HomeMy WebLinkAbout20031064.tiff RESOLUTION
RE: APPROVE FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR
VARIOUS PROGRAMS AND AUTHORIZE CHAIR TO SIGN - NORTH COLORADO
MEDICAL CENTER, YOUTH PASSAGES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with four Notification of Financial Assistance
Awards between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and North
Colorado Medical Center, Youth Passages, commencing June 1, 2003, and ending May 31,
2004, with further terms and conditions being as stated in said awards for the following
programs:
1) Option B - Home Based Services
2) Mediation and Facilitation under the Intensive Family Therapy Program
Area
3) Day Treatment Program
4) Life Skills, and
WHEREAS, after review, the Board deems it advisable to approve said awards, 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 four Notification of
Financial Assistance Awards for the above listed programs between the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of
the Department of Social Services, and North Colorado Medical Center, Youth Passages, be,
and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said awards.
2003-1064
SS0030
FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS - NORTH COLORADO
MEDICAL CENTER, YOUTH PASSAGES
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 30th day of April, A.D., 2003.
BOARD OF COUNTY COMMISSIONERS
WEL OUNTY, COLORADO
ATTEST: gitski
vid E. Lo , Chair
Weld County Clerk to B acrd '
`� , R bert D asden, Pro-Tem
BY: / 3� �►I
Deputy Clerk to the Bdara 1
M. J.
Geile
O TO M: vC 3l%-,
Willie rp H. Jerke /
ou y Atto ney
Date of signature:
575, Glenn Vaad
2003-1064
SS0030
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY03-CORE-0010
Revision (FP-FYC-03010)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2003 and North Colorado Medical Center-Youth Passages
Ending 05/31/2004 Option B-Home Based Services
1801 16 Street
Greeley, CO 80031
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
This program includes family treatment Assistance Award is based upon your Request for
interventions that provide re-parenting,problem Proposal (RFP). The RFP specifies the scope of
solving, communication skill building, and services and conditions of award. Except where it is
parent-child conflict management. Services in conflict with this NOFAA in which case the
available in the home and in the clinic-based NOFAA governs, the RFP upon which this award is
Multi Family Systems Group held each Saturday. based is an integral part of the action.
A full-time Bilingual therapist will provide Special conditions
services up to 12 hours per day,40 hours per 1) Reimbursement for the Unit of Services will be based
week. A per diem Master's Level therapist will on a hourly rate per child or per family.
be available to assist in high census periods. 2) The hourly rate will be paid for only direct face to face
Maximum concurrent caseload is 15. South contact with the child and/or family or as specified in
County services are limited to 25%of total cases the unit of cost computation.
referred. 3) Unit of service costs cannot exceed the hourly and
yearly cost per child and/or family.
4) Payments will only be remitted on cases open with,
Cost Per Unit of Service and referrals made by the Weld County Department of
Hourly Rate Per $ 67.09 Social Services.
5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by the
Unit of Service Based on Approved Plan end of the 25th calendar day following the end of the
Enclosures: month of service. The provider must submit requests
X Signed RFP: Exhibit A for payment on forms approved by Weld County
X Supplemental Narrative to RFP: Exhibit B Department of Social Services.
X Recommendation(s)
_Conditions of Approval
Approval . Progra Off cia
By By
David E. ong, Chair Jud e o,Dire t r
Board of Weld County Co sioners Wel oun epartment of Social Services
Date: -7-,30 - 2oQ3 Date: zy '03
otW -/O4054
EXHIBIT "A"
INVITATION TO BID
OFF-SYSTEM BID 02-03 RFP-FYC-03010
DATE:February 19, 2003 BID NO: RFP-FYC-03010
RETURN BID TO: Pat Persichino,Director of General Services
915 10th Street,P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-FYC-03010) for:Colorado Family Preservation Act--Home Based Intensive
Emergency Assistance Program
Deadline: March 14,2003,Friday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-
5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement
Act(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted
to run from June 1, 2003, through May 31,2004, at specific rates for different types of service. The County
will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention
Program is a family strength focused home-based services to families in crisis which are time limited,phased
in intensity, and produce positive change which protects children,prevents or ends placement, and preserves
families. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Jon Sewell
TYPE OR PRINTED SIGNATURE
VENDOR North Colorado Medical Center _
(Name) Handwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS 1801 16th Street TITLE Chief Executive Officer
Greeley, CO 80631 DATE 3/apA
PHONE# (970) 352-1056
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
/
RFP-FYC-03010 Attached A
HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
OFF-SYSTEM BID RFP-FYC-03010
NAME OF AGENCY: North Colorado Medical Center
ADDRESS: 1801 16th Street Greeley. CO 80631
PHONE 970) 352-1056
CONTACT PERSON: Pam Johnson TITLE: Reg. Dir. Behavioral Health
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention
Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity,and
produce positive change which protects children,prevents or ends placement,and preserves families.
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:'
Start June 1,2003 Start June 1, 2003
End May 31, 2004 End May 31, 2004
TITLE OF PROJECT: Youth Passages -Intensive Family Intervention Program
Pam Johnson .Ta n C iw t o iA. 11/0 3
Name and Signature of Person Preparin Document Date
Jon Sewell
�J c---------___)
— 3 -/7- 3
Name and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal
for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2002-
2003 to Program Fund year 2003-2004.
Indicate No Chance from FY 2002-2003 to 2003-2004
_ Project Description x
_ Target/Eligibility Populations x
Types of services Provided x
_ Measurable Outcomes x
Service Objectives x
Worldoad Standards x
_ Staff Qualifications x
Unit of Service Rate Computation x
_ Program Capacity per Month x
Certificate of Insurance
Assurance Statement
Date of Meeting(s)with Social Services Division Supervisor: avip3
Page 26 of 32
RFP-FYC-03010 Attached A
Comts by SSD Supervisor:
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Name and Signature of SSD Supt__AA., , ,v ervisor Date
•
Page 27 of 32
RFP-FYC-03010 Attached A
Program Category Home Based Intensive Family Intervention Program Bid Category
Project Title Home Base intensive Family Intervention Program
Vendor NCMC
PROJECT DESCRIPTION
Provide a brief one-page description of the project.
II. TARGET/ELIGIBILITY POPULATIONS
Provide a one page brief description of the proposed target/eligibility populations. At a minimum
your description must address:
A. Total number of clients to be served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. Sub-total of Individuals who will have access to 24-hour service.
G. The monthly maximum program capacity.
H. The monthly average capacity.
I. Average stay in the program (weeks).
J. Average hours per week in the program.
III. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Please address if your project
will provide the service minimums as follows:
A. Therapeutic Services -includes re-parenting, limited family therapy,problem solving,
communication skills,parent-child conflict management, etc. Duration of service is limited to
20 hours face-to-face contact per referral.
B. Concrete Services-means concentrated assistance in the development and enhancement of
parenting skills,problem solving,hands-on parenting.
C. Collateral Services -teaching families to work with other community agencies such as drug
and alcohol,health care,job training, information and referral, advocacy, etc.,use of
community support groups.
D. Crisis Intervention Services -including in-home counseling and other interventions available
on a 24-hour basis.
Provide your quantitative measures as they directly relate to each service. At a minimum, include a
number to be served in each service component. Describe your internal process to assure that FYC
resources will not supplant existing and available services in the community; e.g. mental health
capitation services, ADAD and professional services otherwise funded.
Page 28 of 32
I. PROJECT DESCRIPTION
Youth Passages has been an FYC provider for nine years. Throughout that time we have
provided high quality intensive treatment to youths experiencing significant emotional,
behavioral, psychiatric, educational, interpersonal, familial and chemical dependency
problems. Treatment modalities that we specialize in include: milieu, individual, group,
experiential, behavioral and family therapy. Our family therapy program is one of the
strengths of our service delivery system. Youth Passages staff has consistently
demonstrated the ability to develop positive relationships and facilitate growth with an
unmotivated clientele. We feel this skill base will be an asset in working with the type of
families referred for Home Based Intensive Family Intervention Program (IFIP).
The Youth Passages Home Based IFIP program will consist of 2 to 3 hours of direct
service per week per family. The therapist assigned to these cases is bilingual and
experienced in the treatment, management and life skills education for families with
chemical dependency and domestic violence issues. The intervention model will be based
on a brief therapy solution oriented model with an average length of treatment of 7 to 10
weeks.
Youth Passages Home Based IFIP will serve children and adolescents under age 18 and
their families. This program will serve new clients in our system as well as being utilized
as a step down service for our partial hospitalization and intensive outpatient program
clients. It should be noted that clients and their families can enter the Home Based
Intensive Family Intervention Program directly without having been a Youth Passages
partial hospitalization client.
An individualized intervention plan will be developed for each family to specify
appropriate and attainable goals. Input from referring agencies will be utilized in the
formulation of these plans. Youth Passages staff will communicate progress toward
treatment goals via biweekly phone reports to WCDSS caseworkers and a written
discharge summary at the end of treatment.
A clinic based adjunctive therapy program, titled Multi Family Systems Group, held
every Saturday at PsychCare from 10:00 A.M. to 1:00 P.M. is available to our home
based clients. This program offers one hour of education and two hours of group therapy
focusing on goal setting and family system interventions. Our treatment approach is
based on an integrative model that incorporates effective family system interventions
which are well known, commonly used and effective. The open enrollment multi family
group brings the experience of several families together to assist in finding effective
methods to handle family difficulties.
Families who successfully complete the Intensive Family Intervention Program are
invited to participate in North Colorado PsychCare's Family Continuing Care Group.
This free of charge service is offered on Thursdays from 6:00 pm to 8:00 pm at the
PsychCare/Family Recovery Center building.
1
X 12 Mo Program
Name of Project: Youth P � Vendor: NCMC
Yes/No (Be Specific)
Explain How This Item Will Be Met
2.TARGET ELIGIBILITY POPULATIONS
QUANTITATIVE MEASURES
A.96 Total number of clients to be served in the 12-month 8 kids/month for 12 months
program.
B.96 Total individual clients who are children under age 18 With younger children(under age 4)the parents may be the primary client
C.96 Total family units as described as follows:
Immediate family.extended family and/or foster family
D.72 Sub-total of individuals who will receive bicultural/ Youth Passages will employ one full time bilingual therapist to provide services for this
bilingual services program.
E. 24 Sub-total of individuals who will receive services in We will accept a limited percentage(25%)of cases for which we will provide services in
South Weld County the client's home in South Weld County.
F. 96 Subtotal of individuals who will have access to 24 hour PsychCare/FRC is staffed with licensed professionals 24 hours per day,365 days per
Services. year.These staff members will collect relevant case information and communicate it to
the direct service provider.
G. 15 The monthly maximum program capacity
H.8 The monthly average capacity
I. 7-10 Average stay in the program(weeks)for IFIP
J.22=3 Average hours per week in the program
2
III. TYPE OF SERVICES TO BE PROVIDED
A. Youth Passages Home Based IFIP will include family treatment interventions
which provide re-parenting, problem solving, communication skill building
and parent-child conflict management. These interventions are available not
only in the home to individual families but in our clinic based Multi Family
Systems Group which is held every Saturday at PsychCare from 10:00 AM to
1:00 PM. Families that successfully complete the program are invited to
participate in North Colorado PsychCare's Family Continuing Care Group.
This free of charge service is offered on Thursdays from 6:00 P.M. to 8:00
P.M. at the PsychCare/Family Recovery Center building.
