HomeMy WebLinkAbout20031527 RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE
CHAIR TO SIGN -THE VILLA AT GREELEY, LLC
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Child Protection Agreement for
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and The Villa
at Greeley, LLC, commencing June 1, 2003, and ending June 30, 2004, with further terms and
conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the Child Protection Agreement
for Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, and The Villa
at Greeley, LLC, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 16th day of June, A.D., 2003, nunc pro tunc June 1, 2003.
BO• ' , OF COUNTY COMMISSIONERS
WEL COUNTY CO O DO
ATTEST: getki oa7._ ,.
:�J vid E. Long, Chair
Weld County Clerk to t B a:t�i�
1861 S�
o
••u.� Robert D. asden, Pro-Tem
BY:
Deputy Clerk to the a
M. J.
eile
7DRM:- Will' m H. J e riu e
ountyAttbrney -
Glenn Vaad
Date of signature: /6
2003-1527
SS0030
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Contract Number. PY 03-CORE-SA-0008
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND THE VILLA AT GREELEY,L.L.C.
This Agreement,made and entered into the fin day of June 2003,by and between the Board of Weld
County Commissioners, on behalf of the Weld County Department of Social Services, hereinafter referred to as
"Social Services,"and The Villa at Greeley L.L.C.,a wholly owned subsidiary of Southern Corrections Systems,
Inc., a wholly owned subsidiary of Avalon Correctional Services, Inc.,hereinafter referred to as"Avalon."
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Colorado Family Preservation Act
fund resources to Social Services for monitored sobriety services for families,children,and adolescents; and
WHEREAS, Social Services requires the services of a substance abuse treatment provider to assist the
County to deliver monitored sobriety services to child welfare clients, and Avalon is willing and able to provide
such services; and
WHEREAS, Avalon is an Oklahoma for-profit corporation organized for the purpose of managing and
coordinating high quality,cost efficient,integrated chemical dependency and related behavioral health care
services in the State of Colorado.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2003,upon proper execution of this Agreement and
shall expire June 30,2004,unless sooner terminated as provided herein. The Core Services funds
provided, as set forth herein will be used to compensate services provided for the period commencing on
June 1, 2003,to and including May 31, 2004.
2. Scope of Services
Services shall be provided by Avalon network providers to any person(s)eligible for child protection
services in compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule," and Exhibit C,"Core
Services Fee Schedule,"copies of which are attached hereto and incorporated herein by
reference.
"Payment Schedule" shall establish the maximum reimbursement,which will be paid from
Colorado Family Preservation Act funds during the duration of this Agreement.
Avalon, in accordance with federal HIPAA regulations,will be adopting the standard transaction
code set for all treatment services on or before October 16,2003. Even though this compliance
will change the service labels and groupings,the net fees associated with those services will not
change.
b. Avalon shall submit an itemized monthly bill to Social Services for all costs incurred and
services provided pursuant to Exhibit A of this Agreement in accordance with criteria established
by Social Services. The Contractor shall submit all itemized monthly billings to Social Services
no later than the twenty-fifth(25)day of the month following the month the cost was incurred.
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Contract Number. PY 03-CORE-SA-0008
Failure to submit monthly billings in accordance with the terms of this agreement may result in
Avalon's forfeiture of all rights to be reimbursed for such expenses. In the event of a forfeiture of
reimbursement. Avalon may appeal such circumstance to the Director of Social Services. The
decision of the Director of Social Services shall be final.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the
availability of Colorado Family Preservation Act funds to Social Services.
d. Social Services shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A or in the"Weld County Guidelines." Work
performed prior to the execution of this Contract shall not be reimbursed or considered part of
this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,the Contractor shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Services and the Family and Children's Program must conform to the
Single Audit Act of 1984 and OMB Circular A-133.
5. Payment Methad
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Avalon shall provide proper monthly invoices and verification of services performed for costs incurred
in the performance of the agreement.
b. Social Services may withhold any payment if Avalon has failed to comply with the Financial
Management Requirements,program objectives,contractual terms,or reporting requirements. In
the event of a forfeiture of reimbursements, Avalon may appeal such circumstance to the Director
of Social Services. The decision of the Director of Social Services shall be final.
