HomeMy WebLinkAbout20031780.tiff RESOLUTION
RE: APPROVE 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 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 providers,commencing July 1,2003,and ending June 30,2004,with further terms
and conditions being as stated in said agreements, and
1) Adolescent and Family Institute
2) Alternative Youth Adventures
3) Colorado Christian Home
4) Emily Griffith Center, Inc. (ID #39212)
5) Emily Griffith Center, Inc. (ID #39212 Transition)
6) Emily Griffith Center, Inc. (ID #1512515)
7) Griffith Center (ID #49547)
8) Monarch Youth
9) Namaqua Center (ID #45142)
10) Namaqua Center (ID #100889)
11) PSI Cedar Springs Hospital, Inc.
12) Third Way Center
13) Turning Point Center for Youth (ID #45178)
14) Turning Point Center for Youth (ID #45179)
15) Turning Point Center for Youth (ID #45179 Transition)
16) Turning Point Center for Youth (ID #100441)
17) Turning Point Center for Youth (ID #100441 Transition)
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 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.
2003-1780
SS0030
(16/; SIT c ,(02(9
17 RESIDENTIAL TREATMENT CENTER AGREEMENTS
PAGE 2
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 2nd day of July, A.D., 2003, nunc pro tunc July 1, 2003.
���� BO OF COUNTY COMMISSIONERS
a����� WEL UNTY, COLORADO
ATTEST:
vid E. Long, C air
Weld County Clerk to the Board
Robert D. Malden, Pro-Tem
k to the Board EXCUSED
M. J. Geile
1861
EXCUSED
WilliaH. Jerke l l
Lorne
Glenn Vaad
Date of signature: *2.._
2003-1780
SS0030
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES 4zi3 ✓
Co
THIS AGREEMENT made this/- day of/
in,, 2003 between the Board of Weld •;F 0.
County Commissioners, sitting as the Board of S ial Services, on behalf of the Weld County is
Department of Social Services, hereinafter called "County" and Adolescent and Family Institute,
10001 W 32nd Ave, Wheat Ridge, CO 80033, 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$50.00 per day for children placed within
the Residential Treatment Center identified as Provider ID#53594. These services will
be for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
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Agreement to Purchase
RTC Services aiDD 3 —/7J'd
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation(including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 53594
Adolescent and Family Institute
10001 W 32nd Ave
Wheat Ridge CO 80033
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
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Agreement to Purchase
RTC Services
•
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
io
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ONo
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care
❑ CORE Services ❑ RTCer Care D Substance r Abuse Treatment
Ce
O Receiving Home O CPA ❑ RTC
❑ Day Treatment O Kinship Care ❑ Group Home ❑ Cty regular Foster Care
O Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender O Aggressive/Violent O Substance Abuse ❑ Truancy
o ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency y ❑ Special Medical Needs O Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School
❑ On-grounds School ❑ Day Treatment
❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-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: a� le///11.
Weld County Clerk to the Board
WELD COUNTY BOARD OF SOCIAL SERVICES,
861 p�F, ON BEHALF OF THE
'Q WELD COUNTY DEPARTMENT OF SOCIAL SE VICES
M1M1M1 ,L,
,yJ By:
eputy Cler to the oard avid E. Long,C
JUL 1 4 2003
APPROVED AS TO FORM:
CONTRACTOR
County Attorney
Adolescent and Family Institute
10001 W 32nd Ave
Wheat Ridge, CO 0033
By: r
,19
WELD COUNTY DEPARTMENT
OF SOCIAL fltor +t
SERVICES
By: ✓ Afir
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE r �
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this/1 day oc , 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Alternative Youth Adventures,
O
1236 N. Townsend, Montrose, CO 81401, 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$29.95 per day for children placed within
the Residential Treatment Center identified as Provider ID#105500. These services will
be for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services /78e
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance(food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 105500
Alternative Youth Adventures
1236 N. Townsend
Montrose CO 81401
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department(Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department(Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor,within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
•
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care O Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services O Receiving Home ❑ CPA O RTC O Cty regular Foster Care
O Day Treatment ❑ Kinship Care O Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure O Other(Explain)
Appropriate Counseling:
O Individual O Family O Group
Appropriate Treatment:
O Sex Offender O AggressiveNiolent O Substance Abuse O Truancy ❑ Victim Behavior O Depression
O Self-destructive ❑ Delinquency O Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School O Day Treatment
❑ On-grounds School O Additional Tutoring ❑ Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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: 12461/1.14/4
Weld County Clerk to the Hoard
\ ' WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE
X861 em."L , WELD COUNTY DEPARTMENT OF SOCIAL S VICES
_
<a' "P a_ i /� By: C9
\car Clerk to the Board avid E.Long,C it JUL 1 4 2003
APPROVED AS TO FORM:
CONTRACTOR
County Attome
Alternative Youth Adventures
1236 N. Townse
Montrose, CO 8 40
By: �--
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
irecto
12
Agreement to Purchase
RTC Services
contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this/ day of Qj /-i , 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social S&rvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Colorado Christian Home, 2950
Tennyson St, Denver, CO 80212-3029, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Residential Treatment Center.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. County agrees to purchase and Contractor agrees to provide Room and Board services
which are listed in this Agreement at a rate of$36.50 per day for children placed within
