HomeMy WebLinkAbout20032821.tiff RESOLUTION
RE: APPROVE AGREEMENT TO PURCHASE CHILD PLACEMENT AGENCY
SERVICES AND AUTHORIZE CHAIR TO SIGN - BETHANY CHRISTIAN SERVICES
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 an Agreement to Purchase Child
Placement Agency 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 Bethany Christian Services, commencing October 1, 2003, and ending June 30,
2004, with 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 Agreement to Purchase
Child Placement Agency 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 Bethany Christian Services, 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 8th day of October, A.D., 2003, nunc pro tunc October 1, 2003.
BOARD OF COUNTY COMMISSIONERS
���� COUNTY, COLORADO
ATTEST: a4 #4
D vid E. Lo , Chair
Weld County Clerk to the Bo- d
OR bert D. M en, Pro-Tem
Clerk to the Board
,� ► ® M. J. Geillee
1861 I t ' STO ' /./
Willia H. Jerke
ttorn y• 01447
GI nn Vaad
Date of signature: 171/37!'
2003-2821
SS0030
(O ; SS
Contract No: PY 03/04-SS-23A-CPA
AGREEMENT TO PURCHASE e717)?
CHILD PLACEMENT AGENCY SERVICES ,
/0
THIS AGREEMENT made this day of 2003 between the Board of Weld c� .`
County Commissioners, sitting as the Board of Social Services, on behalf of the Weld County �6
Department of Social Services, hereinafter called "County" and Bethany Christian Services, 9185
E Kenyon Ave 190, Denver, CO 80237, hereinafter called "Contractor".
WHEREAS, the Colorado State Department of Social Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of individuals
through its agents, County Departments of Social Services, and
WHEREAS, County is authorized to purchase certain services for eligible children under
State Department rules, and
WHEREAS, County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, Contractor is licensed as a Child Placement Agency.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual Undertakings
County and Contractor agree as follows:
1. A child specific Needs Based Care Assessment, designated as Attachment B, shall be
used to determine levels of care for each child placed with Contractor.
2. County agrees to purchase and Contractor agrees to provide the care and services, which
are listed in this Agreement, based on the Needs Based Care Assessment levels
determined. The specific rate of payment will be paid for each level of service, as
indicated by the Needs Based Care Rate Table, designated as Attachment C, for children
placed within the CPA identified as Provider ID#45514. These services will be for
children who have been deemed eligible for social services under the statutes, rules and
regulations of the State of Colorado.
Oar-telt 0?
3. This Agreement shall be in force from Atigia 1, 2003, until the end of the Colorado
fiscal year, June 30, 2004; or until the child is removed by the County; or if the child's
behavior would cause harm to himself or other children, and Contractor seeks approval
from the County and the County agrees, in writing, to terminate this Agreement,
whichever event occurs first.
4. This Agreement may be renewed only by entering into a new written Agreement, such as
this Agreement, signed by the authorized representatives of the parties. In addition to the
termination provisions in Paragraph 3 above, either party shall have the right to terminate
this contract by giving the other party thirty(30) days notice by registered mail, return
receipt requested. If notice is so given, this contract shall terminate on the expiration of
the thirty(30) days or until the eligible child can be placed elsewhere, whichever occurs
Agreement to Purchase
1
CPA Foster Care Services
,Contract No: PY 03/04-SS-23A-CPA
earlier, and the liability of the parties hereunder for further performance of the terms of
this Agreement shall thereupon cease,but the parties shall not be released from the duty
to perform their obligations up to the date of termination.
5. This Agreement is in lieu of and supersedes all prior agreements between the parties
hereto and relating to the care and services herein described.
SECTION 1. DESCRIPTION OF SERVICES TO BE PURCHASED.
1. The services purchased under this Agreement are Child Placement Agency services and
may include,but are not limited to: Basic 24-hour care and child maintenance (food,
shelter, clothing, educational supplies and allowance), Administrative Overhead, Case
Management, Direct therapy and evaluation,which may include but are not limited to:
Psychological and/or Neurological, Medication and follow-up, Family Therapy,
Individual Therapy, Group Therapy, Sex Offender Evaluation and/or Sex Offender
Treatment as prescribed by the Sex Offender Management Board Policy, Polygraph,
Plethysmograph, Parent Training for Teens, Independent Living Training,
Mentor/Advocate, Supervised Visitation, Direct Child Care, Therapeutic Recreation,
Transportation, and Special Needs (requires SS-22).
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1 (F).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County will make the decision to return the child to the facility, with input
from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the treatment/case plan.