B. Youth Passages Home Based IFIP will provide concentrated assistance in the
development and enhancement of parenting skills, problem solving and
"hands-on"parenting.
C. Youth Passages Home Based IFIP will provide education and training which
will enable families to improve their ability to access services from other
community agencies such as drug and alcohol, health care,job training,
information and referral, community support groups and client advocacy.
D. Youth Passages Home Based IFIP will include in-home counseling for
referred clients. PsychCare/FRC is staffed with licensed professionals 24
hours per, 365 days per year. These staff members will collect relevant case
information and communicate it to the direct service provider as soon as
possible.
Quantitative Measures
A. 100% of clients will receive family intervention services that include re-
parenting, problem solving, communication skill building and parent-child
conflict management.
B. 100% of clients will receive treatment services that assist in the development
and enhancement of parenting skills, problem solving and "hands-on"
parenting.
C. 100% of clients will receive collateral services which include teaching families
to work with other community agencies.
D. 100% of clients will receive in-home family intervention services and all
clients will be able to call in to speak with a licensed professional 24 hours a
day, 365 days a year. This professional will pass on the relevant information
to the assigned therapist as soon as the therapist is available.
3
North Colorado PsychCare/Family Recovery Center deals daily with patient
funding issues which include mental health capitation, ADAD and private
insurance. We will not utilize FYC funds when other payer sources are available.
IV. MEASURABLE OUTCOMES
A. 80% of children remain in the home at time the case is closed.
This will be tracked by gathering relevant information at discharge.
B. 80% of clients will demonstrate improvements in parental competency,
parent/child conflict management and household management competency
as measured by pre and post placement functional tests.
This will be measured via an approved parenting skills inventory
administered at admission and discharge.
C. 75% of children who are currently in their own homes will remain at least
12 months after the completion of Home Based Intensive Family
Intervention services.
This will be measured via FYC follow-up questionnaire administered 12
months after discharge.
D. 70% of children currently in long-term placement who are provided
reunification Home Based Intensive Family Intervention services will
return to their own home and not reenter out-of-home placement 12
months after completion of Home Based Intensive Family Intervention
services.
This will be measured via: 1) gathering relevant info at discharge; and
2)FYC follow-up family questionnaires administered 12 months after
discharge.
E. 75% of families who receive either family preservation or reunification
services will not have a substantiated abuse or neglect case 12 months
after completion of Home Based Intensive Family Intervention services.
This will be measured via a follow-up phone call to the assigned WCDSS
caseworker.
F. 75% of cases which receive either family preservation or reunification
services by Home Based Intensive Family Intervention will measure
"LOW"on the risk assessment devise at service closure.
4
This will be measured by an approved questionnaire at the time of
discharge.
V. SERVICE OBJECTIVES
A. 80% of our clients will demonstrate improved family conflict management
which will lead to decreased child maltreatment, running away and other
offenses.
This will be measured via an approved parenting skills and family
functioning inventory administered at admission and discharge.
B. 80% of our clients will demonstrate improved parental competency as
based on their capacity to provide a safe household environment for their
children. This will be accomplished during the intervention by addressing
safety issues and improving parental protection of their children.
This will be measured via an approved parenting skills inventory
administered at admission and discharge.
C. 100% of our clients will have increased their knowledge of and
ability to access other resources in the community and those
offered by the local, state and federal governments.
This will be measured via an approved parenting skills inventory
administered at admission and discharge.
VI. WORKLOAD STANDARDS
A. The person providing this service for North Colorado PsychCare will be a
fulltime bilingual therapist who will not work more than 12 hours per day,
40 hours per week, or 173 (on average)per month. One per diem Master's
Level therapist will be available to assist in high census periods.
B. Youth Passages plans on treating no more than 15 families concurrently at
its maximum capacity. Master's Level therapist(s), as specified in Section
A, will handle this caseload.
C. Maximum caseload per therapist - 15
D. The treatment modality is a systems based approach to family
interventions. The treatment philosophy is brief in nature with solution
oriented interventions. Anticipated duration of treatment is 8 to 10 weeks.
5
E. Total Number of Hours of Service -
1-3 hours per day of home based family treatment (on days clients are
seen)
2-3 hours per week of family treatment
6 - 12 hours per month of family treatment
F. Total number of individuals providing these services-
1 fulltime bilingual therapist
1 per diem therapist for high census
G. Maximum caseload per supervisor- 15
H. Insurance - See attached certificate of insurance
VII. STAFF QUALIFICATIONS
A. The Behavioral Health Therapist(s)providing services will have a
minimum of a Master's Degree in psychology, counseling, social work or
a related field and work experience treating children, adolescents and
families.
B. Two staff members will be available for the direct service phase of this
project with one additional staff member providing supervision.
Additional direct service staff is available on a per diem basis if census
dictates.
C. Youth Passages staff members will participate in mandated orientation and
training as required by NCMC. Our providers are not employees of DSS
and should not require the 12 days of training mandated for new
caseworkers. We are open to discussing orientation and short term training
for our therapists in order for them to become more familiar with DSS
rules and regulations.
D. The therapists providing services to this program will be fully trained to
cover all aspects of the Behavioral Health Therapist II position at North
Colorado Medical Center. This includes providing assessment coverage at
the Emergency Department as well as providing care to involuntary
patients on our locked psychiatric unit. A significant portion of the
training for this position includes risk assessment, involuntary treatment
and legal reporting requirements.
E. Our staff members are not employees of the State of Colorado and should
not be subject to state training requirements. As previously mentioned, our
6
therapists possess a minimum of a Master's Degree in psychology,
counseling, social work or related field. They also possess direct service
experience providing family therapy to at risk children and adolescents.
We are open to discussing an orientation period for our therapists to
become more familiar with the requirements and requests of DSS.
7
PROGRAM BUDGETS
PROGRAM Home Based Intensive EAPr Family MediaascSkills-RTC Home Integratioi
A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 20 5 20
B TOTAL CLIENTS SERVED 96 96 96
C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 1,920 480 1,920
D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $42.56 $46.40 $42.56
E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $81,710 $22,273 $81,710
F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $35,214 $9,604 $35,214
G OVERHEAD COSTS ALLOCABLE TO PROGRAM $7,600 $129 $7,600
H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $124,525 $32,006 $124,525
I PROFITS CONTRIBUTED BY THIS PROGRAM $4,400 $1,200 $4,400
J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $128,925 $33,206 $128,925
K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 1,920 480 1,920
L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE
(J/K) $67.09 $69.18 $67.15
CERTIIC ON STATEMENT
I declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wag'
and other factual unit costs supporting the compensation paid or to be paid under this contract are accurate, complete and includes no duplicate costs and
and that I am the CEO or duly authorized agent of 844.1s4 N. niX AAD-tit G w MTo crit
••1 VERIFICATION OF COVERAGE ISSUE DATE:Jan. 17, 2003
This verification or coverage:5 iS5Ue0 as a me of Ji information only,and toes not extend or altef the coverage carrier]by Issuer:Banner Health System
5 Banner Health System.
COVERED PARTY COMPANIES PROVIDING COVERAGE
I
COMPANY
BANNER HEALTH SYSTEM
1441 N. 12TH STREET L`-ER A SAMARITAN INSURANCE FUNDING.LTC.
PHOENIX, AZ 65006 ET
LTERCOMPANY
LE TER 3
COMPANY
LETTER C
COMPANY
LETTER 0
-
COVERAGES
THIS IS TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
VERIFICATION OF COVERAGE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS
AND CONDITIONS OF THE POLICIES OF INSURANCE CARRIED BY BANNER HEALTH SYSTEM.
CO
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE
LIMITS
A HOSPITAL PROFESSIONAL& SIFL 2003 01/01/03
GENERAL LIABILITY 01/01/03 PL EACH LOSS
§10.000,000
GL EACH LOSS §10.000.000 -
GL AGGREGATE $10,000,000
HOSPITAL PROFESSIONAL
LIABILITY HPL EACH LOSS S
HPL AGGREGATE $
I
HOSPITAL PROFESSIONAL
LIABILITY HPL EACH LOSS $
• HPL AGGREGATE $
MEDICAL PROFESSIONAL
LIABILITY PER MEDICAL INCIDENTS
ANNUAL AGGREGATE $
EXCESS LIABILITY
UMBRELLA FORM EACH EGE OCCURRENCE $
= OTHER THAN UMBRELLA FORM AGGREGATE $
WORKER'S COMPENSATION
AND ISTATUTCRY UNITS $
EMPLOYER'S LIABILITY EMP!DYER'S LIABILITY q
7OMMENTS.
ANNER HEALTH SYSTEM HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL
ENTER.
SRTIFICATE HOLDER CANCELL
ATION
WHOM IT MAY CONCERN [SHOULD ANY OF THE,-ECVE.:ESCRIBED POL,C:ES SE U'ANCSSL LED CR MATERIAL_,' I
I(CHANGED BEFORE'uE EXPIRATION DATE,BANNER HEALTH SYSTEM WILL ENDEAVOR I
TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTFICATE HOLDER.BUT FAILURE TO
MAIL S UCH NOTICE SHALL MPCSE NC LABILITY OF A NY KIND UPON BANNER
H . F
L. d.TS:N URERS !-' E 4 AGENTS P REPRESENTATIVES.(AUTHORIZED REPRESENTATIVE 'I/ y
Al9
;srsc raaeoes
EXHIBIT B
RECOMMENDATION(S)
Weld County Dept. of
Social Serviges
Clerical Unit
'ti, APR 17 2003
Psychcare/Family Recovery Center
North Colorado Medical Center
Banner Health Colorado
Gloria Romansik
Weld County Department of Social Services
P.O.Box A
Greeley,CO 80632 - •- -
April 16,2003
Re:Recommendations and/or Conditions for FRP 03008 and REP 03010
Dear Ms.Romansik:
RFP 03008—Mediation
Response to Recommendation:
North Colorado Medical Center agrees to the recommendation put forth by the FYC Commission in
reference to RFP 03008 which states the provider shall make efforts to train staff to meet professional
interpretation standards when interpreting during mediation sessions.The bilingual staff member assigned
to this project already meets all professional standards in this area.
RFP 03010—Option B
Response to Recommendation:
North Colorado Medical Center,as stated on p.2 section E of our bid,will provide this service to south
Weld county residents for 25%of all Option B cases.In an effort to provide cost reduction for this grant
cycle and cost containment in future years we are not able to increase this percentage.If this limit is
unacceptable to the FYC commission then NCMC wishes to: 1)re-bid the financial agreement taking into
account an acceptable percentage of south Weld county cases with this percentage being stipulated by the
FYC commission;or 2)formally withdraw our bid to provide services under RFP 03010.
Response to Condition:
North Colorado Medical Center,as stated on p.2 sections D and E of our bid,will: 1)provide bilingual
services for 75%of all Option B cases;and 2)provide services to south Weld county residents for 25%of
all Option B cases.
If you wish to discuss this issue further,please do not hesitate to contact me.
Respectfully
sub
Dive Rast5ttbr
Clinical Services Coordinator
a
DEPARTMENT OF SOCIAL SERVICES
P.O.BOX A
GREELEY,CO. 80632
' Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
COLORADO
_ April 8,2003
Jon Sewell Chief Executive Officer
North Colorado Medical Center
1801 16th Street
Greeley, CO 80631
Re: RFP 03008: Mediation and Facilitation under the Intensive Family Therapy
Program Area
RFP 03005: Lifeskills
RFP 03006: Day Treatment
Dear Mr. Sewell:
The purposes of this letter are to outline the results of the Core Service Bid process for
PY 2003-2004 and to request written information or confirmation from you by
Wednesday, April 16,2003.