6. Assurances
Avalon shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Taws
At all times during the performance of this contract, Avalon shall strictly adhere to all applicable federal
and state laws,orders, and all applicable standards, regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. Avalon acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d—1 of seq.and its implementing
regulation,45 C.F.R.Part 80 et seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and its
implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
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Contract Number.PY 03-CORE-SA-0008
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,national
origin,and, sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)or AIDS
related conditions, covered under Section 504 of the Rehabilitation Act of 1973, as amended,cited above.
If necessary,Avalon and Social Services will resist in judicial proceedings any efforts to obtain access to
client records except as permitted by 42 CFR Part 2. Social Services and Avalon shall sign a Qualified
Service Organization Agreement in compliance with 42 CFR Part 2(Exhibit E).
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible, as sources of supplies, equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Certifications
Avalon certifies that,at the time of entering into this Contract,it has currently in effect all necessary
licenses, approvals,insurance,etc.required to properly provide the services and/or supplies covered by this
contract.
9. Monitoring and Evaluation
Avalon and Social Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by Avalon and Social Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and Avalon.
Avalon shall permit Social Services,and any other duly authorized agent or governmental agency,to
monitor all activities conducted by the contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on-site checking, formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Social Services or designee may exercise the following remedial actions should s/he find
Avalon substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Avalon.
These remedial actions are as follows:
a. Withhold payment of Avalon until the necessary services or corrections in performance are satisfactorily
completed;
Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by Avalon cannot be performed or if performed
would be of no value to the Social Services. Denial of the amount of payment shall be reasonably
related to the amount of work or deliverables lost to Social Services;
b. Incorrect payment to Avalon due to omission,error,fraud,and/or defalcation shall be recovered from
Contractor by deduction from subsequent payments under this Agreement or other agreements between
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Contract Number.PY 03-CORE-SA-0008
Social Services and Avalon,or by Social Services as a debt due to Social Services or otherwise as
provided by law.
12. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Social Services:
Gloria Romansik Social Services Administrator
Name Title
For Avalon:
lames Saffle President
Name Title
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: Social Services To: Avalon Correctional Services,Inc.
holyA Griege Director James Sane President
P O Box A 13401 Railway Drive
Greeley,CO fl0637 Oklahoma City,OK 73114
14. Litigation
Avalon shall promptly notify Social Services in the event that Avalon learns of any actual litigation in
which it is a party defendant in a case that involves services provided under this Agreement. Avalon,
within five(5)calendar days after being served with a summons,complaint, or other pleading which has
been filed in any federal or state court or administrative agency,shall deliver copies of such document(s)
to the Social Services Director. The term"litigation"includes an assignment for the benefit of creditors,
and filings in bankruptcy,reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is subject
to the availability of funding. Avalon reserves the right to suspend services to clients if funding is no longer
available. Social Services acknowledges financial responsibility for services authorized before the effective date
of termination.
16. Entireligeement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 10 herein.
17. In the absence of any formal agreement beyond the term of this agreement, Avalon agrees to continue
providing treatment,under the terms of this agreement, for clients that are in treatment or referred by
Social Services for treatment. This is with the further understanding that service delivery and payment
are subject to the terms under"Termination"(section 15).
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above
written.
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Contract Nump PY 03;�(�RE 00
Al1EST: •_.i i
WELD COUNTY S ARD OF COUNTY
CLERK TO THE BOARD �` ,, MMISSIONERS WELD
is v
186' f- e
By. illte
Deputy Clerk Y David E.Long,Chair (le-ib-" OJ
P7
AP
PR AST TO -y~ The Villa t ley,LLC
BY .Z-Ob
Correcti s yst s, .,Member
County Attorney James Sa1₹le,President
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES Qwop
BY L
I
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arni3- /sa7
Contract Number.PY 03-CORE-SA-0008
EXHIBIT A
SCOPE OF SERVICES
Special Conditions:
A. Avalon with each UA will follow their UA policy,herein described below under"Norchem UA Collection
Procedure Example."
