages provides education thru Centennial BOCES
C.Program components of:
1)Educational? Yes 1) School 5 days per week
2)Therapeutic? Yes 2)Group treatment 5 days per week
Individual therapy as indicated
Family therapy a minimum of one time per week
3)Behavioral? Yes 3)Strong milieu management daily
4)Recreational? Yes 4)Provided 3 days per week
5)Substance Abuse Programming Yes 5)Minimum of 2 days per week
D.Parental/Caretaker involvement in all program components as indicated in the
case plan and as required? Yes Required;family signs family contract to participate in
family therapy and education
E.Assessment and plan to meet the needs of child and family including:
1)Education through a certified teacher? Yes 1)On-site school
2)Vocational/Independent living for age appropriate children? No 2)N/A
3)Individual and family therapy which includes all family members? Yes 3)Family therapy a minimum of one time per week
4)Physical health needs,i.e.,nutrition, medical,dental, sex education, Yes 4)All attended by physician minimum of once per week
HIV,contraception,etc.? Nutritional consults available as needed via NCMC
Nutritionist
5)Mental health needs such as psychotropic medications,etc? Yes 5)Evaluated by physician weekly
3
Yes/No (Be Specific)
Explain How This Item
Will Be Met
3.TYPE OF SERVICE TO BE PROVIDED:(Continued)
F. Proactive planning for transition to public school setting or independent
living:
1)Reintegration into public school? Yes 1)Adolescents transitioned back into home school or viable
alternative
2)Follow-up for individual and family therapy? Yes 2)Follow-up via North Colorado PsychCare's Intensive
Outpatient Program and outpatient services or community
therapists
3)Completion of Day Treatment? Yes 3)Youth Passages will complete day treatment or intensive 2
outpatient program unless patients leave&...A.br fail to
participate appropriately in program
4)Identifies progress/outcomes? Yes 4)Identify through treatment program and case conference
5)Reinforce gains? Yes 5)Through family training,school staffings and community
referral for continued service
QUANTITATIVE MEASURES
(Relate to previous described services)
Total Number to be served up to 12 continuous months plus completion of partial
semester the child is enrolled in Please refer to program description which defines Youth
Passages'role in the community in relation to other professional
Fl. 96 Services in the county.
F2. 96
F3. 80
F4. 96
F5. 96
4
Yes/No (Be Specific)
Explain How This Item
Will Be Met
4.MEASURABLE OUTCOMES
Will your project provide the measurable outcomes as follows:
a. The children completing the Day Treatment Program will be residing in their Yes *80%will be residing in their own homes
own homes 6 months after discharge from the program.
b.The children will enter public school upon graduation from Day Treatment. Yes *80%will enter public school;20%will enter other forms of
education(ie:Homebound,home school,Aims,or work study)
Total= 100%
QUANTITATIVE MEASURES
(Relate to actual outcomes at time of discharge and to previous described
measurable outcomes) *These statistics are tracked through the utilization of PAC
Total Numbers follow-up questionnaire. Refer to 94-95 PAC Grant,page 5,
dated 1/7/94. If we do not receive appropriate information via this
3a. 77(rounded) method phone calls will be made to families and DSS caseworkers
to assess current living situation.
3b. 96
3c.Other
5
Yes/No (Be Specific)
Explain How This Item
Will Be Met
5. SERVICE OBJECTIVES
Will your project provide the service objectives as follows:
a.The number of children placed within six months of Day Treatment graduation/ Yes 20%of Youth Passages graduates may be placed in out-of-home
discharge. placement by DSS within 6 months of graduation from Youth
Passages.
b.The number of children that were enrolled in public school from graduation/ Yes 100%of children are enrolled in public school or other education
discharge from the Day Treatment Program. (ie: Homebound,workstudy,Aims).
c. Improve parents'ability to access full range of community services. 100%of parents,guardians, foster parents or residential treatment
Yes center staff members will be invited to multi-
disciplinary case conferences involving treating physician,
PsychCare staff,and home school personnel. Private therapists,
WCDSS case workers and counselors will be invited per client
circumstance.
QUANTITATIVE MEASURES
(Relate to previously described service objectives)
Total Number How will these services be measured? Utilization of PAC follow-up questionnaire. Refer to 94-95 PAC
grant,page 5,dated 1/7/94. Phone calls to families and DSS
caseworkers will be utilized to gather data if necessary.
5a. 19
5b. 96
5c. 96
nrbh
6
Yes/No
(Be Specific)
Explain How This Item
Will Be Met
6. WORKLOAD STANDARDS
Will your project be measured by:
Yes
a.Total number of children and families served. 96 youth per year and their families.
b.Duration/length of time in program. Anticipated average length of stay in treatment is 12-20 weeks.
c.Total number of hours per day/week/month Youth Passages: 8 hours per day,40 hours per week; 160
hours per month.