A. Results of the Bid Process for PY 2003-2004
The Families, Youth and Children(FYC)Commission has reviewed the bids
according to the criteria established in the bids and provides recommendation(s)
and/or condition(s)as follows:
1. RFP 03005—Lifeskills: The FYC Commission has no recommendations or
conditions.
2. RFP 03006-Day Treatment: The FYC Commission has no
recommendations or conditions.
3. RFP 03008—Mediaton and Facilitation under the Intensive Family
Therapy Program Area. The FYC Commission has a recommendation as
follows: The provider shall make efforts to train staff in using a professional
interpretation standard when interpreting during mediations.
4. RFP 03010—Option B. The FYC Commission has a recommendation as
follows: The provider shall make an effort to develop and/or expand
Bilingual services to the South County area during the program Year. The
FYC has a condition as follows: The provider shall identify Bilingual and
South County services provided through their bid.
Page 2
North Colorado Medical Center/Results of Bid Process for PY 2003-2004
B. Required Response by FYC Bidders Concerning FYC Commission
Recommendations and Conditions
The Weld County Department of Social Services is requesting your written
response to the FYC Commission's recommendations and/or conditions. Please
respond in writing to Gloria Romansik, Weld County Department of Social
Services, P.O. Box A, Greeley, CO, 80632, by Wednesday,April 16, 2003, close- .-
ofbusiness..--
1. FYC Commission Recommendations:
You are requested to review the FYC Commission recommendations and
to:
a. accept the recommendation(s) as written by the FYC Commission;
or
b. request alternatives to the FYC Commission's recommendation(s);
or
c. not accept the recommendation(s) of the FYC Commission.
Please provide in writing how you will incorporate the recommendations)
into your bid. If you do not accept the recommendations, please provide
written reasons why. Your responses that are accepted by the FYC
Commission and the Weld County Department of Social Services will be
incorporated as part of your bid and Notification of Financial Assistance
Award(NpF
2. FYC Commission Conditions;
All conditions will be incorporated as part of your Bid and Notification of
Financial Assistance Award(NOFAAI If you do not accept the
condition(s), you will not be authorized as a vendor unless your mitigating
circumstances are accepted by the FYC Commission and the Weld County
Department of Social Services. If you do not accept the condition, you
must provide in writing reasons why. A meeting will be arranged to
discuss your response. Your response to the above conditions will be
incorporated in the Bid and Notification of Financial Assistance Award
OFAA.
If you wish to arrange a meeting to discuss the above conditions and/or
recommendations,please do so through Elaine Furister, 352.1551, extension 6295, and
one will be arranged prior to April 16, 2003.
Sin erely,
Ju A. ri go, Dir for
cc: Dick Palmisano, Chair, FYC Commission
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY03-CORE-0003
Revision (RFP-FYC-03008)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2003 and North Colorado Medical Center-Youth Passages
Ending 05/31/2004 Mediation and Facilitation under the Intensive Family Therapy
Program Area
1801 16th Street
Greeley, CO 80631
Computation of Awards Description
The issuance of the Notification of Financial Assistance
Unit of Service Award is based upon your Request for Proposal(RFP).
Solution-focused therapy that is designed to The RFP specifies the scope of services and conditions
resolve conflicts and disagreements within the of award. Except where it is in conflict with this
family contributing to child maltreatment, NOFAA in which case the NOFAA governs, the RFP
running away, and to the behavior constituting upon which this award is based is an integral part of the
status offenses. Goal specific services limited to action.
5 hours of therapy per referral. Services do not Special conditions
include treatment services. A full-time Bilingual
therapist provides services for this program. 1) Reimbursement for the Unit of Services will be based on
South County services limited to 75% of cases. an hourly rate per child or per family.
2) The hourly rate will be paid for only direct face to face
contact with the child and/or family, as evidenced by
Cost Per Unit of Service client-signed verification form,as specified in the unit of
costs computation.
Hourly Rate Per $69.18 3) Unit of service costs cannot exceed the hourly and yearly
cost per child and/or family.
Unit of Service Based on Approved Plan 4) Payment will only be remitted on cases open with, and
referrals made by the Weld County Department of Social
Services.
Enclosures: 5) Requests for payment must be an original submitted to
X Signed RFP:Exhibit A the Weld County Department of Social Services by the
X Supplemental Narrative to RFP: Exhibit B end of the 25th calendar day following the end of the
X Recommendation(s) month of service.The provider must submit requests for
_Conditions of Approval payment on forms approved by Weld County
Department of Social Services.
Approval . Program Official:
By By
David E. Long,Chair Judy A. 'ego, ector
Board of Weld County Co sioners Weld ty Department of Social Services
Date: 4-30 ..2a)23 Date: N/Z` I
.13
oxv3-104V
EXHIBIT "A"
s
INVITATION TO BID
OFF-SYSTEM BID 02-03 RFP-FYC 03008
DATE:February 19, 2003 BID NO: RFP-FYC-03008
RETURN BID TO: Pat Persichino,Director of General Services
915 10th Street,P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-FYC-03008) for:Colorado Family Preservation Act--Intensive Family Mediation
and Facilitation under the Intensive Family Therapy Program
Area—Emergency Assistance Program
Deadline: March 14, 2003, Friday, 10:00 a.m.
The Families, Youth, and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-
101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act
(C.R.S. 26-5.3-101). The Families, Youth, and Children Commission wishes to approve services targeted to
run from June I, 2003, through May 31, 2004, at specific rates for different types of service,the County will
authorize approved vendors and rates for services only. The Intensive Family Mediation and Facilitation
program under the Intensive Family Therapy Program area must provide for therapeutic intervention through
one or more qualified family therapists,typically with all family members,to improve family communication,
function, and relationships. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Jon Sewell
TYPED OR PRINTED SIGNATURE
VENDOR North Colorado Medical Center
(Name) Handwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS 1801 16th Street TITLE Chief Executive Officer
Greeley CO, 80631 DATE 3/1110
PHONE# (970) 352-1056
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
//.
RFP-FYC-03008 Attached A
• INTENSIVE FAMILY THERAPY MEDIATION/FACILITATION PROGRAM BID PROPOSAL
FAMILY PRESERVATION PROGRAM
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
OFF-SYSTEM BID 02-03 RFP-FYC-03008
NAME OF AGENCY: North Colorado Medical Center
ADDRESS: 1801 16th Street Greeley, CO 80631
PHONE: ( 970 ' 352-1056
CONTACT PERSON: Pam Johnson TITLE: Reg. Dir. Behavioral Health
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Mediation/Facilitation Program must
provide for solution-focused therapy through one or more qualified therapists,typically with all family members,to resolve
conflicts and disagreements within the family contributing to child maltreatment,running away, and to the behavior
constituting status offenses.
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1, 2003 Start June 1, 2003 .
End May 31,2004 End May 31, 2004
TITLE OF PROJECT: Youth Passages - Mediation Program
AMOUNT REQUESTED: $69.18/hour
Pam Johnson 2194--gg/t;,.,rt0-yc, 7/rj1Q1
Name and Signature of Person Preparing Do ent Date
Jon Sewell ) C— 9 - /1 - 3
Name and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal
for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2002-
2003 to Program Fund Year 2003-2004.
Indicate No Change from FY 2002-2003 to 2003-2004
Project Description x
Target/Eligibility Populations x
Types of services Provided x
Measurable Outcomes x
Service Objectives x
Workload Standards x
Staff Qualifications x
t.
Unit of Service Rate Computation x
Program Capacity per Month x
Certificate of Insurance
Assurance Statement
Page 26 of 32
RFP-FYC-03008 Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD Supervisor:
I,, k tfi( i11
_p
(1 (� -( tL_.i— 445-1(23-
Name and Signature of SSD Supervisor Date
Page 27 of 32
RFP-FYC-03008 Attached A
Program Category Intensive Family Mediation and Facilitation under the Intensive Family Therapy Program
Area Bid Category
Project Title Family Mediation Program
Vendor NCMC
PROJECT DESCRIPTION
Please provide a one page brief description of the project.
II. TARGET/ELIGIBILITY POPULATIONS
Please provide a one page brief description of the proposed target/eligibility populations. At a
minimum your description must address:
A. Total number of clients to be served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. Sub-total of individuals who will have access to 24-hour services.
G. The monthly maximum program capacity.
H. The monthly average capacity.
I. Average stay in the program(weeks).
J. Average hours per week in the program.
III. TYPE OF SERVICES TO BE PROVIDED
Please provide a two-page description of the types of services to be provided. Please address if your
project will provide the service minimums as follows:
A. Solution-focused therapy that is designed to resolve conflicts and disagreements within the
family contributing to child maltreatment,running away, and to the behavior constituting
status offenses. Service is goal specific and limited to five(5)hours of therapy per referral.
Services are limited to therapy services only, and do not include treatment services.
Also,provide your quantitative measures as they directly relate to each service. At a minimum,
include a number to be served in each service component. Describe your internal process to assure
that FYC resources will not supplant existing and available services in the community; e.g. mental
health capitation services, ADAD and professional services otherwise funded.
IV. MEASURABLE OUTCOMES
Pleasq provide a two-page description of your expected measurable outcomes of the project. Please
address the measurable outcomes for each area as described below:
A. Children receiving services do not go into placement.
Page 28 of 32
I. PROJECT DESCRIPTION
Youth Passages has been an FYC provider for nine years. Throughout that time we have
provided high quality intensive treatment to youths experiencing significant emotional,
behavioral, psychiatric, educational, interpersonal, familial and chemical dependency
problems. Treatment modalities that we specialize in include: milieu, individual, group,
experiential, behavioral and family therapy. Our family intervention program is one of
the strengths of our service delivery system. Youth Passages staff has consistently
demonstrated the ability to develop positive relationships and facilitate change with an
unmotivated clientele. We feel this skill base will be an asset in working with the type of
families referred for Family Mediation Program (FMP).
The Youth Passages FMP will offer services to Weld County Department of Social Services
and families court-ordered into mediation who have children and adolescents under age 18.
This service will be staffed by a minimum of one Youth Passages Master's Level Behavioral
Health Therapist II (BHT) working as a co-facilitator with the assigned WCDSS
caseworker(s). The BHT will aid the caseworker in organizing the family meetings by
making the necessary contacts with family members. An individualized intervention plan will
be developed for each family which specifies the presenting problem and numerous relevant,
appropriate and attainable solutions. Input from referring and involved community agencies
will be utilized in the formulation of these plans.
This service will focus on issues such as: 1) permanency planning for children who are
imminently going to be placed out of the home as well children who are already placed out of
the home; 2) parenting issues which must be immediately addressed in order to meet the
treatment plan established by DSS and the court so the parent's may retain or regain custody;
3) involving the extended family to define and agree upon a placement within the extended
family in lieu of a foster care placement; 4) establishing appropriate community and family
support systems so the children can remain in the home.
We will offer these services in one block of continuous time up to five hours or two separate
blocks of time on different days which will not exceed a total of five hours of direct service.
Youth Passages staff will conduct the mediation sessions at WCDSS or, if a neutral site
would be more conducive to success, we will offer services at our facility. This decision will
be made on a case by case basis with input from all parties taken into account.