5. Any transportation costs to be incurred on behalf of this child which are to be borne by
persons or agencies which are not a party to this contract shall be specified in the
treatment/case plan, and those persons shall acknowledge their responsibility by signing
the treatment/case plan.
6. Contractor will provide the purchased care and services at:
Provider ID#: 45514
Bethany Christian Services
9185 E Kenyon Ave 190
Denver, CO 80237
Agreement to Purchase
CPA Foster Care Services 2
,Contract No: PY 03/04-SS-23A-CPA
7. Contractor shall not charge any additional fees to children or families of children referred
by County for services provided under this Agreement.
8. Contractor agrees not to assign the obligations under this Agreement nor enter into any
sub-contracts without the express written approval of the Executive Director of the
Colorado Department of Social Services or his appointed designee.
SECTION II. MEDICAL CARE
1. In accordance with the Weld County Department of Social Services policies (2.710.70,
2.710.71, 2.710.72, 2.710.73, 2.710.74) and Colorado Department of Human Services
Child Care Licensing Division policy(7.714.131), the contractor may obtain: 1) Ordinary
medical care, and 2) Emergency medical, surgical or dental care for said child after
making reasonable efforts to contact the County to obtain consent. Emergency care is
defined as any medical treatment as recommended by a licensed medical authority to
protect the life and health of a child and treatment cannot be delayed without placing the
child at risk.
2. Contact by the Contractor with the County regarding emergency medical, surgical or
dental care will be made in a person-to-person communication, not through phone mail
messages.
3. During regular work hours, the Contractor will make every effort to notify the assigned
caseworker, supervisor, or Intake Screener of any emergency medical, surgical or dental
issues prior to granting authorization. During non-regular work hours, weekends and
holidays, the Contractor will contact the Emergency Duty Worker at the pager number
(970) 350-8389.
4. The County will be notified by the facility no later than the following working day of any
administration of emergency medical, surgical or dental services provided under this
authorization.
5. Prior to any elective, non-routine or non-emergency medical, surgical or dental services
being provided, authorization must be obtained from the assigned caseworker or
supervisor. If parental rights are intact, authorization or attempts to obtain authorization
from the parent(s) should also be documented. If the placement is made through a
voluntary placement agreement between the parent(s) and the County, the parent(s) must
be contacted for authorization.
6. The Contractor is required to maintain a complete record of all medical, surgical or dental
services provided and the medications administered to the child.
7. The Contractor will provide an up-to-date copy of the medical record to the County at the
time of submittal of each progress report, including the discharge report at the time of the
child's termination from the care of the Contractor.
8. County and Contractor shall insure that the Child is enrolled in the Early and Periodic
Screening, Diagnosis and Treatment Program.
Agreement to Purchase
3
CPA Foster Care Services
,Contract No: PY 03/04-SS-23A-CPA
9. It is agreed and permission is granted for the child to participate in planned recreational
and social activities of Contractor, including supervised off grounds excursions and
extended trips within the State,provided that Contractor has written permission from
County and legal custodian for any trips out of Colorado for any reason and any planned
absence from the facility of over seven(7) days within a consecutive 30-day period. Such
written permission maybe in the treatment/case plan. Further, Contractor and County
will also secure, where possible,permission from parents or guardians of the child placed
with the Contractor.
10. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status, which comes to their attention.
SECTION III. REASONS FOR REFERRAL AND TREATMENT PLAN
1. Attachment A will be designated as the Placement Referral form. This referral will be
child specific and shall include the initial Treatment Plan that shall be goal oriented and
time-limited.
2. The Treatment Plan shall include the anticipated living arrangement and the anticipated
educational arrangement for the child upon completion. Also included will be the
anticipated date for discharge from treatment purchased as well as provisions concerning
the involvement of the child's family in treatment of the child.
3. County and Contractor agree and understand that the psychological (mental and
behavioral) or physical problems which necessitate purchasing services for this child are
specified in the Attachment A.
4. Modifications to the initial Treatment Plan shall be agreed upon by the County and
Contractor and shall be reflected in the Attachment A.
5. At no longer than three-month intervals after placement, Contractor shall provide County
with written reports, which address the child's physical condition,psychological and
social functioning, the child's family situation, educational progress, significant incidents
or disciplinary actions, and progress made to achieve goals specified in the Treatment
Plan. Further, the Contractor agrees to sequence reports to be received by the County
fifteen (15) days prior to judicial or administrative hearings or reviews when provided
with thirty(30) day advance notice of such dates by County. Contractor shall participate
in all Foster Care Reviews as scheduled by the County and insure the attendance of the
child.