Intensive Outpatient Program: 4 hours per day M,W,F
12 hours per week;48 hours per month.
Outpatient Program: Individual and family therapy scheduled in
one-hour increments as needed. Group therapy scheduled in
two-hour increments as needed.
d.Total number of individuals providing these services. Five full-time staff members dedicated solely to adolescent
services with per diem therapists and staff available as
needed. MD contracted to see patients a minimum once per week.
e. Insurance See attached insurance certificate
7
Yes/No (Be Specific)
Explain How This Item
Will Be Met
7. STAFF QUALIFICATIONS
A. Will your staff who are providing direct services have the minimum qualifications Yes Personnel staffing at Youth Passages meets or exceeds standards
as enumerated in Volume VII(7.303)? enumerated in Vol. VII(7.303).
13. Total number of staff(5 full time, MD part time) 1 Teacher
available for project based on projected average daily census of 10. 2 Behavioral Health Therapists
(per diem therapists and team assistants if census dictates) 1 Behavioral Health Team Assistant
1 Behavioral Health Youth Clinical Coordinator
C.. 2 staff member to 5 children ages 5 years to 13 years
(minimum is 1 staff member to 8 children)? All participants of Youth Passages are between 10 and 18 years
old
D. 2 staff member to 6 children ages 16 years and over
(minimum is 1 staff member to 10 children)? A full census is 18 and the number of kids at each age varies
week to week. We will increase our staffing pattern per
guidelines outlined in sections c and d when census is greater than
11.
8
PROGRAM BUDGETS
PROGRAM Youth Passages Day Treatmen
A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 385
B TOTAL CLIENTS SERVED 96
C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 36,960
D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $13.85
E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $511,729
F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $184,931
G OVERHEAD COSTS ALLOCABLE TO PROGRAM $78,650
H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $775,310
I PROFITS CONTRIBUTED BY THIS PROGRAM $2,890
J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H + I) $778,199
K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 36,960
L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE
(J I K) $21.00
CERTIFICATI TE T
�� declare to the best of my knowledge and belief that the statements made on this document are true and complete and that th
and other actual unit costs supporting the compensation paid or to be paid under this contract are accurate, complete and includes no duplicate costs and
and that I am the CEO or duly authorized agent of o r:an f + 0164 nt'.a CO LarL,L, nita,o cr:,
DIRECT SERVICE COSTS
COMPUTERIZED ACTUAL
Minimum Budget Average Total %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY
Degree 0Of SslerylBane Salaries/ 100% SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND
DESCRIPTION or Celt FTEs ®1.0 FTE Benents/Other ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS
PROGRAM Youth Passages Day Treatment
A TOTAL CLIENT HOURS PER PROGRAM 385
3 TOTAL CLIENTS TO BE SERVED PER PROGRAM 98
C TOTAL HOURS PER PROGRAM FOR YEAR 36960.00 0.00 0.00 0.00 0.00 0.00
DIRECT LABOR FACE.TO.FACE POSITION.TITLE OR JOB FUNCTION
Therapist MA/MS 4.50 $58,908 $265,075.20 NO 80.00% $159,045 12 $0.00 $0.00 $0.00 $0.00 $0.00
iTawher MA/MS 2.00 $53,190 $106,360.00 NO 60.00% $63,828.00 $0.00 $0.00 50.00 50.00 $0.00