the Residential Treatment Center identified as Provider ID#45205. These services will
be for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase �7
RTC Services ; L'G',j / /SO
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 45205
Colorado Christian Home
2950 Tennyson St
Denver CO 80212-3029
8. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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 maybe 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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system,which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term"litigation"includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No:,PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
O In home services O Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment O Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure O Other(Explain)
Appropriate Counseling:
O Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive O Delinquency ❑ Special Medical Needs O Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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: Midid.„..4
Weld County Clerk to the Board
E La
0 WELD COUNTY BOARD OF SOCIAL SERVICES,
861ray
SL�I�.•
ON BEHALF OF THE
� WELD COUNTY DEPARTMENT OF SOCIAL SE CES
fHl
By:
eputy Clerk to the oard avid E. ong,C it JUL 1 4 2003
APPROVED AS TO FORM:
CONTRACTOR
County Atto ey
Colorado Christian Home
2950 Tennyson St
Den712307 O 802 - 2
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Direct
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this/may day of•ltaici, 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social S rvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Emily Griffith Center Inc
Colorado Springs, 14142 Denver West Pkwy, Lakewood, CO 80401-3189, 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$31.67 per day for children placed within
the Residential Treatment Center identified as Provider ID#39212. These services will
be for children who have been deemed eligible for social services under the statutes, rules
and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services 22)3-/710
, Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation(including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
, Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 39212
Emily Griffith Center Inc Colorado Springs
17 N Farragut
Colorado Springs CO 80909
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
. Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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
s
Agreement to Purchase
RTC Services
. Contract No: PY 03/04-SS-23A-RTC
Services.
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
. Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
8
Agreement to Purchase
RTC Services
, Contract No: PY 03/04-SS-23A-RTC
RCCFs and RTCs must be completed and a copy provided to the State
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department(Field Audits) for approval
within four(4)months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department(Field Audits) for approval within four(4)months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender 0 AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
. , Contract No: PY 03/04-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: �G / 11a
Weld County Clerk to the Board
WELD COUNTY BOARD OF SOCIAL SERVICES,
IE k /A ON BEHALF OF THE
`�/ WELD COUNTY DEPARTMENT OF SOCIAL SE ICES
ep a Clerk to the :oard avid E. Long, a JUL 14 niipt
D AS TO FORM:
CONTRACTOR
County Att mey
Emily Griffith Center Inc Colorado
Springs
14142 Denver West Pkwy
Lake od, C 1-3189
B . CEO
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: �G
'rector
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this/i of
ofpj y, 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services,hereinafter called "County" and Emily Griffith Center Inc, 14142
Denver West Pkwy, Lakewood, CO 80401-3189, 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$15.00 per day for children placed within
the Residential Treatment Center identified as Provider ID#39212 Transition. These
services will be for children who have been deemed eligible for social services under the
statutes, rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for an"A"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, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services ‘271Z)e9 —/`7 E)
•
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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:
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Facility ID#: 39212
Emily Griffith Colo Springs - Transition Program
17 N Farragut
Colorado Springs CO 80909
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
SECTION IV. CONTRACTOR SHALL:
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
11. Bill the County for services rendered, using the required Division of Child Welfare
s
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 and the County to
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
Department of Human Services (Attn: RTC Administrator) within 90 days after
a
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department(Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4)months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor,within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s)to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
to
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative O Cty CC Foster Care O Shelter Care
O CORE Services ❑ Receiving Home O CPA ❑ Substance regular Abuse Care
❑ Day Treatment ❑ RTC O Cty Foster Care
❑ Kinship Care O Group Home O Ind.Living
❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender O Aggressive/Violent O Substance Abuse ❑ Truancy O Victim Behavior O Depression
O Self-destructive ❑ Delinquency ❑ Special Medical Needs O Behavior Modification ❑ Anger Management
O Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School O Day Treatment
❑ On-grounds School ❑ Additional Tutoring O Independent Living Training
❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is In need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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: Midi-
tr l�'��` Weld County Clerk to thard
Las
O _„x WELD COUNTY BOARD OF SOCIAL SERVICES,
61 ( ,01 L ON BEHALF OF THE
�i WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
`4%. I C By:
eputy Clerk to a Board avid .Long,C JUL 1 4 2003
APPROVED AS TO F
CONTRACTOR
County tt rney
Emily Griffith Center Inc
14142 Denver West Pkwy
Lake ood, CO 0 1-3189
B • ( e
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
4!ctQ
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this f 4 day ofJ/,tec , 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Emily Griffith Center Inc, 14142
Denver West Pkwy, Lakewood, CO 80401-3189, 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$41.36 per day for children placed within
the Residential Treatment Center identified as Provider ID#1512515. These services
will be for children who have been deemed eligible for social services under the statutes,
rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services cWe)3-- /YR('
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation(including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 1512515
Emily Griffith Center- Western Academy
1252 CR 294
Rifle CO 81650
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90,regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
s
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system,which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4)months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case,which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s)to the Social Services' Director. The term"litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
O Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
O Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
O In home services O Placement with Relative ❑ Cty CC Foster Care O Shelter Care O Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home O CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment O Kinship Care O Group Home O Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender ❑ Aggressive/Violent O Substance Abuse O Truancy O Victim Behavior O Depression
❑ Self-destructive O Delinquency ❑ Special Medical Needs O Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
O Special Ed. O Public School O Day Treatment
O On-grounds School O Additional Tutoring ❑ Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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: ^GE�/�'!/�C!/
Weld County Clerk to e oard
roily
,ft\\ 1Ce Iy ` WELD COUNTY BOARD OF SOCIAL SERVICES,
,a ON BEHALF OF THE
,1 -���r%, -, WELD COUNTY DEPARTMENT OF SOCIAL SERV ES
861
ry Aesppi _gz/ By:
`,��p IN � Q►' Clerk to e Board avid E. Long,Chao JUL } 4 2003
-ants OVED AS TO FORM:,
CONTRACTOR
County Attome
Emily Griffith Center Inc
14142 Denver West Pkwy
Lakew od, CO 8 -318
By: rU
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Direct()
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
a.THIS AGREEMENT made this/9 day ofjititi, 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social S rvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Griffith Center, 14142 Denver
West Pkwy, Lakewood, CO 80401-3189,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$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 State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
Agreement to Purchase
RTC Services OO3—/CidDO
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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 maybe
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15`h and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
e
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department(Field Audits) for approval
within four(4)months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department(Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five(5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term"litigation"includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
io
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
O Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes ❑No
Number of times per week expected for visits? O
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care O Shelter Care
ment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ Substance r Abuse Care
❑ Day Treatment O Kinship Care O Group Home O RTC O Cty regular Foster Care
O Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
O Sex Offender ❑ Aggressive/Violent O Substance Abuse O Truancy
❑ Self-destructive ElDelin Delinquency O Victim Behavior O Depression
q y O Special Medical Needs O Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School O Day Treatment
O On-grounds School ❑ Additional Tutoring O Independent Living Training
❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year firstabove written.
ATTEST: �M�/��!/!/GU• S
Weld County Clerk to the oard
WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE
1861
,e � WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
��
By:
J fib i. Clerk to the Board avid E.Long,C a' JUL 1 4 200?
APPROVED AS TO F •
CONTRACTOR
only Attom y
Griffith Center
14142 Denver West Pkwy
Lakew od, CO 4 1-3189
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
'rector
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this Mt 1 ay ofottLl'z , 2003 between the Board of Weld CO
County Commissioners, sitting as the Board of Social S rvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Monarch Youth, 2695 W
Eisenhower Blvd, Suite 208, Loveland, CO 80537-4339, 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$41.00 per day for children placed within
the Residential Treatment Center identified as Provider ID#1510165. These services
will be for children who have been deemed eligible for social services under the statutes,
rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services dLmt3- /76'd
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 1510165
Chenango Treatment Center
4075 Chenango Dr.
Colorado Springs CO 80911
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
s
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public(federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4)months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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: gat
,mar_ WelaBoard
,,\s, I . N
WELD COUNTY BOARD OF SOCIAL SERVICES,
1.61tiara'
ONBEHALFOFTHE
WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
�?�_ \ I'1 1. B
Y•
,Akira,;ilool:r putt'Clerk to the Board avid E.Long,Chair UL 1 4
APPROVED AS TO FO
CONTRACTOR
County Attome
Monarch Youth
2695 W Eisenhower Blvd, Suite 208
Loveland, CO 88'053377-4339
By: sal/J.10-
.1 -�1AIc.