SECTION IV. CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Social Services, the State of Colorado and any federal laws and regulations, as such,
which may be amended from time to time, and shall be binding on Contractor and control
any disputes in this Agreement.
Agreement to Purchase
4
CPA Foster Care Services
Contract No: PY 03/04-SS-23A-CPA
2. Maintain a current license and maintain license requirements as specified under State law.
3. Not collect any fees from children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub-contract without
the express written approval of the Executive Director of the Colorado Department of
Human Services or his/her appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act
of 1975 as revised, and provide confidentiality of information concerning the child and
the child's family.
6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000
for property damage liability, $150,000 for injury and/or damage to any one person, and
$400,000 for total injuries arising from any one accident.
7. Maintain during the term of this Agreement a liability insurance policy of at least
$400,000 for property damage liability, $150,000 for injury and/or damage to any one
person, and $400,000 for total injuries arising from any one accident.
8. Indemnify County, the Colorado Department of Social Services and the State of Colorado
against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the
performance of this contract or by conditions created thereby, or based upon any
violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
9. Maintain service program records, fiscal records, documentation and other records, which
will sufficiently and properly reflect all direct and indirect costs of any nature incurred in
the performance of this Agreement. The above shall be subject at all reasonable times to
inspection, review or audit by federal, State Department or county personnel, and other
persons authorized in writing by the Executive Director, Colorado Department of Social
Services.
10. Bill the County for services rendered, using the required Division of Child Welfare
Provider Roster. This roster is to be mailed to the County department by the last day of
the month of care. If Provider Rosters are not received, payments will be held until the
required paperwork is received.
11. Attend and participate in Foster Care Reviews for children in placement longer than 60
days, and any subsequent appeal process, for children in placement with the Contractor
pursuant to two (2) weeks written notice by the County. If the facility is in a different
part of the state from the county in which the review is held, participation may be by
teleconference.
Agreement to Purchase
5
CPA Foster Care Services
Contract No: PY 03/04-SS-23A-CPA
12. Agree to cooperate with any vendors hired by Weld County Department of Social
Services to shorten the duration of placement at CPA level.
13. Obtain physical examinations within 14 days of placement and forward all appropriate
information to the County.
14. Obtain Dental examinations within 60 days of placement and forward all appropriate
information to the County.
15. A full evaluation of an Individualized Educational Plan (IEP) for youth designated as a
Special Education Students will be conducted every 3 years and reviewed every year. If
the IEP is due while the child is in placement, the Contractor will complete or obtain a
completed IEP. A copy will then be forwarded to the County.
16. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph(B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
SECTION V. COUNTY SHALL:
1. Determine eligibility of the child under this Agreement for placement and medical
coverage.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Social Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate specified herein, when Provider Rosters are submitted as described in
Section IV,Number 8.
Agreement to Purchase
6
CPA Foster Care Services
.Contract No: PY 03/04-SS-23A-CPA
4. Abide by all the rules and regulations of the Colorado Department of Social Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. Monitor child's progress in accordance with the treatment/case plan and the requirements
of State Department Staff Manual, Volume VII, and provide consultation and/or technical
assistance to Contractor in relation to the services purchased under this Agreement.
6. Involve Contractor in planning for the child and give the Contractor a copy of the
Discrete Case Plan at time of placement or as soon as completed and when updated or
revised.
SECTION VI. GENERAL PROVISIONS.
1. The Parties to this Agreement intend that the relationship between them, contemplated by
this Agreement is that of employer-independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, agent, or servant of County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub-contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado or federal funds,whether in
whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard
and protect personal items brought to Contractor by the Child, Contractor will be released
from responsibility for loss or damage to such personal items.
4. This Contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or affect whatsoever, unless embodied herein in writing. No subsequent
notation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written Agreement.
5. The Contract shall permit the Colorado Department of Social Services and the County to
monitor the service program, fiscal books and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the
aforementioned child through program reports, on-site visits where applicable and other
contracts as deemed necessary. The Contractor understands that the Colorado
Department of Social Services will provide consultation and technical assistance to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
6. In the event this contract is terminated, final payment to the Contractor may be withheld
at their discretion of the County until final audit. Incorrect payments to the Contractor
due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor
either by deduction from subsequent payments under this contract or other contracts
between the County and the Contractor or by the County, as a debt due to both the State
Agreement to Purchase
CPA Foster Care Services
,Contract No: PY 03/04-SS-23A-CPA
of Colorado, Colorado Department of Social Services and the County. The waiver of any
violation shall not be construed as a waiver of any other or subsequent violation of this
contract or appropriate statutes and regulations.