IBusiness APIGGMe HS 2.50 $29,453 $73.832.00 NO 60,00% $44,17920 $0.00 $0.00 $0.00 $0.00 $0.00
+Team Assistant HS 2.00 330,925 $61,850.88 NO 80.00% $37,110.53 $0.00 $0.00 $0.00 $0.00 $0.00
IPsytleeaist MD 0.30 3260,000 578.000,00 NO 80.00% 562,400.00 $0.00 $0.00 $0.00 $0.00 5000
(Para Professional HS 1,00 525.501 $25,501.22 NO 60.00% $15,300.73 $0.00 $0.00 $0.00 $0.00 30,00
FoodMueieonsl Assistant WA 2.50 $29,453 $73,632.00 NO 35.00% $25,771.20 $0.00 $0.00 $0.00 $0.00 $0.00
!Clinical Psychologist PHD 1,00 178,088 578,086.40 NO 80.00% 545,651.84 50.00 $0.00 $0.00 $0.00 $0.00
'Ciinical Coordinator MAIMS 1.00 585,904 585,904.00 NO 60.00% 551,542.40 $0.00 $0.00 $0.00 $0.00 $000
$0.00 NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 NO $0.00 $0.00 $0.00 50.00 $0.00 $0.00
$0.00 NO 50.00 50.00 $0.00 $0.00 $0.00 $0.00
$0.00 NO $0.00 $0.00 $0.00 $0.00 $0.00 $0,00
$0.00 NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
TOTAL DIRECT LABOR PER PROGRAM $846,081.70 $13.68 $504,829.02 $0.00 $0.00 50.00 $0.00 $0.00
OTHER DIRECT COSTS PER PROGRAM FACE-TO-FACE
Therapy Supplies $3,500.00 NO 60% $2.100.00 $0.00 50.00 $0.00 $0.00 $0.00
Educational supplies $8,000.00 NO 80% 54,800.00 $0.00 $0.00 30.00 $0.00 $0.00
NO $0.00 50.00 $0.00 $0.00 $0.00 $0.00
NO 50.00 $0.00 50.00 $0.00 $0.00 $0.00
NO $0.00 30.00 50.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 50.00 $0.00 $0.00 $0.00
TOTAL OTHER DIRECT COSTS PER PROGRAM 511.500.00 50.19 $6,900.00 $0.00 50.00 $0.00 30.00 $0.00
3 GRAND TOTAL DIRECT SERVICE COSTS 5857,581.70 513.85 $511,729.02 $0.00 $0.00 $0.00 $0.00 $0.00
ADMIN COST NON-FACE-TO-FACE
COMPUTERIZED ACTUAL
Minimum Budget Avenge Total %OF TIME SALARY Ye OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY
' Degree N0$ Salary/Bane Salaries/ 100% SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND
DESCRIPTION orCert FTEs a 1.0 FTE BeneMs/Other ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTB2ROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS
PROGRAM Youth Passages Day Treatment
A TOTAL CLIENT HOURS PER PROGRAM 385
2 TOTAL CLIENTS TO BE SERVED PER PROGRAM 98
C TOTAL HOURS PER PROGRAM FOR YEAR 38960.00 0.00 0.00 0.00 0.00 0.00
DIRECT LABOR NOT FACE-TO-FACE
Regional Director B5 1.00 $122,720 5122,720.00 NO 25.00% $30,680.00 $0.00 $0.00 $0.00 $0.00 $0.00
CIInical Services Coordinator MA 1.00 $85,904 $85,904.00 NO 55.00% $47,247.20 $0.00 $0.00 $0.00 $0.00 $0.00
Administrative Assistant HS 1.00 $44,179 $44,179.20 NO 20.00% $8,835.84 $0.00 $0.00 $0.00 $0.00 $0.00
Reimourlwmxtt Coordinator HS 1.00 $44,179 $44,179.20 NO 25.00% $11,04480 $0.00 $0.00 $0.00 $0.00 $0.00
Maintenance Technician HS 1.00 $41,725 $41,724.80 NO 26.00% $10,431.20 $0.00 50.00 $0.00 $0.00 $0.00_
ITTeMnidans B5 2.00 581,380 $122,720.00 NO 20.00% $24,544.00 $0.00 $0.00 $0.00 $0.00 $0.00
Medial Retards HS 4,00 $31,907 5127,628.80 NO 20.00% 525,525.76 $0.00 $0.00 5000 $0.00 $0.00
Director Risk Management BS 1.00 $122,720 5122,720.00 NO 3,00% $3,681.60 $0.00 $0.00 50.00 $0.00 $0.00
Asaoaare Administrator B5 1.00 $245,440 $245,440.00 NO 3,00% $7,383220 $0.00 $0.00 $0.00 $0.00 $0.00
Operations Coordinator BS 1,00 $85,904 $85,904.00 NO 3.00% $2,577.12 $0.00 $0.00 $0.00 $0.00 50.00
Haueekeepig N/A 2.00 $28,000 $52,000.00 NO 25.00% $13,000.00 $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 NO $0.00 $0.00 $0.00 5000 50,00 $0.00
$0.00 NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
TOTAL DIRECT LABOR PER PROGRAM NOT FACE-TO-FACE $1,095,120.00 $5.00 $184,930.72 $0.00 50.00 $0.00 $0.00 $0.00