1
X 12 Mo Program
Name of Project: Youth Passages FMP Vendor: North Colorado PsychCare
Yes/No (Be Specific)
Explain How This Item Will Be Met
2.TARGET ELIGIBILITY POPULATIONS
QUANTITATIVE MEASURES
A.96 Total number of clients to be served in the 12-month 8 kids/month for 12 months
program.
B.96 Total individual clients who are children under age 18 With younger children(under age 4)the parents may be the primary client
C.96 Total family units as described as follows:
Immediate family,extended family and foster family
I).72 Sub-total of individuals who will receive bicultural/ Youth Passages will employ one full time bilingual therapist to provide services for this
bilingual services program.
E. 72 Sub-total of individuals who will receive services in We will accept a limited percentage(75%)of cases for which we will provide services in
South Weld County the client's home in South Weld County.
PsychCare/FRC is staffed with licensed professionals 24 hours per day,365 days
F.96 Subtotal of individuals who will have access to per year. These staff members will collect relevant case information and communicate it
24-hour services to the direct service provider as soon as possible.
G. 15 The monthly maximum program capacity
H.8 The monthly average capacity
I. 1-2 Average stay in the program(days)for FMP
J. 5 Average hours per week in the program
2
III. TYPE OF SERVICES TO BE PROVIDED
A. Youth Passages FMP will utilize a solution-focused intervention approach
that is designed to resolve conflicts and disagreements within the family
contributing to child maltreatment, running away, and to the behavior
constituting status offenses. This service is goal specific and will not exceed
five hours of mediation per referral. It is understood that the services we will
provide are limited to "therapy services" only, and do not include "treatment
services".
Quantitative Measures
A. 100% of clients will receive a solution-focused intervention approach that is
designed to resolve conflicts and disagreements within the family contributing
to child maltreatment, running away, and to the behavior constituting status
offenses. This service is goal specific and will not exceed five hours of
mediation per referral. It is understood that the services we will provide are
limited to "therapy services" only, and do not include "treatment services".
North Colorado PsychCare/Family Recovery Center deals daily with patient
funding issues which include mental health capitation, ADAD and private
insurance. We will not utilize FYC funds when other payer sources are available.
IV. MEASURABLE OUTCOMES
A. 75% of children will not go into placement, excluding placement of the
child in the extended family.
This will be tracked by gathering relevant information at the end of
mediation.
B. 80% of clients' families will remain intact.
This will be tracked by gathering relevant information at the end of
mediation.
C. 75% of families will reunite.
This will be tracked by gathering relevant information at the end of
mediation.
D. 80% of families will demonstrate improvements in parental
competency and parent/child conflict.
This will be measured by an approved questionnaire.
3
E. 80% of clients will receive more cost efficient services through FM 13
as compared to placement of the child.
This will be measured via a follow-up phone call to the assigned WCDSS
caseworker.
F. 75% of clients will experience therapeutic outcomes which include
fundamental changes in family functioning and dynamics.
This will be measured by an approved questionnaire given at the
beginning and end of mediation
V. SERVICE OBJECTIVES
A. 80% of our clients will demonstrate improved family conflict management
which will lead to decreased child maltreatment, running away and other
offenses.
This will be measured via an approved parenting skills and family
functioning inventory administered at the beginning and end of mediation.
B. 80% of our clients will demonstrate improved parental competency as
based on their capacity to provide a safe household environment for their
children including an increased ability to maintain sound relationships.
This will be accomplished during the intervention by addressing safety,
supervision, discipline, nutrition and hygiene issues.
This will be measured via an approved parenting skills inventory
administered at the beginning and end of mediation.
C. 100% of our clients will have increased their knowledge of and
ability to access other resources in the community and those
offered by the local, state and federal governments.
This will be measured via an approved parenting skills inventory
administered at the beginning and end of mediation.
D. 100% of clients will receive services which are solution focused and
specifically address issues outlined by the Department of Social Services.
4
VI. WORKLOAD STANDARDS
A. The person providing this service for North Colorado PsychCare will be a
fulltime bilingual therapist who will not work more than 12 hours per day,
40 hours per week, or 173 (on average)per month. One per diem Master's
Level therapist will be available to assist in high census periods.
B. Youth Passages plans on treating no more than 15 families concurrently at
its maximum capacity. Master's Level therapist(s), as specified in Section
A, will handle this caseload.
C. Maximum caseload per therapist - 10
D. The treatment modality is a systems based approach to family
interventions. The treatment philosophy is focused on providing solution
oriented interventions.
E. Total Number of Hours of Service -
1-5 total hours per day of mediation services which may occur on one or
two days
F. Total number of individuals providing these services-
1 fulltime bilingual therapist
1 per diem therapist for high census
G. Maximum caseload per supervisor- 15
H. Insurance - See attached certificate of insurance
VII. STAFF QUALIFICATIONS
A. The Behavioral Health Therapist(s) providing services will have a
minimum of a Master's Degree in psychology, counseling, social work or
a related field and work experience treating children, adolescents and
families.
B. Two staff members will be available for the direct service phase of this
project with one additional staff member providing supervision.
Additional direct service staff is available on a per diem basis if census
dictates.
5
C. Youth Passages Behavioral Health Therapist II staff members possess a
minimum of a Master's Degree in psychology, counseling, social work or
related field. They also possess direct service experience providing family
therapy to at risk children and adolescents. It is an expectation of this
position that staff members will remain current in their training by
attending specialized training and workshops on a yearly basis.
D. The therapists providing services to this program will have a minimum of
eight hours of training or review of literature per year. The completion of
this requirement will be documented in their Human Resources portfolio.
E. Our staff members, as a required part of their employment with us, receive
a minimum of one hour of supervision per week by a staff member highly
skilled in all types of family interventions.
F. The clinical supervisor for this program is involved in regular training as
both an educator and student in order to keep current in state of the art
treatment modalities and their efficacy.
6
PROGRAM BUDGETS
PROGRAM Home Based Intensive EAPr Family MediaS wSkilis-RTC Home Integratioi
A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 20 5 20
B TOTAL CLIENTS SERVED 96 96 96
C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 1,920 480 1,920
D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $42.56 $46.40 $42.56
E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $81,710 $22,273 $81,710
F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $35,214 $9,604 $35,214
G OVERHEAD COSTS ALLOCABLE TO PROGRAM $7,600 $129 $7,600
H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $124,525 $32,006 $124,525
, I PROFITS CONTRIBUTED BY THIS PROGRAM $4,400 $1,200 $4,400
J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $128,925 $33,206 $128,925
K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 1,920 480 1,920
L RATE PER HOURS OR DAYS OF DIRECT, FACE-TO-FACE SERVICE
(J/K), $67.09 $69.18 $67.15
CERTIFI ATIO TATEMENT
I declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wags
and other factual unit costs supporting the compensation paid or to be paid under this contract are accurate, complete and includes no duplicate costs and
and that I am the CEO or duly authorized agent of 64.,vs4 I/,+'a /,lo-s+. G/oA.do Afro cm .
••
VERIFICATION OF COVERAGE
ISSUE DATE:Jan. 17, 2OO3
' ;This verification of coverage.s isscec as a;racier of information only,and Coes nor extend or alter;he coven carriec„
mIssuer Banner Health System
COVERED PARTY 5e �,�Eanr,er Health System.
COMPANIES PROVIDING COVERAGE
/BANNER HEALTH SYSTEM COMPANY
'1441 N. 12TH STREETLori E.R A SAMARITAN INSURANCE FUNDING.LTD.
Lt—ER 3
COMPANY
LETTER C
COMPANY
LE-ER 9
COVERAGES
THIS IS TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
IVE.RIF!CATICN OF COVERAGE MAY BE ISSUED CR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS
iANO CONDITIONS OF THE POLICIES CF INSURANCE CARRIED BY BANNER HEALTH SYSTEM.
CO
'LTR TYPE OF INSURANCE (POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE
LIMITS
A HOSPITAL PROFESSIONAL 3
GENERAL LIABILITY SIFL 2003 01/01/03
01/01/04 PL EACH LOSS
GL EACH LOSS 510.000,000
GL AGGREGATE $10900.000 310,000.000
HOSPITAL PROFESSIONAL I $
LIABILITY HPL EACH LOSS
HPL AGGREGATE S
S
HOSPITAL PROFESSIONAL I $
LIABILITY
HPL EACH LOSS 5
HAL AGGREGATE 5
MEDICAL PROFESSIONAL
LIABILITY I /
PER MEDICAL INCIDENT -
ANNUAL AGGREGATE S
S
EXCESS LIABILITY
UMBRE_I.A FORM
OTHER THAN UMBRELLA FORM EACH OCCURRENCE S
AGGREGATE S
WORKER'S COMPENSATION
'STATUTORY
ANC I O,RY LIMITS S
EMPLOYER'S LIABILITY
S
EMPLOYER'S S
E
/
.MLENTS.
NNER HEALTH SYSTEM HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL
NTER.
•
RTIFICATE HOLDER
CANCELLATION
'�HCM I7 MAY CONCERN [SH' J.. ANY n cCJE CR 2cD E NC IC ANt cC EE ORE E EXPIRATION N DATE SANK `c' Q ILL END
TO MAIL 0 DA S WRITTEN NC TICE TO c cR HEALTH ER EU WIL_EVD ENDEAVOR I
i MAIL SUCH NOTICE SHALL r, 'C HOLDER. UT BANNER TC
Hr.., c 1G L BIL c,:NV ERFE UPON TVRE n.ITS iN5U cos,Rl ,rc r
AUTHORIZED REPRESENTATIVE °°'E!J i'/EC.
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EXHIBIT B
RECOMMENDATION(S)
Weld County Dept. of
Social Services
Clerical Unit
004.2.4 APR 1 7 2003
Psychcare/Family Recovery Center
North Colorado Medical Center
Banner Health Colorado
Gloria Romansik
Weld County Department of Social Services
P.O.Box A
Greeley,CO 80632 -
April 16,2003
Re:Recommendations and/or Conditions for FRP 03008 and RFP 03010
Dear Ms.Romansik:
RFP 03008—Mediation
Response to Recommendation:
North Colorado Medical Center agrees to the recommendation put forth by the FYC Commission in
reference to RFP 03008 which states the provider shall make efforts to train staff to meet professional
interpretation standards when interpreting during mediation sessions.The bilingual staff member assigned
to this project already meets all professional standards in this area.
RFP 03010—Option B
Response to Recommendation:
North Colorado Medical Center,as stated on p.2 section E of our bid,will provide this service to south
Weld county residents for 25%of all Option B cases.In an effort to provide cost reduction for this grant
cycle and cost containment in future years we are not able to increase this percentage.If this limit is
unacceptable to the FYC commission then NCMC wishes to: 1)re-bid the financial agreement taking into
account an acceptable percentage of south Weld county cases with this percentage being stipulated by the
FYC commission;or 2)formally withdraw our bid to provide services under RFP 03010.
Response to Condition:
North Colorado Medical Center,as stated on p.2 sections D and E of our bid,will: 1)provide bilingual
services for 75%of all Option B cases;and 2)provide services to south Weld county residents for 25%of
all Option B cases.
If you wish to discuss this issue further,please do not hesitate to contact me.