7. It is expressly understood and agreed that the enforcement of the terms and conditions of
this Agreement, and all rights of action relating to such enforcement, shall be strictly
reserved to the undersigned parties or their assignees, and nothing contained in this
Agreement shall give or allow any claim or right of action whatsoever by any other
person not included in this Agreement. It is the express intention of the undersigned
parties that any entity other than the undersigned parties or their assignees receiving
services or benefits under this Agreement shall be an incidental beneficiary only.
8. No portion of this Agreement shall be deemed to constitute a waiver of any immunities
the parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have created a duty of care, which did not previously exist with
respect to any person not a party to this Agreement. The parties hereto acknowledge and
agree that no part of this Agreement is intended to circumvent or replace such
immunities.
9. The Director of Social Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions are
as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Social Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Social Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services or otherwise as
provided by law.
10. The contractor shall promptly notify Social Services in the event that the Contractor
learns of any actual litigation in which it is a party defendant in a case, which involves
services provided under the agreement. The Contractor, within five (5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s)to the Social Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
Agreement to Purchase
8
CPA Foster Care Services
Contract No: PY 03/04-SS-23A-CPA
SECTION VII. ATTACHMENTS
PLACEMENT REFERRAL
FOR CPA SERVICES
(Attachment A)
Child's Name: State ID No: Date of Placement:
I. Legal Status of Child. (Mark appropriate box)
❑ Placed through a Voluntary Placement Contract signed by(Fill in Name).
❑ Placed through court order and legal custody/guardianship is held by Weld County DSS.
❑ Placed through a Petition for Review of Need for Placement with custody retained by(Fill in Name).
❑ Other (please explain)
2. Reasons for purchasing services for this child are:
REASON (If Other,please Explain)
3. Expected parent/guardian/relative involvement? ❑ Yes ❑No
Number of times per week expected for visits? 0
Will transportation for visits be provided by the facility/provider listed below? O Yes ❑No
Number of times per week transportation from facility/provider is expected? 0
Comments:
4. Services already utilized prior to placement. (Mark appropriate box)
❑ In home services ❑ Placement with Relative ❑ Cty CC Foster Care O Shelter Care
❑ CORE Services0Cty Substance Abuse Treatment
❑ Receiving Home ❑ CPA O RTC
❑ regular Foster Care
❑ Day Treatment ❑ Kinship Care ❑ Group Home ❑ Ind.Living
❑ Other(Specify)
5. Services needed within the Initial Treatment Plan. (Mark appropriate box)
Appropriate Setting:
❑ Therapeutic(Behavior Modification) O Secure ❑Other(Explain)
Appropriate Counseling:
❑ Individual ❑ Family ❑ Group
Appropriate Treatment:
❑ Sex Offender ❑ AggressiveNiolent ❑ Substance Abuse ❑❑ Truancy O Victim Behavior El Depression
Self-destructiveMan
❑ Delinquency ❑ Special Medical Needs ❑ Behavior Modification
ID Other (Explain) ❑ Anger Management
Appropriate Educational Services:
❑ Special Ed. O Public School ❑ Day Treatment
❑ On-grounds School ❑ Additional Tutoring ❑ Independent Living Training P ❑ Other (Explain)
Estimated date for accomplishing treatment plan goals are June 30,2004,or before.
6. CCAR Level of Care:(for RTC Placements Only) (Level) (copy to Business Office)
❑ It has been determined that this child is in need of rehabilitative services.
(Check Box if child is placed within a RTC)
Need Based Care Assessment Completed. (CPA Placements Only) ❑ Yes ❑ No (copy to Business Office)
7. The anticipated living arrangement of child upon completion of the Treatment Plan is:
ARRANGEMENT (If other,please explain)
If the outcomes are not achieved in the amount of time as planned,Contractor agrees to meet with the County to revise this plan.