OTHER DIRECT COSTS PER PROGRAM NOT FACE-TO-FACE
NO 5000 $0.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 $0.00 $000 $0.00 $0.00
NO $0.00 $0.00 $0.00 $0.00 50.00 $0.00
NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
TOTAL OTHER DIRECT COSTS NOT FACE-TO-FACE PER PROGRAM $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
F GRAND TOTAL DIRECT SERVICE COSTS NOT FACE-TO-FACE $1,095,120.00 $5.00 $184,930.72 $0.00 $0.00 $0.00 $0.00 $0.00
OVERHEAD COSTS AND PROFITS
COMPUTERIZED ACTUAL
TOTAL ALLOCATED I ALLOCATED ALLOCATED ALLOCATED i ALLOCATED I ALLOCATED 1
OVERHEAd 100% %ALLOCATED OVERHEAD COST %ALLOCATED OVERHEAD COSTS %ALLOCATED OVERHEAD COSTS %ALLOCATECOVERHEAD COSTS %ALLOCATED OVERHEAD COSTS %ALLOCATED OVERHEAD COSTS
DESCRIPTION COSTS ((ALLOCATED TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM
PROGRAM Youth Passages Day Treatment
A TOTAL CLIENT HOURS PER PROGRAM $355.00
3 TOTAL CLIENTS TO GE SERVED PER PROGRAM $98.00
C TOTAL HOURS PER PROGRAM FOR YEAR 36960.00 0.00 0.00 0.00 0.00 0.00
OVERHEAD
Utilities 387.000.00 NO 15.00% $13,050.00 $0.00 80.00 5000 $0.00 $0.00
Bldg Maintenance $10,000.00 NO 15.00% 51,500.00 $0.00 $0.00 $0.00 $0.00 $0.00
Food $77,000.00 NO 15.00% $1155000 $0.00 $0.00 $0.00 $0.00 $0.00
Housekeeping $52,000.00 NO 15.00% $7,800.00 $0.00 80.00 $000 $0.00 $0.00
Depreciation NO 15.00% $15,05000 $0.00 $0.00 $0.00 $0.00 $000
Other Operating Expenses NO 5.00% $6,20000 50.00 $0.00 $0.00 $000 $0.00
Upgrades NO 5.00% $22,500.00 $0.00 50.00 80.00 $0.00 $0.00
NO $0.00 $000 $0.00 $0.00 $0,00 $0.00
NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 S0.00 50.00 40.00 $0.00 $0.00
NO $0.00 40.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 50.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 50.00 $0.00 50.00 $0.00
NO $0.00 80.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
NO $0.00 $0.00 40.00 $000 $000 $0.00
NO $000 $0.00 80.00 $0.00 $0.00 $0.00
NO $0.00 50.00 $0.00 $0.00 $0.00 $0.00
G TOTAL OVERHEAD COSTS #k######$ $78.650.00 $000 $0.00 40.00 $0.00 $0.00
TOTAL ANTICIPATED PROFITS $10,320.00 I NO 28% $2,889.50 $0.00 $0.00 $0.00 $0.00 $0.00
TOTAL OVERHEAD AND ANTICIPATED PROFITS NOMPINNSPIO# $81,539.60 $0.00 $0.00 $0.00 $0.00 $0.00
VERIFICATION OF COVERAGE ISSUE DATE: Jan. 19, 2004
Issuer:Banner Health
This verification of coverage is issued as a matter of information only,and does not extend or alter the coverage carried by Banner Health.
COVERED PARTY COMPANIES PROVIDING COVERAGE
COMPANY
BANNER HEALTH LETTER A SAMARITAN INSURANCE FUNDING,LTD.
1441 N.12TH STREET COMPANY
PHOENIX, AZ 85006 LETTER B
COMPANY
LETTER C
COMPANY
LETTER D
COVERAGES
THIS IS TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
VERIFICATION OF COVERAGE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL.THE TERMS,EXCLUSIONS
AND CONDITIONS OF THE POLICIES OF INSURANCE CARRIED BY BANNER HEALTH.
CO
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE LIMITS
A HOSPITAL PROFESSIONAL 8 SIFL 2004 01/01/04 01/01/05 PL EACH LOSS 510,000,000
GENERAL LIABILITY GL EACH LOSS
$10,000,000
GL AGGREGATE $10,000,000
HOSPITAL PROFESSIONAL HPL EACH LOSS $
LIABILITY HPL AGGREGATE
$
HOSPITAL PROFESSIONAL HPL EACH LOSS $
LIABILITY HPL AGGREGATE $
MEDICAL PROFESSIONAL PER MEDICAL INCIDENT $
LIABILITY ANNUAL AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY LIMITS $
A AND SIFL 2004 01/01/04 01/01/05 EMPLOYER'S LIABILITY $1,000,000
EMPLOYER'S LIABILITY
COMMENTS.
BANNER HEALTH HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL CENTER.