WELD COUNTY DEPARTMENT r^
OF SOCIAL SERVICES
By:
hector
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this, day oft f, 2003 between the Board of Weld
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Namaqua Center, 1327 W
Eisenhower Blvd, Loveland, CO 80537, 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$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 State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services : QV'3 -J2/O&
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation(including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
s
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department(Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency El Special Medical Needs ❑ Behavior Modification ❑ Anger Management
El Other (Explain)
Appropriate Educational Services:
❑ Special Ed. El Public School ❑ Day Treatment
❑ On-grounds School O Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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 to the Board
dionsinftair
'\N, 4% WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE
a:'f�p_ . WELD COUNTY DEPARTMENT OF SOCIAL SE ICES
IB.I �1�=Y�"
• l `y Clerk t Board g
o I eavid E. Long,
,C a' JUL 14 201,
APPROVED AS TO FORM:
CONTRACTOR
o Atto ey
Namaqua Center
1327 W Eisenhower Blvd
Lov 1 , op.8 7
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
irector
12
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
THIS AGREEMENT made this/'-day ofQ,'4 , 2003 between the Board of Weld
County Commissioners, sitting as the Board of Sotiial Services, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and Namaqua Center, 1327 W
Eisenhower Blvd, Loveland, CO 80537, 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$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 State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services ca70D3 --/7C)6'
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (maybe reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
'Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
• ' Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
• ' Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term"litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
El CORE Services O Receiving Home ❑ CPA ❑ RTC El Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home El Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure El Other(Explain)
Appropriate Counseling:
El Individual ❑ Family ❑ Group
Appropriate Treatment:
El Sex Offender El AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs El Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST:
Weld County Clerk to the Board
',t\N / 2' WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE
WELD COUNTY DEPARTMENT OF SOCIAL SE VICES
1861 tb"4— _ ■
et B �^F Ai�L -e-c-, E......-.1- By:
® !►�NI Clerk to the Board David E.Long,Chi� (� � ' JUL 142003
mow" " i ED ASTOFO
CONTRACTOR
ounty Att mey
Namaqua Center
1327 W Eisenho r Blvd
Loy , C ,807
,94
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
ector
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES `c?
• /i
a
THIS AGREEMENT made this N day of jay , 2003 between the Board of Weld is
County Commissioners, sitting as the Board of So al Sbrvices, on behalf of the Weld County
Department of Social Services, hereinafter called "County" and PSI Cedar Springs Hospital, Inc.,
2135 Southgate Rd, Colorado Springs, CO 80906-2605, 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$32.88 per day for children placed within
the Residential Treatment Center identified as Provider ID#1517006. These services
will be for children who have been deemed eligible for social services under the statutes,
rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services L9003 -/7cfO
• Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
, Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 1517006
PSI Cedar Springs Hospital, Inc.
2135 Southgate Rd
Colorado Springs CO 80906-2605
8. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
9. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
s
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
. Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day,regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department(Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess,nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative O Cty CC Foster Care ❑ Shelter Care O Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living O Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. O Public School O Day Treatment
❑ On-grounds School O Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
• Contract No: PY 03/04-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: Mididital
Weld County Clerk to the Board
E t�i WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE
' 1861 WELD COUNTY DEPARTMENT OF SOCIAL SE ICES
A6
�'r_� By: t
!if y i b yty Clerk to the Board David E. ong,Cha
L 1 4 2003
APPROVED AS TO FORM:
CONTRACTOR
?atone
PSI Cedar Springs Hospital, Inc.
2135 Southgate Rd
Colorado Springs,/COO�8�0�9066/2660055
By: � ,�t►f� `'
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
irector
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
tj
AGREEMENT TO PURCHASE LA,
RESIDENTIAL TREATMENT CENTER SERVICES O a THIS AGREEMENT made this/41 day o4r ;/ , 2003 between the Board of Weld <-1/County Commissioners, sitting as the Board of S ial 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#1507881. These services
will be for children who have been deemed eligible for social services under the statutes,
rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 1507881
Third Way Center
4821 S Bannock Street
Englewood CO 80010
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
s
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions (federal, state, and local)terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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 maybe
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the l5`h and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s)to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
•
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
O Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
O Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care O Shelter Care O Substance Abuse Treatment
❑ CORE Services O Receiving Home O CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home O Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family O Group
Appropriate Treatment:
❑ Sex Offender O Aggressive/Violent O Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive O Delinquency O Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
O It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year
�first above
�,wriittttte�n..
ATTEST: J" y tedja """'
Weld County Clerk to the Board
*1E Zia WELD COUNTY BOARD OF SOCIAL SERVICES,
I ➢r ` ON BEHALF OF THE
r 1861 �a�!Ot WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
41
P 1 i eP t' Clerk to the Board David .Long,Chi jut. 1 4 2003
APPROVED AS TO FORM:
CONTRACTOR
County Attom y
Third Way Center
PO Box 61385
Denver, 06
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: Qchr
I
J
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
"5 '11 U: r0
THIS AGREEMENT made this.2O day of Lost, 2003 between the Board of Weld
County Commissioners, sitting as the 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#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 State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services ol6yD3 - /2 Sc')
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 45178
Turning Point For Drugs and Alcohol
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
s
Agreement to Purchase
RTC Services
• Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
•Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
•
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract Nd: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes LING
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care O Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services O Receiving Home O CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual O Family ❑ Group
Appropriate Treatment:
❑ Sex Offender O AggressiveNiolent O Substance Abuse ❑ Truancy O Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification ❑ Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring O Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first
4412/%4
abboovve�wrriittteen.
ATTEST: �"' '""'^/ ��h' 47
Weld County Clerk to the Board
WELD COUNTY BOARD OF SOCIAL SERVICES,
ON BEHALF OF THE
,,1 \ 1' I,a WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
1861 (.�'� :__ / _. _ !s! By:
1 ' � Jerk to the Board David E. Long,Chair a 1 4 2003
4I it's +1AS TO FO .