Respe}tfully sub
Dave RasYa•tter
Clinical Services Coordinator
J
a
relit cf., DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY,CO.80632
1
' Website:www.co.weld.co.us,8
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
•
COLORADO
April 8, 2003
Jon Sewell Chief Executive Officer
North Colorado Medical Center
1801 16th Street
Greeley, CO 80631
Re: RFP 03008: Mediation and Facilitation under the Intensive Family Therapy
Program Area
RFP 03005: Lifeskills
RFP 03006: Day Treatment
Dear Mr. Sewell:
The purposes of this letter are to outline the results of the Core Service Bid process for
PY 2003-2004 and to request written information or confirmation from you by
Wednesday, April 16,2003.
A. Results of the Bid Process for PY 2003-2004
The Families,Youth and Children(FYC)Commission has reviewed the bids
according to the criteria established in the bids and provides recommendation(s)
and/or condition(s)as follows:
1. RFP 03005—Lifeskills: The FYC Commission has no recommendations or
conditions.
2. RFP 03006-Day Treatment: The FYC Commission has no
recommendations or conditions.
3. RFP 03008—Mediaton and Facilitation under the Intensive Family
Therapy Program Area. The FYC Commission has a recommendation as
follows: The provider shall make efforts to train staff in using a professional
interpretation standard when interpreting during mediations.
4. RFP 03010—Option B. The FYC Commission has a recommendation as
follows: The provider shall make an effort to develop and/or expand
Bilingual services to the South County area during the program year. The
FYC has a condition as follows: The provider shall identify Bilingual and
South County services provided through their bid.
Page 2
North Colorado Medical Center/Results of Bid Process for PY 2003-2004
B. Required Response by FYC Bidders Concerning FYC Commission
Recommendations and Conditions
The Weld County Department of Social Services is requesting your written
response to the FYC Commission's recommendations and/or conditions. Please
respond in writing to Gloria Romansik, Weld County Department of Social
Services, P.O. Box A, Greeley, CO, 80632,by Wednesday, April 16, 2003, close
of business.
1. FYC Commission Recommendations:
You are requested to review the FYC Commission recommendations and
to:
a. accept the recommendation(s) as written by the FYC Commission;
or
b. request alternatives to the FYC Commission's recommendation(s);
or
c. not accept the recommendation(s) of the FYC Commission.
Please provide in writing how you will incorporate the recommendation(s)
into your bid. If you do not accept the recommendations, please provide
written reasons why. Your responses that are accepted by the FYC
Commission and the Weld County Department of Social Services will be
incorporated as part of your bid and Notification of Financial Assistance
Award(NOFAA.)
2. FYC Commission Conditions:
All conditions will be incorporated as part of your Bid and Notification of
Financial Assistance Award (NOFAA). If you do not accept the
condition(s), you will not be authorized as a vendor unless your mitigating
circumstances are accepted by the FYC Commission and the Weld County
Department of Social Services. If you do not accept the condition, you
must provide in writing reasons why. A meeting will be arranged to
discuss your response. Your response to the above conditions will be
incorporated in the Bid and Notification of Financial Assistance Award
(NOFAA.)
If you wish to arrange a meeting to discuss the above conditions and/or
recommendations,please do so through Elaine Furister, 352.1551, extension 6295, and
one will be arranged prior to April 16, 2003.
Sin erely,
Ju A. ri go, Dir4 tor
cc: Dick Palmisano, Chair, FYC Commission
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY03-PAC-10000
Revision (RFP-FYC-03006)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2003 and North Colorado Medical Center-Youth Passages
Ending 05/31/2004 Day Treatment Program
1801 16th Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
Adolescent Partial Hospitalization is a program designed Award is based upon your Request for Proposal(RFP).
to address the multifaceted needs of adolescents The RFP specifies the scope of services and conditions
experiencing significant emotional,behavioral, of award. Except where it is in conflict with this
educational, interpersonal, familial problems, and NOFAA in which case the NOFAA governs, the RFP
adolescents suffering from a wide range of psychiatric upon which this award is based is an integral part of the
disorders and chemical dependency. 96 adolescents(10- action.
18 years)per year,and/or(range of 5-18 years), 8
monthly average capacity,40 hours per week, for 6-10 Special conditions
weeks. Average hours in intensive outpatient program per
week is 12. Day program is conducted in English while 1) Reimbursement for the Unit of Services will be based on
family sessions can be conducted in Spanish through a an hourly rate per child or per family.
Bilingual therapist. Transportation for South County 2) The hourly rate will be paid for only direct face to face
families provided through Weld BOCES and RE-8. contact with the child and/or family, as specified in the
unit of costs computation.
Cost Per Unit of Service 3) Unit of service costs cannot exceed the hourly and yearly
cost per child and/or family.
Hourly Rate Per Unit of Service $ 19.00 4) Payment will only be remitted on cases open with, and
referrals made by the Weld County Department of Social
Based on Approved Plan Services.
5) Requests for payment must be an original submitted to
Enclosures: the Weld County Department of Social Services by the
X Signed RFP:Exhibit A end of the 25th calendar day following the end of the
Supplemental Narrative to RFP: Exhibit B month of service.The provider must submit requests for
Recommendation(s) payment on forms approved by Weld County
Conditions of Approval Department of Social Services.
Appro s. Program Official:
By By a (/�David E. Long, Chair Judy A. 'ego,lector !_
Board of Weld County Co ssioners Weld C (Department of Social Services
Date: g-3O Date: �1/21Q3
So3-/OGV
EXHIBIT "A"
2
INVITATION TO BID
OFF SYSTEM BID 02-03 RFP-FYC 03006
DATE: February 19, 2003 BID NO: RFP-FYC-03006
RETURN BID TO: Pat Persichino,Director of General Services
915 10th Street,P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-FYC-03006) for:Colorado Family Preservation Act--Day Treatment Program
Emergency Assistance Program
Deadline: March 14,2003,Friday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of
Weld County Commissioners authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101) and
Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S.
26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to rim from
June 1, 2003, through May 31, 2004, at specific rates for different types of service,the county will authorize
approved vendors and rates for services only. The Day Treatment Program Category must provide a
comprehensive, highly structured program alternative to placement or more restrictive placement that
provides therapy and education for children. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNID IN INKY
Jon Sewell
TYPED OR PRINTED SIGNATURE
VENDOR North Colorado Medical Center
(Name) Handwritten Signature By Authorized
Officer or Agent of Vendor
ADDRESS 1801 16th Street TITLE Chief Executive Officer
Greeley, CO 80631
DATE 3II'f03
PHONE# (970) 352-1056
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
RFP-FYC-03006 Attached A
DAY TREATMENT PROGRAM BID PROPOSAL
COLORADO FAMILY PRESERVATION ACT
2003/2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
OFF-SYSTEM BID 02-03 RFP-FYC-03006
NAME OF AGENCY: North Colorado Medical Center
ADDRESS: 1801 16th Street, Greeley, CO 80631
PHONE: ( 970) 352-1056
CONTACT PERSON: Pam Johnsom TITLE: Reg Di r Rphavi nrnl Health
DESCRIPTION OF COLORADO FAMILY PRESERVATION ACT CATEGORY: The Day Treatment Program Category
must provide a comprehensive,highly structured program alternative to placement that provides therapy and education for
children.
12-Month approximate Project Dates: 12-month contract with actual time lines of:
Start June 1,2003 Start June 1, 2003
End May 31,2004 End May 31, 2004
TITLE OF PROJECT: �YouthPassages
Pam Johnson 710- �, anry 3/"J/Q
Name and Signature of Person efj paring Document Date
Jon Sewell 3--// - 3
Name and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REOUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Posposal
for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2002-
2003 to Program Fund year 2003-2004.
Indicate No Change from FY 2002-2003
Project Description x
_ Target/Eligibility Populations x
_ Types of services Provided x
Measurable Outcomes x
Service Objectives x
Workload Standards x
Staff Qualifications x
Unit of Service Rate Computation x
Program Capacity per Month x
Certificate of Insurance x
Assurance Statement x
Provider Number for State Child Care Licensing We are licensed by JCAHO,Division of Mental Health and
ADAD as a Partial Hospitalization Program.This level of cue
is considered more intensive than day treatment so we do not
possess a license far this less intensive treatment nodality.
Page 26 of 32
RFP-FYC-03006 Attached A
-- -- - 3i 03O3 _--- -- - - -- - ---- -__- __-- ---
Date of Meeting(s)with Social Services Division Supervisor: ;SUMO)
Comments by SSD Supervisor:
•
•
cid
ed./ -
Name and Signature of SSD pervis ate
e�
Page 27 of 32
RFP-FYC-03006 Attached A
Program Category Day Treatment Program Bid Category
Project Title Youth Passages
Vendor NCMC
Please list your provider number as given to you from the State Child Care Licensing 122 np, on F.3b J 3d.
I. PROJECT DESCRIPTION
Provide a brief one-page description of the project.
II. TARGET/ELIGIBILITY POPULATIONS
Provide a one page brief description of the proposed target/eligibility populations. At a minimum
your description must address:
A. Total number of clients to be served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. The monthly maximum program capacity.
G. The monthly average capacity.
H. Average stay in the program(weeks).
I. Average hours per week in the program.
III. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Please address if your project
will provide the service minimums as follows:
A. Site based services (The Bidder must state that a minimum of site based services of 5 hours
per day, ages eight through twenty-one(21)and two and one-fourth hours minimum per day
for children ages three to seven)will be provided.
B. Community collaboration efforts. The Bidder must describe its community collaborative
efforts with:
1. The Department of Social Services.
2. The Department of Mental Health.
3. The Department of Education.
4. Others (Please Describe).
C. Program components. The Bidder must describe the program components of:
1. Educational
2. Therapeutic
3. Behavioral
4. Recreational
D. Parental/Caretaker involvement in all program components as indicated in the case plan and
as required.
Page 28 of 32
FYC PROPOSAL
1. STATEMENT OF NEED
Youth Passages Adolescent Partial Hospitalization Program has been designed to address
the multifaceted needs of adolescents experiencing significant emotional, behavioral,
educational, interpersonal, and familial problems. As such, it serves adolescents
suffering from a wide range of psychiatric disorders and chemical dependency. Youth
Passages can intensively treat these adolescents while simultaneously minimizing the
disruption and stigma often associated with inpatient treatment or other restrictive
settings. Youth Passages offers programming options of day treatment (Monday through
Friday, 8:00 a.m. -4:00 p.m.), intensive outpatient (Monday through Thursday, 12:00 -
4:00 p.m.) and outpatient services (individual, group and family therapy). Psychiatric
evaluations and ongoing care are provided on a weekly basis by a board certified child
and adolescent psychiatrist. In addition, a Colorado Department of Education accredited
school program, staffed by licensed master's level affective needs special education
teachers, addresses academic and behavioral issues in the classroom.
Until the opening of Youth Passages, adolescents needing a more intensive treatment
modality than outpatient therapy were necessarily treated outside of our community
and/or separated from family. Indeed, in order to assure the adolescent's safety, they
were often hospitalized because there were no intermediate levels of care available.
Youth Passages is currently the sole community provider of medical model adolescent
partial hospitalization services. Given the level of utilization of our PAC program since
June '93, Youth Passages appears to be meeting a vital need within our community. We
believe that the therapeutic scope and intensity of our program is well suited to
successfully intervene with children that are at risk for being placed outside of their
homes. By utilizing a partial or day hospitalization model specific therapeutic
interventions can be implemented with the family system or with the child's problem
behavior while they continue to reside at home.