COUNTY FACILITY
Weld County Department of Social Services Facility Name
PO Box A Trails provider ID
Greeley CO 80632 Address
City,State,Zip
Provider Info:
(If applicable) Foster Care Provider
Trails provider ID
Provider Address
Caseworker Signature City,State,Zip
(Worker Name) Date
Gloria Romansik,Administrator Signature of Person Authorized to Sign Agreement
Date Date
Agreement to Purchase
CPA Foster Care Services 9
Contract No: PY 03/04-SS-23A-CPA
COLORADO DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE ASSESSMENT
WELD COUNTY
(ATTACHMENT B)
IDENTIFYING INFORMATION
CHILD'S NAME STATE ID# SEX Trails Case ID DOB
Sex
WORKER COMPLETING ASSESSMENT HH# IDATE OF ASSESSMENT
AGENCY NAME ROVIDER NAME ROVIDER CWEST ID
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT FOR CHILDREN AGES 1 DAY
THROUGH 18 YEARS OLD.
• For each question below,please select the response which most closely applies to this child.
• Please check the number for that response in the corresponding box below.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does this child require transportation by the provider for one of the following: therapeutic or medical treatment,emotional or
social counseling,etc.,as outlined in the treatment plan or approved by the caseworker?
O0)one trip a week or less ❑1)2-3 trips a week ❑2)4-5 trips a week O3)6 or more trips a week
P 2. How often is the provider required to participate in child's therapy or counseling sessions?
❑0)one a month 01)twice a month O2)once a week O3)2 or more times a week
P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular or special
education plan?
❑0)less than a'/2 hour per day ❑1)'/2 hour a day
O2)more than'/2 hour per day,up to 2 hours per day O3)more than 2 hours per day
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time and/or activities
and/or crisis management?
❑0)less than 5 hours per week ❑1)5 to 10 hours per week ❑2)at least daily O3)on a constant basis
P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feeding,bathing,
grooming,physical,and/or occupational therapy?
❑0)less than 5 hours per week ❑1)5 to 10 hours per week
❑2) 11 to 20 hours per week O3)21 or more hours per week
A 1. How often is CPA case management required?
O0) 1 face to face contact per month and/or no crisis intervention
❑1) 2-3 contacts per month(must include 1 face to face)and/or minimal crisis intervention
O2) 2 face to face contacts per month and/or occasional crisis intervention
❑3) at least I face to face contact per week and/or ongoing crisis intervention
T 1. How often are therapy services needed to address child's individual needs per NBC assessment?
O0)not needed or Provided by another source(i.e.Medicaid) ❑1)less than 4 hours per month
❑2)4-8 hours per month ❑3)8-12 hours per month
RATING OF SERVICE AREAS Initial Assessment Date:
SERVICE AREAS 0 1 2 3
P 1 Transportation 0 0 0 0
P 2 Therapy/Counseling 0 0 0 0
P 3 Educational Intervention O O O ❑
P 4 Behavior Management ❑ 0 ❑ 0
P 5 Personal Care 0 0 0 0
A 1 Case Management 0 0 0 0
T 1 Therapeutic Services 0 0 0 ❑
Agreement to Purchase
10
' CPA Foster Care Services
Contract Nq: PY 03/04-SS-23A-CPA
COLORADO DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE ASSESSMENT
WELD COUNTY
(ATTACHMENT B Continued)
SUMMARY-Please identify all specific requirements and expectations which support Level of Care.
EVEL OF PROVIDER SERVICES NEEDED(Average of PI through P5)
ERIOD 1: LEVEL#
omments:
EVEL OF CASE MANAGEMENT SERVICES NEEDED(Al)
EVEL #
omments:
EVEL OF THERAPY SERVICES NEEDED(TI)
EVEL #
omments:
SPECIAL MEDICAL NEEDS: (Medically Fragile Children Only)
EVEL #
omments:
EXT SCHEDULED RATE REVIEW: Initial Date:
maximum of 6 month intervals)
•
Agreement to Purchase
11
CPA Foster Care Services
Contract No: PY 03/04-SS-23A-CPA
WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
NEEDS BASED CARE RATE TABLE
Calculated as Daily Rates
(Attachment C)
.. ., , . . is
LEVEL'OF RECOMMENDED RECOMMENDED AGENCY RATE INTERVENTION RATE ` MEDICAL NEEDS'.