B. Avalon will only conduct monitored sobriety for Social Service clients at their Day Reporting Center.
C. Avalon will have enough staff available to meet Social Service clients'needs. Avalon will not turn a client
away,or have them wait more than fifteen(15)minutes to provide a sample.
D. Avalon will confirm any positive monitored sobriety result within 24 hours through a fax and a phone call to the
Social Services caseworker
E. Avalon will provide court testimony at no additional charge.
NORCHEM UA COLLECTION FEES
Standard Five-Panel UA,with GM/MS confirmation on positive results,
(screens for THC,Cocaine,Meth/Amphetamines, Opiates,and Barbiturates) $15.00
Automatic GC/MS confirmation on positive UA screens at no additional cost
If a UA screen tests positive, and it is confirmed positive by GC/MS,the client may pay to have the specimen re-
screened by GC/MS confirmation $20.00
Saliva Tests $15.00
Breath analysis testing 2 00
Other illicit substances can be screened at an additional cost.Please contact Contractor for fees.
NORCHEM UA COLLECTION PROCEDURE EXAMPLE
A. Important Point
The collector and the donor shall keep the urine in view at all times prior to its being sealed with a tamper-
evident sealing label.
B. Prior to Collection
I. The collection facilities must be clean,well lighted, and dedicated solely to urine collection during
the collection process.
2. The toilet water must not be available to the donor for specimen adulteration:
• Regular Flushing Toilets:Bluing agent(or dye)should be placed in the toilet bowl and
tank,and secure the tank cover with tamperproof tape.
• Pressure flushing toilets:Bluing tablets(or dye)should be placed in the toilet bowl after
each flush or before the next donor.
3. No other source of water should be accessible to the donor during the collection process.
C. Collection:
1. Collector must positively identify the donor.If the collector is not the caseworker for the donor,
the collector must ask the donor for a photo identification. The only other form of acceptable
identification is for the donor's identity to be verified by their caseworker, or supervisor,in person.
2. Collector must assure that all applicable information on the Chain-of-Custody(COC)form is
complete.
3. Collector must ask the donor to remove all items from their pockets,and pull their pockets inside
out.
4. All personal belongings, such as purse or briefcase,are to remain outside the collection location
(with outer garments.)
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Contract Number.PY 03-CORE-SA-0008
5. Collector instructs donor to wash and dry hands. (Do not use soap.Use water only.)
6. Collector instructs donor to fill the specimen collection bottle.
7. Donor enters the toilet stall, if an observed collection, collector accompanies the donor.
D. I ipon Receiving Specimen from Donor.
1. Collector visually checks the specimen for signs of contamination or adulteration(discoloration,
precipitation,etc.)and notes all observations in the Test Request space provided on the Chain-of-
Custody form.
2. In the presence of the donor,collector notes the temperature of the specimen using the temperature
strip provided on the container within four(4)minutes from the time of urination.The acceptable
sample temperature range is 90-100 degrees Fahrenheit.
3. Record the temperature on the Chain-of-Custody form.
4. If tamper proof tape was used on the toilet tank,check that the tape was not tampered with.
5. Collector and donor shall keep the specimen in view at all times prior to the specimen being sealed
with tamper evident tape.
6. Make sure the bottle is tightly capped.
7. Seal the specimen by placing the tamper evident tape over the lid of the bottle with the ends of the
tape coming down the sides of the bottle.
8. Have the donor place their initials in the space provided on the security seal. This is to certify that
the specimen has been sealed with a tamper-evident sealing label in the donor's presence, and that
the donor gave the specimen.
9. Using a ballpoint pen,donor and collector sign the appropriate area on the Chain-of-Custody form.
10. Collector encourages donor to wash hands.
E. Specimen Rejection Criteria•
You should reject the specimen if one of the following occur:
I. If the specimen is not within the acceptable temperature range(90-100 degrees Fahrenheit),
discard the specimen and request another specimen from the donor.
2. Jf the specimen shows signs of discoloration from the addition of bluing agent/dye, clearly state
this fact on the Chain-of-Custody form,and send specimen to laboratory.
3. If there is the distinctive odor of bleach in the specimen collection area or on the donor, clearly
state this fact on the Chain-of-Custody form,and send specimen to the laboratory.