Youth Passages steps children down into less intensive services as soon as they become
stabilized. Criterion of stabilization includes, but is not limited to: 1) significant
reduction of behavioral acting out; 2) achieving a sustained period of abstinence from
drugs and alcohol; 3) a reduction in family conflict; and 4) a decrease of psychiatric
symptoms (e.g. level of depression). Stepping down a level of service is achieved by
returning a youth to his or her home school while continuing treatment at our facility.
Examples of how we accomplish this include: 1) youth attends school in the morning and
Youth Passages in the afternoon; and 2) youth attends Youth Passages all day on
Monday, Wednesday and Friday and school all day on Tuesday and Thursday. We also
offer a continuing care group to successful program graduates, free of charge, one hour
per week (Thursday from 4:00 P.M. to 5:00 P.M.).
X 12 Mo Program
Name of Day Treatment Project: Youth Passages Vendor: North Colorado PsychCare
Yes/No (Be Specific)
Explain How This Item Will Be Met
2.TARGET ELIGIBILITY POPULATIONS
QUANTITATIVE MEASURES
A.96 Total number of clients to be served in the 17-month 8 youth/month for 12 months
program or 12-month program.
B.96 Total individual clients who are ages 10 through 18;and/or All Youth Passages participants are ages 10 to 18 years
(Range is 5 years to 18 years)
C.96 Total family units as described as follows:
Immediate family and/or foster family
D. 0 Sub-total of individuals who will receive bicultural/ Youth Passages employs a bilingual therapist.The day program is conducted in English
bilingual services while family sessions can be conducted in Spanish.
E. 0*Sub-total of individuals who will receive services in *Youth Passages does not prohibit south Weld County residents
South Weld County from attending. Daily transportation to Greeley has been
prohibitive in the past. We have worked with Weld BOCES and
RE-8 to provide transportation for 3 children in the past year
and are hopeful this trend will continue into '03& '04.
F. 12 The monthly maximum program capacity
G. 8 The monthly average capacity
H. 6-10 Average stay in the program(weeks)
I. 40 Average hours per week in the program for day ***M-F 8:00 AM-4:00 PM
treatment***
12 Average hours per week in the program for intensive ****12:00 PM-4:00 PM three days per week
outpatient program****
2
Yes/No (Be Specific)
Explain How This Item
Will Be Met
3.TYPE OF SERVICE TO BE PROVIDED:
100%of children and families enrolled in Youth Passages will receive the following
services. We are the sole community provider of medical model partial
hospitalization services and,as such,will not supplant any existing and available
services otherwise funded.
A.Site based services with a minimum of 5 hrs.per day? M-F 8:00 a.m.-4:00 p.m.
M-F 12:00 p.m.-4:00 p.m.
B.Community collaboration efforts among:
1)The Department of Social Services? 1)Continue collaboration with MD referrals from DSS.
2)The Department of Mental Health? 2)Continue collaboration with MD and referrals to-from
3)The Department of Education? NRBH
4)Others(Please Describe)? 3)Youth Passages provides education thru Centennial BOCES
C.Program components of:
1)Educational? 1)School 5 days per week
2)Therapeutic? 2)Group treatment 5 days per week
Individual therapy as indicated
Family therapy a minimum of one time per week
3)Behavioral? 3)Strong milieu management daily
4)Recreational? 4)Provided 3 days per week
5)Substance Abuse Programming 5)Minimum of 2 days per week
D.Parental/Caretaker involvement in all program components as indicated in the Required;family signs family contract to participate in
case plan and as required? family therapy and education
E.Assessment and plan to meet the needs of child and family including:
1)Education through a certified teacher? 1)On-site school
2)VocationaUIndependent living for age appropriate children? 2)N/A
3)Individual and family therapy which includes all family members? 3)Family therapy a minimum of one time per week
4)Physical health needs,i.e.,nutrition,medical,dental,sex education, 4)All attended by physician minimum of once per week
HIV,contraception,etc.? Nutritional consults available as needed via NCMC
Nutritionist
5)Mental health needs such as psychotropic medications,etc? 5)Evaluated by physician weekly
Yes/No (Be Specific)
Explain How This Item
Will Be Met
3.TYPE OF SERVICE TO BE PROVIDED:(Continued)
F.Proactive planning for transition to public school setting or independent
living:
1)Reintegration into public school? Yes 1)Adolescents transitioned back into home school or viable
alternative
2)Follow-up for individual and family therapy? Yes 2)Follow-up via Youth Passages' Intensive Outpatient Program,
Intensive Family Therapy program and outpatient services or
community based therapists
3)Completion of Day Treatment? Yes 3)Youth Passages will complete day treatment or intensive
outpatient program unless patients leave AMA or fail to
participate appropriately in program
4)Identifies progress/outcomes? Yes 4)Identify through treatment program and case conference
5)Reinforce gains? Yes 5)Through family training,school staffings and community
referral for continued service
4.MEASURABLE OUTCOMES: Please refer to program description which defines Youth
(Relate to previous described services) Passages'role in the community in relation to other professional
Services in the county as well as expected outcomes for clients
enrolled in our services.
4.MEASURABLE OUTCOMES
Will your project provide the measurable outcomes as follows:
a. The children completing the Day Treatment Program will be residing in their Yes *80%will be residing in their own homes
own homes 6 months after discharge from the program.
*80%will enter public school;20%will enter other forms of
Yes
b.The children will enter public school upon graduation from Day Treatment. education(ie:Homebound,home school,Aims,or work study)
Total= 100%
*These statistics are tracked through the utilization of PAC
follow-up questionnaire. Refer to 94-95 PAC Grant,page 5,
dated 1/7/94. If we do not receive appropriate information via this
method phone calls will be made to families and DSS caseworkers
to assess current living situation.
Yes/No (Be Specific)
Explain How This Item
Will Be Met
5.SERVICE OBJECTIVES
Will your project provide the service objectives as follows:
a.The number of children placed within six months of Day Treatment graduation/ Yes 20%of Youth Passages graduates may be placed in out-of-home
discharge. placement by DSS within 6 months of graduation from Youth
Passages.
b.The number of children that were enrolled in public school from graduation/ Yes 100%of children are enrolled in public school or other education
discharge from the Day Treatment Program. (ie:Homebound,C.E.P.,workstudy,Aims).
c.Improve parents'ability to access full range of community services. Yes 100%of parents,guardians,foster parents or residential treatment
center staff members will be invited to multi-disciplinary case
conferences involving treating physician, PsychCare staff,and
home school personnel. Private therapists,WCDSS case workers
and counselors will be invited per client circumstance. One of the
main goals of this meeting will be to coordinate and streamline
treatment as well as foster open communication between involved
parties.
Compliance with service objective a will be accomplished via
utilization of PAC follow-up questionnaire. Refer to 94-95 PAC
grant,page 5,dated 1/7/94. Phone calls to families and DSS
caseworkers will be utilized to gather data if necessary.
Compliance with service objectives b and c will be accomplished
by closed record review.
5
Yes/No
(Be Specific)
Explain How This Item
Will Be Met
6. WORKLOAD STANDARDS
a.Total number of children and families served. 96 youth per year and their families.
b.Duration/length of time in program. Anticipated average length of stay in treatment is 12-20 weeks.
c.Total number of hours per day/week/month Youth Passages: 8 hours per day,40 hours per week; 160
hours per month.
Intensive Outpatient Program: 4 hours per day M,W,F
12 hours per week;48 hours per month.
Outpatient Program: Individual and family therapy scheduled in
one-hour increments as needed. Group therapy scheduled in two-
hour increments as needed.
d.Total number of individuals providing these services. Seven full-time staff members dedicated solely to adolescent
services with per diem therapists and staff available as
needed. MD contracted to see patients a minimum once per week.
e. Insurance See attached insurance certificate
6
Yes/No (Be Specific)
Explain How This Item
Will Be Met
7.STAFF QUALIFICATIONS
A. Will your staff who are providing direct services have the minimum Yes Personnel staffing at Youth Passages meets or exceeds standards
qualifications as enumerated in Volume VII Section 7.303.17 and Section enumerated in Vol.VII Section 7.303.17 and Section 7.000.6,Q.
7.000.6,Q,Colorado Department of Human Services?
B. Total number of staff(7 full time,MD part time) 2 Teacher
available for project based on projected average daily census of 12. 3 Behavioral Health Therapists
(per diem therapists and team assistants will be added if census dictates) 1 Behavioral Health Team Assistant
1 Behavioral Health Youth Clinical Coordinator
C.. 2 staff member to 5 children ages 5 years to 13 years All participants of Youth Passages are between 10 and 18 years
(minimum is 1 staff member to 8 children)? old
D. 2 staff member to 6 children ages 16 years and over A full census is 18 and the number of kids at each age varies
(minimum is 1 staff member to 10 children)? week to week. We will increase our staffing pattern per
guidelines outlined in sections c and d when census is greater than
11.
7
PROGRAM BUDGETS •
PROGRAM Youth Passages Day Treatmen
A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 400
B TOTAL CLIENTS SERVED 96
C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 38,400
D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $12.71
E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $488,115
F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $184,931
G OVERHEAD COSTS ALLOCABLE TO PROGRAM $58,150
H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $729,196
I PROFITS CONTRIBUTED BY THIS PROGRAM $2,890
J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $732,086
K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 38,400
L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE
(J/K)K) $19.00
CERTI ICA T6O//N STATEMENT
I declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wage
and other factual unit costs supporting the compensation paid or to be paid under this contract are accurate, complete and includes no duplicate costs and
and that I am the CEO or duly authorized agent of ,3r+MM44 N n-irk /,.I,„n, iv)at, .Tho cr4 .
•
VERIFICATION OF COVERAGE IISSUE DATE:Jan. 17, 2003
This verification of coverage.s issuec as a matter of information oniy,ant does not exterc or alter the coverage cameo by Banner Heath System.
Issuer:Banner Health System
COVERED PARTY
COMPANIES PROVIDING COVERAGE
'BANNER HEALTH SYSTEM COMPANY
1441 N. 12TH STREET LETTER A SAMARITAN INSURANCE FUNDING,LTD.
PHOENIX, AZ 85006 COMPANY
LETTER a
COMPANY
LETTER C
COMPANY
LETTER D
COVERAGES
THIS iS TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
VERIFICATION OF COVERAGE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS
AND CONDITIONS OF THE POLICIES OF INSURANCE CARRIED BY BANNER HEALTH SYSTEM.
CO
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE
LIMITS
A HOSPITAL PROFESSIONAL& SIFL 2003 01/01/03 -
GENERAL LIABILITY 01/01/04 PT_EACH LOSS
$10.000,000
GL EACH LOSS 510.000.000
•
GL AGGREGATE 310,000,000
HOSPITAL PROFESSIONAL
LIABILITY HPL EACH LOSS $
HPL AGGREGATE $
HOSPITAL PROFESSIONAL
HPL EACH LOSS $
LIABIUTY
HP!AGGREGATE $
MEDICAL PROFESSIONAL
LIABILITY PER MEDICAL INCIDENT $
ANNUAL AGGREGATE $
EXCESS LABILITY
jUMBRELLA FORM EACH OCCURRENCE $
OTHER THAN UMBRELLA FORM AGGREGATE $
WORKER'S COMPENSATION
AND
STATUTORY LIMITS $
$
EMPLOYERS LIABILITY EMPLOYER'S LIABILITY
:OMMENTS. '
ANNER HEALTH SYSTEM HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL
ENTER.