SERVICE' PROVIDER RATE Al 'TI` ' ADDENDUM
E'E#,EIS
Level Rate Adman Overhead Case Management Ttlerapy
(Admin.Malnt,) (Admire.Maint.) :, (Adm1n),Sgrviees)
o Age 0-10...$11 47 Level 0...$4.56
iiiiLevel $4.93 .'"Level0 $0 i Level 0 $0
IT Age 11-14..$12.89 :i (Minimal CPA involvement,no
0 crisis intervention. Only doing (Therapy not needed or provided (None)
III. IIII it: by another source,i.e.mental
0 Age 15-21...$13 91 I what is necessary to maintain ii I,
iiiimonthly responsibility.) iii
Ii +$ii, .66 Respite Care 3:
Y
Ti
TT in
Iii iii„
Level1 $8.22 ii Level 1 $4.93
1 $19.07 IT. Level 1......$2.99
„'.` +$.66 Respite Care Level 1...$4.56 ig (Low level of case management,. (Regularly scheduled therapy,
iIII ($19.73) ` minimal crisis intervention,2-3 4 hours/month.)
contacts/month,minimal crisis
intervention, ii
III iii t,' 2-3 contacts/month.) ni
Tit Hi IT
iiiii ill: TT Level2 $11.51 141 Level2 $9.86
2
$25.64 t (Moderate level of case (Weekly scheduled therapy, i.1-
Level 2 $4.47
+$.66 Respite Care Level 2...$4.56 'Management including 4-8 hours a month with 4 hours of
($26.30) Weekly support services, Group therapy.)
ii I
Occasional crisis intervention, .
ir, AI Face to face contact 1 time
Iii
ii: iii Per month.) iii Tr
]thiI
Level 3 $14.79 4,. Level 3 $14.79
$32 22 (High level of case management (Regularly scheduled weekly
3 + : and CPA involvement with child : multiple sessions,can include ' Level 3 $6.02
$.66 Respite Care Level 3...$4.56 and provider including ongoing more than 1 person,i.e.family
($32.88) crisis intervention and face to "iiii therapy,for 8-12 hours/monthly.)
iii
,, face contactl-2 time per week ::
:iii minimum.)
ith th 4th l 4th.
=�l Level 4 $18.08 l's.Level 4 $14.79 "
4 $39.45 IIII(High level of case management 'T (Regularly scheduled weekly Level 4 Neg.
RTC +$.66 Respite Care ' Level 4...$4.56 ii and CPA involvement with child multiple sessions,can include
Drop ($40.11) and provider,including on-going more than 1 person,i.e.family iI
Down crisis intervention and face to Iii therapy,for 8-12 hours/monthly.) "`,
iii
face contact 2-3 times per Til
iii iIfs week minimum.) ii
Assess. Assessment iiiii
Assessment isTT
Period Period......$26.30 Period $4.56 r Assessment Period $11.51 . Assessment Period $0 iiiiI
iii (Includes Respite)
Effective 10/01/01
Agreement to Purchase
CPA Foster Care Services 12
Contract No: PY 03/04-SS-23A-CPA
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
ATTEST: aaa
dAti
, 1 Weld County Clerk to the Board
•r
I,. � \4 L i4\
a. ,k WELD COUNTY BOARD OF SOCIAL SERVICES,
' * _ ON BEHALF OF THE
iy;l el WELD COUNTY DEPARTMENT OF SOCIAL SE ES
1 1, 4.11 1
4k, .(d"�;sA:.i ' tare t -c er By:
4.1` s iS eputy Clerk to e Board —�. David E. Long,C air OCT 0 8 2003
APPROVED AS TO FORM:
„...CZ--,--t CONTRACTOR
County Atto ey
Bethany Christian Services
9185 E Kenyon Ave 190
Denver, CO 80237
•
WELD COUNTY DEPARTMENT -c tv v---P--< O`r
OF SOCIAL SERVICES
By: ,(, a\.). ,l L
Direc
Agreement to Purchase 13
CPA Foster Care Services
iris:salt;%i?,
- - DEPARTMENT OF SOCIAL SERVICES
PO BOX A
I
_ GREELEY,CO 80632
IWEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
VI pC Child Support(970)352-6933
COLORADO MEMORANDUM
TO: David E. Long, Chair Date: October 6, 2003
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services � ( u
RE: Agreement to Purchase Child Placement A ency(CPA) Services
Between Weld County Department of Social Services and Bethany
Christian Services
Enclosed for Board approval is an Agreement to purchase Child Placement Agency
(CPA) Services between the Weld County Department of Social Services and Bethany
Christian Services. This yearly Agreement is in accordance with Board approved
policies of Sections 2.320 and 2.902.22 of the Weld County Department of Social
Services Operations Manual. The Agreement was reviewed at the Board's Work Session
of October 6, 2003.
The major provisions of the Agreement are as follows:
I. The term begins October 1, 2003, and ends June 30, 2004.
2. The Department agrees to reimburse Bethany at a rate based on the Needs Based
Care Assessment levels that include room, board, and treatment services.
If you have any questions, please telephone me at extension 6510.
2003-2821
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