4. Jf there is insufficient volume of specimen to perform the required analysis discard the specimen
and request another from the donor. Insufficient volume here means that the specimen level must
be above the level of the temperature strip on the collection bottle.
F. Prepare Specimen for Shipment to laboratory.
1. Collector removes copy of Chain-of-Custody form, and keeps for records.
2. Place the top copy of Chain of custody form in the front pouch of specimen bag.
3. Place the capped,sealed specimen bottle in the bag(with absorbent pad)and seal specimen bag by
removing adhesive strip.
4. Place the sealed bag into proper mailing product. If specimens are shipped via courier,prepare
according to courier's instructions.
5. Specimens should be shipped as soon as possible(within seven days of collection.)Keep
specimens in a secure area until shipped.
G. Notes.
1. Specimens left at room temperature longer than seven(7)days may produce unreliable results.
2. Minimize the number of people handling specimens.
3. Ensure that all necessary areas of the Chain-of-Command form are filled out.
4. Make sure the specimen is tightly and properly sealed.
5. Ensure the specimen is sealed/labeled.
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Contract Number.PY 03-CORE-SA-0008
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Social Services agrees to reimburse to Avalon in consideration for the work and Services performed,a total
amount not to exceed Fifty-Two Thousand,Three Hundred Ninety-Eight Dollars($52,398.00)under Child
Welfare Services and Family and Children's Program Funding.
Expenses incurred by Avalon, in association with said project prior to the term of this agreement,are not
eligible Social Services expenditures and shall not be reimbursed by Social Services.
Payment pursuant to this Contract, if Colorado Family Preservation Act funds,whether in whole or in part,
is subject to and contingent upon the continuing availability of Colorado Family Preservation Act funds for
the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by
Social Services, Social Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services—as shown on the attached Exhibit A"Core Services Fee Schedule"
Social Service referrals will nul be sent to collections by Avalon for default of co-pay/fees. Services will be
performed regardless of client's refusal or inability to pay co-pay.
3. Submittal of Vourhers
Avalon shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility"in Exhibit D,and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
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Contract Number. PY 03-CORE-SA-0008
EXHIBIT C
ASSURANCES
1. Avalon agrees it is an independent contractor and that its officers and employees do not become employees
of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of
the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of Avalon-contracted
providers or its employees,volunteers, or agents while performing duties as described in this Agreement.
Avalon shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of
Weld County,its employees, volunteers, and agents. Avalon shall provide adequate liability and worker's
compensation insurance for all its employees,volunteers, and agents engaged in the performance of the
Agreement upon request,Avalon shall provide Social Services with the acceptable evidence that such
coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections,paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section.
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs, sentences,clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. Avalon assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person
shall, on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,be
denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. Avalon assures that sufficient,auditable, and otherwise adequate records that will provide accurate, current,
separate,and complete disclosure of the status of the funds received under the Contract are maintained for
three(3)years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local,Federal, and State auditors and representatives to audit and monitor Avalon.
9. All such records,documents,communications, and other materials shall be the property of Social Services
and shall be maintained by Avalon, in a central location and custodian, in behalf of Social Services,for a
period of four(4)years from the date of final payment under this Contract, or for such further period as may
be necessary to resolve any matters which may be pending,or until an audit has been completed with the
following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is
not completed at the end of the four(4)year period,or if audit findings have not been resolved after a four
(4)year period,the materials shall be retained until the resolution of the audit finding.
10. Avalon assures that authorized local,federal and state auditors and representatives shall,during business
hours,have access to inspect any copy records,and shall be allowed to monitor and review through on-site
visits, all contract activities, supported with funds under this Contract to ensure compliance with the terms
of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the
Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation
activities shall be provided to the appropriate and interested parties.
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Contract Number. PY 03-CORE-SA-0008
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. Avalon or Social Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. Avalon certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of
Avalon,to any person for influencing or attempting to influence an officer or employee of an agency,a
Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract,the making of any federal grant,the making of any
federal loan,the entering into of any cooperative agreement,and the extension, continuation,renewal,
amendment,or modification of any Federal contract,loan, grant, or cooperative agreement.