THE INSURED ABOVE IS APPROVED BY THE INDUSTRIAL COMMISSION OF COLORADO TO SELF-INSURE WITHIN THE STATE OF COLORADO.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED OR MATERIALLY
TO WHOM IT MAY CONCERN CHANGED BEFORE THE EXPIRATION DATE.BANNER HEALTH WILL ENDEAVOR
TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER.BUT FAILURE TO
MAIL SUCH OTICE SHALL IMPOSE NO LIABILITY OF ANY KIND UPON BANNER
HEALTH.I INSURERS OR THEIR AGENTS R REPRESENTATIVES.
AUTHORI D REPRESENTATIV
ASSIGNED NO.:2004-119
G:1TammyiCERTIFICATESICERTS.200aFaulilies NCMC.xis Pagel
SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B
X RECOMMENDATIONS
X CONDITIONS
Psychcare/Family Recovery Center
North Colorado Medical Center
Banner Health System
Gloria Romansik
Weld County Department of Social Services
P.O. Box A
Greeley, CO 80632
April 13, 2004
Re: Response to Recommendation for FRP 04006
Gloria:
North Colorado Medical Center(NCMC) requires every employee to complete annual
mandatory training modules addressing diversity and discrimination. In addition,NCMC
has the most comprehensive interpretation service of any county agency with the ability
to translate information in over 20 languages. PsychCare/FRC currently employs six
bilingual staff members and financially supports the bilingual training of 3 other
employees. We will continue to actively pursue the acquisition of this skill set for all of
our staff members.
If I can be of further service in clarifying this issue please do not hesitate to contact me.
ectfully submitted,
David Rastatter
Clinical Resource Coordinator
RECEIVED BY
APR 1 3 2004
WELD UUur 1: DEPT
OF G`r.n.A n'"Ir•cr
a
DEPARTMENT OF SOCIAL SERVICES
P.O.BOX A
GREELEY,CO. 80632
Website:www.co.we►d.w.as
' Administration and Public (970)352-1551
s SSiStRUCC��970)352-6933
O
COLORADO April 7,2004
Jon Sewell Chief Executive Officer
North Colorado Medical Center
1801 16th Street
Greeley, CO 80631
•
Re: RFP 04010: Option B,Home Based Services
RFP 04006: Day Treatment
RFP 006-00: Home Studies,Relinquishment Counseling
Dear Mr. Sewell:
The purpose of this letter is to outline the results of the Bid process for PY 2004-2005 and to request
written information or confirmation from you by Wednesday, April 14,2004.
A. Results of the Bid Process for PY 2004-2005
1. The Families,Youth and Children(FYC)Commission recommended approval of the bids
listed below for inclusion on our vendor list with no recommendations.
1. RFP 04010: Option B,Home Based Services
2. RFP 006-00: Foster Parent Consultation
2. The Families,Youth and Children(FYC)Commission recommended approval of the bid,
RFP 04006,Day Treatment, for inclusion on our vendor list.The FYC Commission
attached the following recommendation regarding your bid.
Recommendation: The provider will explain in writing how their program addresses
Bilingual/cultural sensitivity.
You are requested to review the FYC Commission recommendations and to:
a. accept the recommendation(s)as written by the FYC Commission; or
b. request alternatives to the FYC Commission's recommendation(s); or
c. not accept the recommendation(s)of the FYC Commission.
Please provide in writing how you will incorporate the recommendations)into your bid. If
you do not accept the recommendation,please provide written reasons why. All approved
recommendations under the NOFAA will be monitored and evaluated by the FYC
Commission.
Page 2
North Colorado Medical Center/Results of Bid Process for PY 2004-2005
B. The Families,Youth,and Children Commission recommended the following condition be
applied to all 2004-2005 contracts.
The condition is: the provider will notify the Department of any change in staff at the time of the
change.
All conditions will be incorporated as part of your Bid and Notification of Financial Assistance
Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor
unless the FYC Commission and the Weld County Department of Social Services accept your
mitigating circumstances. If you do not accept the condition,you must provide in writing reasons
why. A meeting will be arranged to discuss your response.Your response to the above conditions
will be incorporated in the Bid and Notification of Financial Assistance Award.
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's recommendations and conditions.Please respond in writing to Gloria Romansik,Weld
County Department of Social Services,P.O. Box A, Greeley,CO, 80632,by Wednesday,April 14,
2004,close of business.
If you have questions concerning the above,please call Gloria Romansik at 352.1551, extension 6230.
Sincerely,
44J A. tieago, ecto
cc: Juan Lopez, Chair,FYC Commission
Gloria Romansik, Social Services Administrator
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