CONTRACTOR
ounty rney
Turning Point Center for Youth
1644 South College Ave
Fort Col ins, CO 80525
BY:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Director
12
Agreement to Purchase
RTC Services
'Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
. '1
THIS AGREEMENT made thisafi day of.jimt,2003 between the Board of Weld
County Commissioners, sitting as the 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 State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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 maybe 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
1
Agreement to Purchase
RTC Services /7Re'
'Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
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Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
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Agreement to Purchase
RTC Services
'Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
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Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
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Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the l5`h and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ONo
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care
❑ CORE Services ❑ RTC er Care ❑ Substance l r Abuse Care
❑ Receiving Home ❑ CPA O
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Cty regular Foster Care
❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
O Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑❑ Truancy Self-destructive ❑ Delinquency o ❑ Victim Behavior ❑ Depression
❑ Special Medical Needs ❑ Behavior Modification
❑ ❑ Anger Management
Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School El Day Treatment
❑ On-grounds School
❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature
City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,
month, and year'first above written.
rien
ak
ATTEST: ellaAh
Weld County Clerk to the Board
WELD COUNTY BOARD OF SOCIAL SERVICES,
IE IL &/ ON BEHALF OF THE
-.4&/ WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
r 1861
( ;.O
�® . :e e p��Clerk toBoardBy: David E.• Long, it
JUL 14 2003
D AS TO FORM:
CONTRACTOR
County ttom
Turning Point Center for Youth
1644 South College Ave
Fort Coll' s, CO 80525
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
irecb r
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
•
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
' !l: LW
THIS AGREEMENT made this aO day of_Tome, 2003 between the Board of Weld
County Commissioners, sitting as the 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$14.50 per day for children placed within
the Residential Treatment Center identified as Provider ID#45179 Transition. These
services will be for children who have been deemed eligible for social services under the
statutes, rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for an "A"Level of Care for this transition program. 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, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
1
Agreement to Purchase
RTC Services o7DO3 /2c'C)
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance(food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 45179 Transition
Turning Point Mathews St- Transition Program
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
. Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local)terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system,which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15`h and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4)months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4)months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term"litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? O Yes O No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services O Placement with Relative O Cty CC Foster Care El Shelter Care O Substance Abuse Treatment
❑ CORE services O Receiving Home O CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment El Kinship Care ❑ Group Home O Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family O Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
El Special Ed. ❑ Public School ❑ Day Treatment
El On-grounds School El Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) El Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST:
Weld County Clerk to the Board
tt\\ JE��`` WELD COUNTY BOARD OF EHALF OFSOCIAL SERVICES,
!!GG WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
'1661O
ep Clerk to e Board By: David E.Long, it
JUL 14 2003
D AS TO FORM:
CONTRACTOR
County ttorn
Turning Point Center for Youth
1644 South College Ave
Fort Coll' s, CO 80525
By: 1.
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
irect
12
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES
" S
THIS AGREEMENT made this day ofJ,,t€<2003 between the Board of Weld ,/
County Commissioners, sitting as the 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 State Vendor
Rate for the approved Level of Care. The assessment instrument used to determine the
Level of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in
the Department of Health Care policy and Finance, Staff Manual Vol. 8, Section
8.765.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30, 2004; 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
Agreement to Purchase
RTC Services ice 3 -/28O
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 be made in person-to-person communication,not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four (4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four (4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor,within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
ContractNo: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
1. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC ❑ Cty regular Foster Care
❑ Day Treatment ❑ Kinship Care O Group Home ❑ Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure O Other(Explain)
Appropriate Counseling:
❑ Individual O Family O Group
Appropriate Treatment:
❑ Sex Offender ❑ Aggressive/Violent ❑ Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification O Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training O Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes O No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first
taabove
�wriitttten.
ATTEST: �� -i"� ��'t/��'er
Weld County Clerk to the Board
\\,E La
WELD COUNTY BOARD OF SOCIAL SERVICES,
0' • ON BEHALF OF THE
7b
186? stay WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
big
dr By:
puty Clerk to e Board Davi E. Long, JUL1 4
Ul 2003
APPROVED AS TO FORM:
CONTRACTOR
ounty A orney
Turning Point Center for Youth
1644 South College Ave
Fort Collins, CO 80525
By:
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
hector
12
Agreement to Purchase
RTC Services
U0/L4/U0 UM:04 rAd MIU J40 IOM° TILL° 1/4,11 JUI. JLA,v1VLJ 114JUUL
•
Contract No: PY 03/04-SS-23A-RTC
AGREEMENT TO PURCHASE
RESIDENTIAL TREATMENT CENTER SERVICES"5 " 1 II: 4 I
THIS AGREEMENT made this.4 day of,t,fi e.,2003 between the Board of Weld
County Commissioners, sitting as the 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$14.50 per day for children placed within
the Residential Treatment Center identified as Provider ID#100441 Transition. These
services will be for children who have been deemed eligible for social services under the
statutes,rules and regulations of the State of Colorado.