BRTIFICATE HOLDER
CANCELLATION
]WHOM IT MAY CONCERN ISHCULL ANY:CF THE ABOVE i,co •<IBED FOLISS BE CANCELLED CR MATERIAL_' I
'CHANGED BEFORE THE EXPIRATION DATE.BANNER HEALTH SYSTEM WILL ENDEAVOR T
TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER.BUT FAILURE TO
:MAIL SLICH NOTICE SHALL IMPOSE NC LABILITY CF ANY KIND UPON BANNER
II-SALMI SYSTEM.ITS INSURERS C� a GEI.I TOR� REPRESENTATIVES
;AUTHORIZED REPRESENTATIVE V f
r� 99
�_ A- ,-A-',.fi1S
":Pr5';2,facNf,e
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission (FYC)Funds
Type of Action Contract Award No.
X Initial Award 03-CORE-LS 0005
Revision (RFP-FYC-03005)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2003 and North Colorado Medical Center
Ending 05/31/2004 Life Skills
1801 16th Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Assistance Award is based upon your Request for
This program is based on a brief therapy solution Proposal (RFP). The RFP specifies the scope of
oriented model. Skills and training include; (1) services and conditions of award. Except where it is
appropriate parenting skills specific to in conflict with this NOFAA in which case the
child(ren)'s ages, (2)communication skills, (3) NOFAA governs,the RFP upon which this award is
understanding of boundaries,and(4)providing based is an integral part of the action.
education on specific issues such as addiction, Special conditions
depression, or other mental health issues. 1) Reimbursement for the Unit of Services will be based
Program capacity is 96 total family units, 15 on an hourly rate per child or per family.
monthly average capacity, 2-3 average hours per 2) The hourly rate will be paid for only direct face to face
week,average stay is 10-12 weeks. A full-time contact with the child and/or family, as evidenced by
Bilingual Therapist is employed for this program. client-signed verification form, and as specified in the
South County services are limited to 25% of unit of cost computation.
cases. 3) Unit of service costs cannot exceed the hourly and
yearly cost per child and/or family.
Cost Per Unit of Service 4) Payment will only be remitted on cases open with,and
referrals made by the Weld County Department of
Hourly Rate Per $67.15 Social Services.
5) Requests for payment must be an original submitted to
Unit of Service Based on Approved Plan the Weld County Department of Social Services by the
end of the 25th calendar day following the end of the
month of service. The provider must submit requests
Enclosures: for payment on forms approved by Weld County
X Signed RFP:Exhibit A Department of Social Services.
Supplemental Narrative to RFP: Exhibit B
_Recommendation(s)
Conditions of Approval
Approv Program Official:
By By l/v r
David E. Long, Chair Judy A e 'ego ►irector
Board of Weld County Co issioners Weld C c ty Department of Social Services
Date: 5'-30-.2003 Date: '.1/2! /15
—2OO3-/olt y
EXHIBIT "A"
i
INVITATION TO BID
OFF-SYSTEM BID 02-03 RFP-FYC 03005
DATE:February 19,2003 BID NO: RFP-FYC-03005
RETURN BID TO: Pat Persichino,Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-FYC-03005) for:Colorado Family Preservation Act--Life Skills Program
Emergency Assistance Program
Deadline: March 14,2003,Friday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of
Weld County Commissioners' authority under the Colorado Family Preservation Program Act(C.R.S. 26-5.5-
101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act
(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to
run from June 1, 2003, through May 31, 2004, at specific rates for different types of service,the county will
authorize approved vendors and rates for services only. The Life Skills Program must provide services that
focus on teaching life skills which are designed to improve household management competency, parental
competency, family conflict management and effectively accessing community resources. This program
announcement consists of five parts,as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Jon Sewell
TYPED OR PRINT D SIGNATURE
VENDOR North Colorado Medical Center ` ) �c--
(Name) Handwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS 1801 16th Street TffLE Chief Executive Officer
Greeley, CO 80631
DATE 3/1i/o
PHONE # (970) 352-1056
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
l
J
RFP-FYC-03005 Attached A
LIFE SKILLS PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2002/2003 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
OFF-SYSTEM BID 02-03 RFP-FYC-03005
NAME OF AGENCY: North Colorado Medical Center
ADDRESS: 1801 16th Street Greeley, CO 80631
PHONE: (970) 352-1056
CONTACT PERSON: Pam Johnson TITLE: Reg. Dir. Behavioral Health
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills Program Category must provide
services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household
management competency,parental competency,family conflict management,effectively accessing community resources, and
encouraging goal setting and pro-social values.
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1. 2003 Start June 1, 2003
End May 31,2004 End May 31, 3004
TITLE OF PROJECT: Youth Passage - RTC Reintegration Project
AMOUNT REQUESTED: $67.15/hour
Pam Johnson Ly r_ 3j7/al
Name'' and Signature of Person Prep'`]/�11,]in E catrhent Date
jar., Saw 2
nti J
htelY , n. 3—h 3
Name and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal
for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2002-
2003 to Program Fund year 2003-2004.
Indicate No Change from FY 2002-2003 to 2003-2004
Project Description
Target/Eligibility Populations x
Types of services Provided
Measurable Outcomes
Service Objectives x
Workload Standards x
Staff Qualifications x
Unit of Service Rate Computation x
_ Program Capacity per Month
Certificate of Insurance
Assurance Statement
Page 26 of 32
RFP-FYC-03005 Attached A
Date of Meeting(s)with Social Services Division Supervisor: :?raj/63
Comments by SSD Supervisor:
7 -7j7 %
/9e-yu/ cam. -7
„ p
c et. f
Name and Signature of SSD Supervisor Date
Page 27 of 32
RFP-FYC-03005 Attached A
Program Category Life Skills Program Bid Category
Project Title RTC REINTEGRATION PROJECT
Vendor NCMC
I. PROJECT DESCRIPTION
Provide a brief one-page description of the project.
II. TARGET/ELIGIBILITY POPULATIONS
Provide a brief one-page description of the proposed target/eligibility populations.At a minimum
your description must address:
A. Total number of clients served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. The monthly maximum program capacity.
G. The monthly average capacity.
H. Average stay in the program (weeks).
I. Average hours per week in the program.
M. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Address if your project will
provide the service minimums as follows:
A. Mentoring:
Address, at a minimum,the following ways the project will:
1. Teach,model, and coach adaptive strategies;
2. Model and influence parenting practices;
3. Teach relational skills;
4. Teach household management, including prioritizing, finances, cleaning, and leisure
activities;
5. Actively help to establish community connections and resources;
6. Encourage goal setting and pro-social values.
B. Visitation:
Address, at a minimum, the following ways the project will:
1. Monitor parent/child interactions for physical and emotional safety;
2. Document clinical observations;
3. Strategize for teaching and modeling parenting skills;
4. Teach relational skills;
5. Encourage goal setting and pro-social values;
6. Plan structured activities in visitation to help achieve the objectives of the treatment
plan.
Page 28 of 32
I. PROJECT DESCRIPTION
Youth Passages has been an FYC provider for nine years. Throughout that time we have
provided high quality intensive treatment to youths experiencing significant emotional,
behavioral, psychiatric, educational, interpersonal, familial and chemical dependency
problems. Treatment modalities that we specialize in include: milieu, individual, group,
experiential, behavioral and family therapy. Our family therapy program is one of the
strengths of our service delivery system. Youth Passages staff has consistently
demonstrated the ability to develop positive relationships and facilitate growth with an
unmotivated clientele. We feel this skill base will be an asset in working with the type of
families referred for life skills training in the Youth Passages Residential Treatment
Center Reintegration (RTCR) program.
The Youth Passages RTCR program will consist of 2 to 3 hours of direct service per
week per family with an expected total of 20 to 24 hours of service time. The intervention
model will be based on a brief therapy solution oriented model with an average length of
treatment of 10 to 12 weeks. The therapist assigned to these cases is bilingual and
experienced in the treatment, management and life skills education for families with
chemical dependency and domestic violence issues.
Youth Passages RTCR will serve children and adolescents under age 18 and their
families. An individualized intervention plan will be developed for each family to
specify appropriate and attainable goals. . The program is a psycho-educational program
for families for the purpose of stabilizing home placements. The families targeted would
be those who have a child or children at risk of being placed out of the home or for those
child(ren) returning home from other placement (i.e. Residential treatment, foster home,
group home,etc.).
The RTCR program will be divided into three phases which include:
Assessment—family information will be gathered on areas such as presenting issues,
family history, and those issues needing to be addressed in order to stabilize the home for
child(ren) returning or at risk of placement. The administration of FACES II, a family
assessment tool that assesses family interaction, communication, discipline,
connectedness, and flexibility, will be utilized to help identify the family goals to be
addressed in the skills training and education phase.
Skills training and education—The main goal of meetings in this phase will be to
stabilize home placement. The following topics will be taught and practiced during
meetings: 1) appropriate parenting skills specific to the children's ages; 2)communication
skills (e.g. positive messages, listening skills, problem-solving strategies);
3) understanding of boundaries (e.g. increasing clear and consistent rules, implementing
and enforcing appropriate consequences); and 4) providing education on specific issues
such as addiction, depression, or other mental health issues. If a child was returning home
from placement such as an RTC, the family worker would help parents interpret any
follow-up with recommendations for the child.
The meetings would initially be conducted weekly and then begin meeting
less frequently(every two or three weeks) to allow for the family to implement and
practice the skills they are learning.
Termination and discharge planning: This phase would focus on providing closure for
the family as well as assisting the family in accessing other relevant community based
services. Appropriate discharge planning will include: 1) review of goals and progress
made; 2) linking family with community resources which may include therapy,
mentoring, parent support groups, etc.); and 3) administration of the FACES II family
assessment tool to measure changes within the family.
2
X 12 Mo Program
Name of Life Skills Project: Youth Passages RTCR Vendor: NCMC
Yes/No (Be Specific)
Explain How This Item Will Be Met
2.TARGET ELIGIBILITY POPULATIONS
QUANTITATIVE MEASURES
A.96 Total number of clients to be served in the 12-month 8 kids/month for 12 months
program.
B.96 Total individual clients who are children under age 18 With younger children(under age 4)the parents may be the primary client
C.96 Total family units as described as follows:
Immediate family,extended family and/or foster family
D.72 Sub-total of individuals who will receive bicultural/ Youth Passages will employ one full time bilingual therapist to provide services for this
bilingual services program.
E. 24 Sub-total of individuals who will receive services in We will accept a limited percentage(25%)of cases for which we will provide services in
South Weld County the client's home in South Weld County.