13. Avalon assures that it will fully comply with all other applicable federal and state laws. Avalon/Avalon
understands that the source of funds to be used under this Contract is: Colorado Family Preservation Act
funds.
14. Avalon assures and certifies that is and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible, or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period of preceding this Agreement,been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain,or performing a public(federal, state, or local)transaction or
contract under a public transaction; violation of federal or state antitrust statutes or commission of
embezzlement,theft, forgery,bribery, falsification or destruction of records,making false
statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the
offenses enumerated in paragraph 11(b)of this certification; and
d. Have not within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
e. Have not with a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
The Appearance of Conflict of Interest applies to the relationship of a contractor with Social Services when
Avalon also maintains a relationship with a third party and the two relationships are in opposition. In order
to create the appearance of a conflict of interest, it is nor necessary for the contractor to gain from
knowledge of these opposing interests. It is only necessary that the contractor know that the two
relationships are in opposition.During the term of the Contract,Avalon shall not enter any third party
relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,Avalon shall submit to Social Services,a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Social Services'
termination, for cause, of its contract with Avalon.
15. Avalon shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. Except for purposes directly connected the administration of the Child
Protection,no information about or obtained from any applicant/recipient in possession of Avalon shall be
disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with Avalon written policies governing access to, duplication and dissemination of,all such
information. Avalon shall advise its employees,agents, and subcontractors,if any, that they are subject to
these confidentiality requirements. Avalon shall provide its employees,agents,and subcontractors,if any,
with a copy or written explanation of these confidentiality requirements before access to confidential data is
permitted.
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Contract Number. PY 03-CORE-SA-0008
16. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties, (2)
that which is in the public domain, or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by Avalon in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by Avalon for similar information in the course of its own business.
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Contract Number.PY 03-CORE-SA-0008
EXHIBIT D
STANDARDS OF RESPONSIBILITY
Avalon agrees to:
1. Report expenditures and case disbursement at agreed upon times.
2. Submit monthly FYC completed billing forms to Ms.Elaine Furister,CPS/CAP, Core Services Specialist,
within twenty-five(25)calendar days of the month following service in order to receive payment, subject to
future modification as prescribed by CYF(Children,Youth,and Families)automation when implemented.
Failure to submit in a timely and complete manner shall result in forfeiture of payment.
3. In the event no service fees are incurred during the service month,an Authorization for Contractual
Services stating no services were provided for that service month shall be submitted within twenty-five(25)
calendar days following the month of service.
4. The provider shall submit an original Request for Reimbursement in complete form to re-bill for services
previously denied by the Department.If in the resolution process,the provider will not re-bill for payment
unless the provider can justify payment by documentation. The Department will not consider payments that
were originally reviewed as deficient in documentation without new documentation to justify payment.The
Department shall receive the Request for Reimbursement no later than five business days from receipt of a
certified letter from the Department documenting such denials of payment.
5. A complete and timely billing form is identified by and must include the following elements.
a. The billing must be an original billing signed by the provider and/or designee.
b. The billing must include all forms designed for Core Services reimbursement and approved by
the Department of Social Services; Core Services Authorization of Funds, Project Report,and
Update Report for each client serviced during the billing period.
c. A re-bill must include all forms designed for re-billing of Core Service Requests for
Reimbursement and approved by the Department of Social Services. This includes a signed
original Authorization for Contractual Services and Weld County Core Services Program Re-bill
and Additional Request for Reimbursement form.
d. Each client who has a current referral,both receiving services and not receiving services during
the service month,must be listed on the billing form.A service summary must be provided by
the provider for clients who have active referrals during the billing month in order to direct
issues to the caseworker and court.
I). Core Services Authorization forms must be submitted completely filled in with an
original signature from the provider and/or designee.
2). Project reports must include the client's full name,Weld County household number,
suffix number,referral number, if applicable,hours served,hourly rate, and total
billed for the month the service was provided.
3). Requests for payment must be date stamped by the Department of Social Services by
the 25th day of the month following the service month. Requests for payment
received after the 25th of the month following service will not be honored.