2. Contractor shall be reimbursed by Medicaid for services provided to County children
placed with Contractor. Medicaid reimbursement shall be based off of the State Vendor
Rate for an"A"Level of Care. The assessment instrument used to determine the Level
of Care will be the Colorado Client Assessment Record (CCAR) as per outlined in the
Department of Health Care policy and Finance, Staff Manual Vol. 8, Section 8/65.30.
3. This Agreement shall be in force from July 1, 2003, until the end of the Colorado fiscal
year, June 30,2004; 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
a
Agreement to Purchase
RTC Services O7/O 3-/2TO
UN/Z4/UJ UU:JZ FAA M/U J4tl /W U In,LU ',,}t JUT, otNV1Lta Ic UUJ
Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance(food, shelter, clothing,personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e_ evaluation services,treatment supervision,treatment liaison,medical
services, and direct child care staff), Administration,Administrative Overhead,
Transportation (including client travel),Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 chap 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.
5. Any transportation costs to be incurred on behalf of this child that 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.
2
Agreement to Purchase
RTC Services
06/24/03 09:32 FAA 97U 346 7691 WtLDI L1Y Jul: stxvlctb WJUU4
Contract No: PY 03/04-SS-23A-RTC
7. Contractor will provide the purchased care and services at:
Facility ID#: 100441
Turning Point Youth&Family-Transition Program
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.
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 be made in person-to-person communication,not through phone mail
messages.
3. During regular work hours,the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours,weekends and
holidays,the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
U0/L4/UJ ua:o4 tAA VII) u40 IOU' 11LLU l,lr Jul, JLAvjI,LLJ 1r4Juua
Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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.
6. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition,psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further,the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
0t$/L4/UJ U9:JJ FAL 97U J4tf 7091 _. ._ACLU tax Jul. JLiV1l.LJ %1 yyy
Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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
perfomianec 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.
10. 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.
5
Agreement to Purchase
RTC Services
UO/ 4/U0 va.00 ran Div vyv ,UDC ,...... _
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appiupiiate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all app&upiiate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public(federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records,making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local)terminated for cause or default.
6
Agreement to Purchase
RTC Services
VO/LY/VJ VO.OO CA6 01V JYV _
Contract No: PY 03/04-SS-23A-RTC
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.
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 finds,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.
7
Agreement to Purchase
RTC Services
UDf & UO U0.JJ "'As Div Qv,' ,vai .. .. .... ...... ........_�_
Contract No: PT 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to,but not including,the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day,regardless of funding
source,the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system,which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
a
Agreement to Purchase
RTC Services
uu/L4/ua u8:JJ FAA. 8!u J4o "Mil WELL Llr Jul: JtKVILLS LeJU1U
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator)within 90 days after
the end of the Contractor's fiscal year..The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department(Field Audits) for approval
within four(4)months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds,the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department(Field Audits) for approval within four(4)months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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 contacts
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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess,nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor,within five(5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency,shall deliver copies of such
document(s)to the Social Services' Director. The term"litigation"includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
YU,LY/ VJ VD.0* CIA at V JYY IVOS !UAW '.l l JVV JL,nIr l,.ar.s yy VLL
Contract No: PX 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement;
1. Legal Statue of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Raman for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/gturdiattirelative involvement? O Yes 0 No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ONo
Number of times per weeklransporotion from facility/provider is expected? 0
Comments:
4. Servicem already utilized pilot to placement. (Mark appropriate box)
❑ in home services O Placement with Relative O Cty CC Foster Care 0 Shelter Care 0 Substance Abuse Treatment
❑ CORE Services O Receiving Home 0 CPA O RTC O CI), regular Foster Care
❑ Day Treatment O Kinship Care O Group Home 0 hid.Living 0 Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) 0 Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual O Family ❑ Group
/Appropriate Treatment:
0 Sex Offender O Aggrensive/Violent O Subetmce Abuse 0 Truancy O Victim Behavlot O Depression
❑ Self-destructive O Delinquency 0 Special Medical Needs O Behavior Modification 0 Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. 0 Public School O Day Treatment
❑ On-grounds School O Additianal Tutoring O Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan spuds are June 30,2004,or before
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
0 It has ban determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) O Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meat with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider JD
Greeley CO 80632 Address
City,Shur,Zip
Provider info:
(If applicable) Footer Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
A 4.4./M4,
ATTEST:
Weld County Clerk to the Board
WELD COUNTY BOARD OF SOCIAL SERVICES,
° Tic,/) ON BEHALF OF THE
`� WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
ta6I n
By: e
O. k t the Board avid E.Long,Chair L 1 203
<< PROVED AS TO FO •
CONTRACTOR
Count} k y
Turning Point Center for Youth
1644 South College Ave
Fort Co tins, CO 80525
By
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By
Dire
12
Agreement to Purchase
RTC Services
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
1 WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
VI D C MEMORANDUM
V�77ff��vvLORTO: David E. Long, Chair Date: July 7, 2003
Board of County Commissioners
/
FR: Judy A. Griego, Director, Social Services /Ott;\ ( cartn=
RE: Agreements to Purchase Residential Treatment 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 Depai lment of Social Services Operations Manual. These
Agreements were reviewed at the Board's Work Session of July 7, 2003.