F. 15 The monthly maximum program capacity
G. 8 The monthly average capacity
H. 10-12 Average stay in the program(weeks)for RTCR
I.2-3 Average hours per week in the program
3
III. TYPE OF SERVICES TO BE PROVIDED
A. Mentoring:
As outlined in our project description the Youth Passages RTCR will:
1) 100% of clients will receive life skills training that will teach, model
and coach adaptive strategies
2) 100% of clients will receive life skills training that will model and
influence parenting practices
3) 100% of clients will receive life skills training that will teach relational
skills
4) 100% of clients will receive life skills training that will teach
household management, including prioritizing finances, cleaning, and
leisure activities
5) 100% of clients will receive life skills training that will actively help to
establish community connections and resources
6) 100% of clients will receive life skills training that will encourage goal
setting and pro-social values
B. Visitation
While supervised visitation is not the aim or goal of this project, the Youth
Passages RTCR staff when on site with the family will:
1) 100% of the time monitor parent/child interactions for physical and
emotional safety
2) 100% of the time document clinical observations
3) 100% of the time will teach and model parenting skills
4) 100% of the time will teach relational skills
5) 100% of the time will encourage goal setting and pro-social values
6) 100% of the time will plan structured activities and interventions to
help achieve the objectives of the treatment plan
North Colorado PsychCare/Family Recovery Center deals daily with patient
funding issues which include mental health capitation, ADAD and private
insurance. We will not utilize FYC funds when other payer sources are available.
4
IV. MEASURABLE OUTCOMES
As outlined in the Project Description section we will utilize FACES II as our
pre and post test instrument to measure change in family functioning levels.
A. 80% of clients will demonstrate an improvement of household
management competency.
B. 80% of clients will demonstrate improvements in parental competency as
evidenced by increased capacity of parents to use adaptive strategies,
maintain sound relationships with their children and provide care,
nutrition, hygiene, discipline, protection, instruction and supervision.
C. 100% of our clients will have increased their knowledge of and
ability to independently access other resources in the community and those
offered by the local, state and federal governments.
D. 75% of families enrolled in the RTCR program will remain intact six
months after discharge.
This will be monitored via follow-up phone calls with families and DSS
caseworkers.
E. 80% of families/participants who complete the RTCR program will
demonstrate improved competency level or reduced risk.
V. SERVICE OBJECTIVES
Mentoring
A. 80% of clients will demonstrate an improvement of household
management competency.
This will be measured by FACES II, as referenced in project description.
B. 80% of clients will demonstrate improvements in parental competency as
evidenced by increased capacity of parents to use adaptive strategies,
maintain sound relationships with their children and provide care,
nutrition, hygiene, discipline, protection, instruction and supervision.
This will be measured by FACES II, as referenced in project description.
5
C. 100% of our clients will have increased their knowledge of and
ability to access other resources in the community and those
offered by the local, state and federal governments.
This will be measured by FACES II, as referenced in project description.
D. 80% of clients will demonstrate improved goal setting and pro-social
values.
This will be measured by FACES II, as referenced in project description.
VISITATION
While supervised visitation is not the aim or goal of this project, the Youth
Passages RTCR staff, when on site with the family, will strive to achieve
the following goals:
A. 80% of clients will demonstrate improved parenting skills, parent/child
interactions and relational skills for physical and emotional safety through
structured activities in, and documentation of, visitations to achieve the
objectives of the treatment plan.
This will be measured by FACES II, as referenced in project description
B. 80% of clients will demonstrate improved goal setting and pro-social
values.
This will be measured by FACES II, as referenced in project description.
VI. WORKLOAD STANDARDS
A. The person providing this service for North Colorado PsychCare will be a
fulltime bilingual therapist who will not work more than 12 hours per day,
40 hours per week, or 173 (on average)per month. One per diem Master's
Level therapist will be available to assist in high census periods.
B. Youth Passages plans on treating no more than 15 families concurrently at
its maximum capacity. Master's Level therapist(s), as specified in Section
A, will handle this caseload.
C. Maximum caseload per therapist- 15
6
D. The treatment modality is a systems based psycho-educational approach to
family interventions. The treatment philosophy is brief in nature with
solution oriented education and intervention. Anticipated duration of
treatment is 20 to 25 hours of direct service spread out over 10 to 12
weeks.
E. Total Number of Hours of Service -
1-3 hours per day of home based family treatment (on days clients are
seen)
2-3 hours per week of family treatment
6 - 12 hours per month of family treatment
F. Total number of individuals providing these services-
1 fulltime bilingual therapist
1 per diem therapist for high census
G. Maximum caseload per supervisor- 15
H. Insurance - See attached certificate of insurance
IV. STAFF QUALIFICATIONS
A. The Behavioral Health Therapist(s) providing services will have a
minimum of a Master's Degree in psychology, counseling, social work or
a related field and work experience treating children, adolescents and
families.
B. Two staff members will be available for the direct service phase of this
project with one additional staff member providing one hour of clinical
supervision per week. Additional direct service staff is available on a per
diem basis if census dictates.
7
PROGRAM BUDGETS
PROGRAM Home Based Intensive EAFF Family MedialetSkills-RTC Home Integratioi •
A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 20 5 20
B TOTAL CLIENTS SERVED 96 96 96
C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 1,920 480 1,920
D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $42.56 $46.40 $42.56
E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $81,710 $22,273 $81,710
F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $35,214 $9,604 $35,214
G OVERHEAD COSTS ALLOCABLE TO PROGRAM $7,600 $129 $7,600
H TOTAL DIRECT,ADMINISTRATION 8 OVERHEAD COSTS(E+F+G) $124,525 $32,006 $124,525
I PROFITS CONTRIBUTED BY THIS PROGRAM $4,400 $1,200 $4,400
J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $128,925 $33,206. $128,925
K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 1,920 480 1,920
L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE
(J/K) $67.09 $69.18 $67.15
CERT TION STATEMENT
declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wag
and other factual unit costs supporting the compensation paid or to be paid under this contract are accurate, complete and includes no duplicate costs and
and that I am the CEO or duly authorized agent of 4a" . MA« /Hong, G� r /Y,ro era •
•
VERIFICATION OF COVERAGE ISSUE DATE:Jan. 17, 2003
This venficatlon of coverage's isaGen as a matter of information and Issuer:Banner.Health System
y,and does not extend or alter the coverage carrieo by Sanner Health System.
(COVERED PARTY COMPANIES PROVIDING COVERAGE
(BANNER HEALTH SYSTEM
COMPANY
1441 N. 12TH STREET LEER A SAMARITAN INSURANCE FUNDING,LTD.
PHOENIX, AZ 85006 COMPANY
LETTER a
COMPANY
LETTER C
COMPANY
LETTER 0
COVERAGES
[THIS i5 TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
VERIFICATION OF COVERAGE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS
AND CONDITIONS OF THE POLICIES OF INSURANCE CARRIED BY 3ANNER HEALTH SYSTEM.
CO
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE
LIMITS
A HOSPITAL PROFESSIONAL& SIFL 2003 01/01/03
GENERAL LIABILITY 07/01/04 PL EACH LOSS
$10,000,000
GL EACH LOSS $10.000.000
GL AGGREGATE $10,000,000
HOSPITAL PROFESSIONAL
LIABILITY HPL EACH LOSS $
HPL AGGREGATE $
HOSPITAL PROFESSIONAL
LABILITY HPL EACH LOSS $
HPL AGGREGATE $
MEDICAL PROFESSIONAL -
LIABILITY PERMEDICAL INCIDENT $
ANNUAL AGGREGATE $
IEXCESS LIABILITY
IflG UMBRELLA FORM EACH OCCURRENCE $
OTHER THAN UMBRELLA FORM AGGREGATE $
WORKER'S COMPENSATION
AND STATUTORY LIMITS $
EMPLOYER'S LIABILITY EMPLOYER'S LIABILITY $
:OMMENTS.
ANNER HEALTH SYSTEM HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL
:ENTER.
ERTIFICATE HOLDER CANCELLATION
]'NHOM IT iAAY CONCERN ISHCULO,ANY OF THE,-BCVE-rEi•, IBEO?OLIC:ES EE CANCELLED CR MATERIALLY
CHANGED BEFORE THE EXPIRATION DATE.BANNER HEALTH SYSTEM WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFRCAT E HOLDER.BUT FAILURE TO
MAIL SUCH NOTICE SHALL IMPOSE NO LIABILITY OF ANY KIND UPON BANNER
HEAL'-S'v'ST=M.ITS INSURERS PI ivp AGEi'T?CR REPQESE:NTAT"/E5.
IAU THORIZED REPRESENTATIVE '•I(
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..rensi2/aoW.es
a
Kit( DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Webslte:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
•
COLORADO MEMORANDUM
TO: David E. Long, Chair Date: April 28, 2003
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services, i?(�1 a cf/2t
RE: Notification of Financial Assistance Award(NOFAA) under Core
Services Funds-North Colorado Medical Center, PsychCare -Youth Passages.
Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAA) for Core
Services Funds with North Colorado Medical Center, PsychCare-Youth Passages. The Families,
Youth and Children Commission(FYC)has reviewed these proposals under a Request for
Proposal process and is recommending approval of these bids.
The major provisions of the NOFAAs are as follows:
1. The period of each NOFAA is June 1, 2003,through May 31, 2004.
2. The source of funding is Core Services, which is comprised of 80% Federal/State and
20% County resources and 100% State resources. The total budget for Core Services is
projected to be $929,822.
3. North Colorado Medical Center(NCMC)agrees to provide services to those children and
families who are in imminent risk of placement under child welfare and as referred by the
Department. The services to be provided through NCMC's PsychCare -Youth Passages
are as follows:
A. Under Option B-Home Based Intensive, this program includes family treatment
interventions that provide re-parenting,problem solving, communication skill
building, and parent-child conflict management. Services are available in the
home and in the clinic-based Multi Family Systems Group held each Saturday.
A full-time Bilingual therapist will provide services up to 12 hours per day, 40
hours per week, that provide re-parenting,problem solving, communication skill
building, and parent-child conflict management. A per diem Master's Level
therapist will be available to assist in high census periods. Maximum concurrent
caseload is 15. South County services are limited to 25% of the total cases
referred. The hourly rate is $67.09.
2003-1064
MEMORANDUM Page 2
David E. Long, Chair, Board of County Commissioners
NOFAAs -North Colorado Medical Center, PsychCare -Youth Passages
B. Under Mediation and Facilitation under the Intensive Family Therapy Program
Area this program provides solution-focused therapy that is designed to resolve
conflicts and disagreements within the family contributing to child maltreatment,
running away, and to the behavior constituting status offenses. Goal specific
services limited to 5 hours of therapy per referral. Services do not include
treatment services. A full-time Bilingual therapist provides services for this
program. South County services limited to 75% of cases. The hourly rate is
$69.18.
C. Under Day Treatment, Adolescent Partial Hospitalization is a program designed
to address the multifaceted needs of adolescents experiencing significant
emotional,behavioral, educational, interpersonal, familial problems, and
adolescents suffering from a wide range of psychiatric disorders and chemical
dependency. 96 adolescents(10-18 years)per year, and/or(range of 5-18 years),
8 monthly average capacity,40 hours per week, for 6-10 weeks. Average hours
in intensive outpatient program per week are 12. Day program is conducted in
English while family sessions can be conducted in Spanish through a Bilingual
therapist. Transportation for South County families provided through Weld
BOCES and RE-8. The hourly rate is $19.
D. Under Lifeskills, this program is based on a brief therapy solution oriented
model. Skills and training include; (1)appropriate parenting skills specific to
child(ren)'s ages, (2)communication skills, (3) understanding of boundaries, and
(4)providing education on specific issues such as addiction, depression, or other
mental health issues. The program capacity is 96 total family units, 15 monthly
average capacity, 2-3 average hours per week. The average stay is 10-12 weeks.
A full-time Bilingual therapist is employed for this program. South County
services are limited to 25% of cases. The hourly rate is $67.15.
If you have any questions,please telephone me at extension 6510.
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