4). Re-bills for services must include only those items Avalon can justify with
documentation and include a signed original Authorization for Contractual Services
form.The Weld County Core Services Program Re-bill and Additional Request for
Reimbursement form must include the client's name,household number, suffix
number,month of billed service,re-bill amount,the approved entry date and exit
dates,the actual hours re-billed,the rate per unit, and the re-bill total for the line
item.
Page 12 of 17
Contract Number.PY 03-CORE-SA-0008
6. Will develop and utilize evaluation tools(pre and post assessment test instruments)to collect necessary data
in cooperation with Social Services staff to monitor effectiveness of program;
7. Will meet with Social Services FPP Supervisor quarterly(more if needed)to review program usage and
effectiveness to discuss necessary improvements to better serve families or increase referrals;
8. Be available to meet with DSS staff to explain program, time lines of response to referrals and answer
questions to enhance program.
9. Be available for the Families,Youth and Children Commission review and attendance at the FYC meetings.
Page 13 of 17
Contract Number.PY 03-CORE-SA-0008
5310.213 (2/79)
COLORADO STATE DEPARTMENT OF SOCIAL SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
1. WELD COUNTY DATE:
2.
Name of Provider
3.
Address
4.
City, State, Zip
THE DESCRIBED SERVICE IS AUTHORIZED FOR THE CLIENT INDICATED:
5.
Name of Client Household# Cat. Cat.Grp.
6.
Description Sv. Code
7.APPROVAL:
Caseworker Date Co. Director or Supervisor
8.TO BE COMPLETED BY PROVIDER
DATE OF SERVICE
CHARGES$
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED AND THE
CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE COUNTY
DEPARTMENT OF SOCIAL SERVICES INDICATED.
Provider Signature Date
Prepare in Triplicate, Original and One copy to Provider,One Copy for Pending File.
Completed Provider's Forms-Original to County Finance Office-Copy to Case Record.
Page 14 of 17
Contract Number.PY 03-CORE-SA-0008
WELD COUNTY CORE SERVICES PROGRAM MONTHLY REQUEST FOR REIMBURSEMENT
Remit to:Elaine Furister,PS/CAP,Core Services Specialist
Name of Program Month of Service Weld County Department of Social Services
Notice to Providers:List all clients currently enrolled in your program. P.O.Box A,315 B N 11 Avenue,Greeley,CO 80632
Enter 0 if no services were provided during billing month Telephone:970.352.1551,extension 6295
FAX:970.346.7698
Client Name HH# Referral# Approved Approved Actual Maximum Hours Rate per Monthly Social Services Payments Services
Entry Date Exit Date Hrs/Service Sessions/Service Unit Total Only-Comments Denied/Delayed Payable
Period Period
•
Social Service Codes:CE-Computation Error;NR-No Referral;EED-Exceeds End Date;EMH-Exceeds Maximum Hours;EMS-Exceeds Maximum Sessions;NP-Not Payable;
PD-Payment Delayed;SPD;Submitted Past Deadline;NDC-No Face to Face Contact;NV-No Client Verification;ICMP-Initial Case Management Plan Needed;PR-Progress Report Needed
Page 15 of 17
Contract Number. PY 03-CORE-SA-0008
WEI D COI INTY CORP SFRVICFS PROGRAM PROJECT REPORT
Remit to:Elaine Furister, CPS,Core Service Specialist
Weld County Department of Social Services
Program Month of Service P.O.Box A,315 B N II Avenue,Greeley,CO 80632
Telephone:970.352.1551,Ext.6295 FAX:970.346.7698
#Households Referred During #of Households Enrolled #of Households Served During #of Households Discharged Monthly Expenditure Expenditures to Date
Month During Month Month During Month
Termination Reason Codes:SEP-Successfully Ended Program;M-Moved;UL-Unable to Locate;RCCF-Entered a Residential Facility;FCR-Foster Care Review;OT-Explain,TM-Transferred to Another Program More
Restrictive;FC-Entered Foster Care;NT-Terminated;Unable to Work with Client;RH-Returning to Relative
Child's Name Direct Service Date Service Termination Client Caseworker Provider Initial Case Monthly Progress Funding Total Cost Social Services
Date Ended Reasons Survey Survey Survey Management Report Source of Program Use
Plan(Date) to Date