The major provisions of the Agreements are as follows:
1. The term period is from July 1, 2003 through June 30, 2004.
2. The Department agrees to reimburse vendors at rates including room and board costs and
excluding Medicaid treatment costs. The rates are as follows:
Rates:
A. Adolescent and Family Institute $50.00 per day
B. Alternative Youth Adventures $29.95 per day
C. Colorado Christian Home $36.50 per day
D. Emily Griffith Center—Colorado Springs $31.67 per day
E. Emily Griffith Center—Transition Program $15.00 per day
(Colorado Springs)
F. Emily Griffith Center -Western Academy $41.36 per day
G. Emily Griffith Center—Larkspur $28.58 per day
H. Monarch Youth—Chenano Treatment Center $41.00 per day
L Namaqua Center -East 8 Street $29.89 per day
J. Namaqua Center -East 7th Street $29.89 per day
K. PSI Cedar Springs Hospital $32.88 per day
L. Third Way Center $40.00 per day
M. Turning Point Center—Drugs and Alcohol $32.20 per day
N. Turning Point Center—Mathews Street $32.20 per day
O. Turning Point Center—Mathews Street Transition $14.50 per day
P. Turning Point Center—Youth and Family $40.44 per day
Q. Turning Point Center—Youth and Family Transition $14.50 per day
If you have any questions,please contact me at extension 6510.
2003-1780
' Contract No: PY 03/04-SS-23A-RTC
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.
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:
Child Maintenance (food, shelter, clothing, personal needs 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: Direct Therapy Staff, Other
Treatment Staff(i.e. evaluation services, treatment supervision, treatment liaison, medical
services, and direct child care staff), Administration, Administrative Overhead,
Transportation (including client travel), Therapeutic Leave Days (may be reimbursed for
up to 52 therapeutic leave days per calendar year), Therapeutic Recreation and Staff, and
Community Liaison Staff.
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 that 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.
2
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
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.
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 be made in person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. 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.
3
Agreement to Purchase
RTC Services
' Contract No: PY 03/04-SS-23A-RTC
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.
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 legal status of the child, 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 three-month intervals after placement, Contractor shall provide County
with written reports which address the child's physical condition, psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen(15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
4
Agreement to Purchase
RTC Services
'Contract No: PY 03/04-SS-23A-RTC
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. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. 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.
6. Abide by the policy and procedures as outline with the State of Colorado rules in Staff
Manual Volume VII, 7.714.90, regarding the use of restraints in an emergency situation.
7. 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.
8. 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.
9. 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.
10. 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.
5
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. 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.
12. 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.
13. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at RTC level.
14. Schedule physical examinations within 14 days of placement and forward all appropriate
information to the County.
15. Schedule Dental examinations within 60 days of placement and forward all appropriate
information to the County.
16. 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.
17. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
6
Agreement to Purchase
RTC Services
. Contract No: PY 03/04-SS-23A-RTC
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.
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.
7
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
5. The Contract shall permit the Colorado Department of Social Services and the County 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 client 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. All reimbursement requests shall be submitted to and approved by the approved by the
appropriate County staff. Reimbursement for placement services shall be paid from the
date of admission up to, but not including, the day of discharge. Furthermore, Medicaid
payments for RTC treatment services are not permitted on the day of discharge and shall
not be limited to funds encumbered in this contract and shall also include Medicaid funds
for RCT treatment programs paid by the Department of Health Care Policy and
Financing. Payment for placement services will not be provided for clients on escape
status unless it has been previously approved by the County. Reimbursement requests for
treatment costs for clients enrolled in RTC programs shall be submitted to the Medicaid
Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The
Contractor shall forward copies of such billings to the County on a monthly basis.
7. In the event that a Contractor receives payment for a discharge day, regardless of funding
source, the Contractor shall refund those dollars forthwith.
8. The purpose of these requirements is to provide minimum assurance the Contractor has
adequate accounting and budgeting information available to allow management to
maintain a financially viable enterprise.
A. The Contractor must have in place a double entry accounting system, which
complies with generally accepted accounting principles (GAAP). All expenses
must be posted to the double entry accounting system. Billings for services must
be reconcilable to the double entry accounting system. The vendor must have
adequate time keeping and cost allocation systems to allocate salary cost and
indirect cost to appropriate cost centers.
B. All billing by the Contractor must be in a format approved by the Fiscal Agent or
County. The Contractor must provide all supporting documentation requested by
the Division of Youth Corrections. Contractors must bill Fiscal Agent and
County at least once a month. Contractor may bill twice a month on the 15th and
the last day of the month, for services rendered. Bills will be returned unpaid if
the bills do not conform to the approved format of the documentation is
inadequate.