Funding Source: M-Medicaid;CI-Client Insurance;O-Other
Page 16 of 17
Contract Number.PY 03-CORE-SA-0008
WELD COUNTY CORE SERVICES PROGRAM RE-BILL AND ADDITIONAL REQUEST FOR REIMBURSEMENT
Remit to:Elaine Furister,CPS/CAP,Core Service Specialist
Name of Program Month of Service Weld County Department of Social Services
Notice to Providers:List all clients currently enrolled in your program. P.O.Box A,315 B N I 1 Avenue,Greeley,CO 80632
Enter 0 if no services were provided during billing month Telephone:970.352.1551,extension 6295 FAX:970.346.7698
Client Name HH#&Client Referral# Month of Re-bill Approved Approved Actual Rate per Re-bill Certified Letter and (DSS Only)
Suffix Service amount Entry Date Exit Date Hrs/ Unit Total Documentation Payable or
(Example: Re-billed Attached Not payable
11111-02) (Include reason if not payable)
Social Service Codes:CE-Computation Error;NR-No Referral;EED-Exceeds End Date;EMH-Exceeds Maximum Hours;EMS-Exceeds Maximum Sessions;NP-Not Payable;
PD-Payment Delayed;SPD;Submitted Past Deadline;NDC-No Face to Face Contact;NV-No Client Verification;1CMP-Initial Case Management Plan Needed;PR-Progress Report Needed
Page 17 of 17
EXHIBIT E
AVALON CORRECTIONAL SERVICES,INC.,
ON BEHALF OF THE VILLA AT GREELEY, LLC
QUALIFIED SERVICE ORGANIZATION AGREEMENT
The Villa at Greeley, LLC and Weld County Department of Human Services (County)
hereby enter into a Qualified Service Organization Agreement whereby The Villa at
Greeley, LLC, agrees to accept and serve Counties' clients substance abuse treatment
needs. In light of the relationship between County and The Villa at Greeley, LLC,
County requires client identifying information and data and information related to the
services furnished to the clients. County and the Villa at Greeley, LLC, will have this
relationship from June 1, 2003 - June 30, 2004, thus the QSOA will be in effect during
this period of time.
Furthermore, the County:
1. acknowledges that in receiving, storing, processing, or otherwise dealing with
any information from the Villa at Greeley, LLC, about the clients in the Villa at Greeley,
LLC's program, it is fully bound by the provisions of the federal regulations governing
Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2; and
2. agrees to undertake in resisting judicial proceedings in any effort to obtain
access to information pertaining to clients otherwise than as expressly provided for in the
federal confidentiality regulations, 42 CFR Part 2.
Executed this / day of -Jttr. 2003.
tap , 7tUttc a c ,Li
Ja es L. Saffle,Prtsident Jucry Griegb) Director i r'
The Villa at Greeley, L. L. C. We d3lCounty Departm t of14annon Services
Southern Corrections Systems Member oc" �
• •
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
_ WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
COLORADO MEMORANDUM
TO: David E. Long, Chair Date: June 12, 2003
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services a, erj
RE: Child Protection Agreement for Services e�Weld County
Department of Social Services and Avalon Correctional Services, Inc.,
on behalf of The Villa at Greeley, L.L.C.
Enclosed for Board approval is a Child Protection Agreement for Services between the Weld
County Department of Social Services(Department) and Avalon Correctional Services, Inc., on
behalf of The Villa at Greeley, L.L.C. The Agreement was discussed and reviewed at the
Board's Work Session of May 12, 2003.
The major provisions of the Agreement are as follows:
1. The term of the Agreement is June 1, 2003 through June 30, 2004, for services provided
for the period of June 1,2003 through May 31, 2004.
2. The source of funding is Core Services.
3. The Department agrees to reimburse The Villa a maximum of$52,398, according to the
service and fee schedule provided by The Villa.
4. The Villa will provide alcohol and drug testing for adults and adolescents under the child
welfare system.
If you have any questions,please telephone me at extension 6510.
2003-1527
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