C. The Contractor must have an annual audit of their financial statements by an
independent public accounting firm if the Contractor receives state funds. If the
Contractor is a government agency that has an independent audit done by another
agency of that government, their audit meets this requirement. The audits of
RCCFs and RTCs must be completed and a copy provided to the State
8
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
Department of Human Services (Attn: RTC Administrator) within 90 days after
the end of the Contractor's fiscal year. The audited financial statements must
contain supplemental statements providing detailed financial information for the
expenditures of this contract. Contractors that are subsidiary of a parent
organization must submit separate financial statements for the subsidiary that
detail each of the Contractor's facilities and/or programs that provide services for
the Department and also must reconcile with the consolidated statements of the
parent organization. In cases where audit deficiencies are noted, a plan of
corrective action shall be submitted to the Department (Field Audits) for approval
within four(4) months of the date of the audit.
D. If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment until the audit and/or requested information is
submitted.
E. If the Contractor is a sub recipient of federal funds, the Contractor is responsible
for complying with all appropriate federal requirements for an adequate
accounting system, audits, reporting and financial management. In cases where
audit deficiencies are noted, a plan of corrective action shall be submitted to the
Department (Field Audits) for approval within four(4) months of the date of the
audit.
F. Failure to comply with any of these requirements is justification for the County to
cancel the contract.
9. 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.
10. 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.
9
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
11. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care that did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
12. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
13. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s)to the Social Services' Director. The term "litigation"includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
10
Agreement to Purchase
RTC Services
Contract No: PY 03/04-SS-23A-RTC
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR RTC SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? ❑ Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services 0 Placement with Relative ❑ Cty CC Foster Care ❑ Shelter Care ❑ Substance Abuse Treatment
❑ CORE Services ❑ Receiving Home ❑ CPA ❑ RTC 0 Cty regular Foster Care
❑ Day Treatment 0 Kinship Care ❑ Group Home 0 Ind.Living ❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) ❑ Secure 0 Other(Explain)
Appropriate Counseling:
❑ Individual 0 Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent 0 Substance Abuse ❑ Truancy ❑ Victim Behavior ❑ Depression
❑ Self-destructive ❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification 0 Anger Management
❑ Other (Explain)
Appropriate Educational Services:
❑ Special Ed. ❑ Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
11
Agreement to Purchase
RTC Services
Contract No: PY 03/04-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°' "^�"�f ��'I/�U. j
Weld County Clerk to the Board
sti\\ I / WELD COUNTYBOARD
OF THE SOCIAL SERVICES,
ON BEHALF
_ WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
1861 (' 4
, 4.e
� . :yam By:
,
g NviiiitClerk to e Board David E.Long,ChiJUL 142003
If
114.
` 1 • 1 ED AS TO FORM:
CONTRACTOR
ounty Atto ey
Turning Point Center for Youth
1644 South College Ave
Fort Co ins, CO 80525
By: T-
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By.
Direc r
12
Agreement to Purchase
RTC Services
•
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
' GREELEY,CO 80632
WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
C
j� �/'� MEMORANDUM
(
_°�R(ADOTO: David E. Long, Chair Date: July 7, 2003
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services ,CA{Lt
RE: Agreements to Purchase Residential Treatment Center(RTC) Services
Between Weld County Department of Social Services with Various •
Vendors
Enclosed for Board approval are Agreements to Purchase Residential Treatment Center(RTC)
Services between the Weld County Department of Social Services with various vendors. These
yearly Agreements are in accordance with Board approved policies of Sections 2.320 and
2.902.22 of the Weld County Department of Social Services Operations Manual. These
Agreements were reviewed at the Board's Work Session of July 7, 2003.
The major provisions of the Agreements are as follows:
1. The term period is from July 1, 2003 through June 30, 2004.
2. The Department agrees to reimburse vendors at rates including room and board costs and
excluding Medicaid treatment costs. The rates are as follows:
Rates:
A. Adolescent and Family Institute $50.00 per day
B. Alternative Youth Adventures $29.95 per day
C. Colorado Christian Home $36.50 per day
D. Emily Griffith Center—Colorado Springs $31.67 per day
E. Emily Griffith Center—Transition Program $15.00 per day
(Colorado Springs)
F. Emily Griffith Center -Western Academy $41.36 per day
G. Emily Griffith Center—Larkspur $28.58 per day
H. Monarch Youth—Chenango Treatment Center $41.00 per day
I. Namaqua Center -East 8`s Street $29.89 per day
J. Namaqua Center -East 7th Street $29.89 per day
K. PSI Cedar Springs Hospital $32.88 per day
L. Third Way Center $40.00 per day
M. Turning Point Center—Drugs and Alcohol $32.20 per day
N. Turning Point Center—Mathews Street $32.20 per day
O. Turning Point Center—Mathews Street Transition $14.50 per day
P. Turning Point Center—Youth and Family $40.44 per day
Q. Turning Point Center—Youth and Family Transition $14.50 per day
If you have any questions,please contact me at extension 6510.
2003-1780
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