HomeMy WebLinkAbout20011412.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR DAY
TREATMENT PROGRAM AND AUTHORIZE CHAIR TO SIGN - NORTH COLORADO
MEDICAL CENTER -YOUTH PASSAGES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Notification of Financial Assistance
Award for a Day Treatment Program between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Social Services, and North Colorado Medical Center-Youth Passages, commencing
June 1, 2001, and ending May 31, 2002, with further terms and conditions being as stated in
said award, and
WHEREAS, after review, the Board deems it advisable to approve said award, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the Notification of Financial
Assistance Award for a Day Treatment Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Social Services, and North Colorado Medical Center- Youth Passages, be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said award.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 30th day of May, A.D., 2001.
BOARD OF COUNTY COMMISSIONERS
t1\SS :.,
WELLDDCO TY, COLORADO
ATTEST: ^2 / $
Weld County Clerk to thiii
-',r"1 .F c`'•°":• �� U//
nn Vaad, Pro-Tem
BY:
deizeAJ
Glenn
Deputy Clerk to the Boar.
Willi . Jerker
APP A5 TfJr RM:
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C) n Att me
Robert D. Masden
2001-1412
pc - SS SS0028
•_itati
DEPARTMENT OF SOCIAL SERVICES
PC BOX A
GREELEY,CO 80632
1lits WEBSITE:www.co.weld.co.us
VIII Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
COLORADO
MEMORANDUM
TO: M. J. Geile, Chair Date: May 23, 2001
Board of County Commissioners
FR: Judy Griego, Director a
Weld County Departme of S ial Se ices
RE: PY 2001-2002 Notification of Financial Assistance Awards (NOFAA)under Core
Services Funds-North Colorado Medical Center, PsychCare, Youth Passages
Enclosed for Board approval are the PY 2001-2002 Notifications of Financial Assistance
Awards (NOFAA) for Families, Youth, and Children Commission (FYC) Core Services
Funds, which are for the period of June 1, 2001,through May 31, 2002.
The Families, Youth and Children Commission (FYC) reviewed proposals under a
Request for Proposal process and are recommending approval of these bids.
North Colorado Medical Center, PsychCare,Youth Passages
A. Option B-Home Based Intensive: Program serves children and adolescents under
the age of 18 and their families, new clients in the YP system, as well as being
used as a step-down service for partial hospitalization program clients. Yearly
capacity is 72 families, two to four hours of direct service per week per family,
with an average length of treatment of 8-10 weeks. Services provided by a
Bilingual therapist who is experienced in the treatment of families with chemical
dependency and domestic violence issues. Rate is$82/hour. Home visits include
30 minutes commute time at $11.12 and 10 miles at$3.25.
B. Intensive Family Therapy_A maximum of 72 clients under the age of 18 for two to
four hours c f brief solution-based therapy per week per,family at an average of 8
to 10 weeks. Home visits will be considered on a case-by-case basis. Rate is
$82.00/hour; $1,800 Multiple Contact rate; $1,800 Network Intervention Rate.
MEMORANDUM TO M. J. GEILE, CHAIR
WELD COUNTY BOARD OF COMMISSIONERS
RE: CORE SERVICE NOFAA PY 2001-2002-NCMC,PSYCHCARE,YOUTH PASSAGES
C. Day Treatment. Sixty adolescents (10-18 years) and/or (range of 5 years to 18
years)per year, 12 monthly average capacity, 40 hours weekly.for 6-10 weeks.
Average hours in intensive outpatient program is 12. Rate is$19/hour;
$2,090/month.
D. Foster Parent Consultation: Two hours of direct service per week,for a period of
six weeks for foster parents under corrective action. Timelines for other types of
foster parent consultation cases will be within the parameters set by WCDSS.
Bilingual services are available. Families completing service are invited to attend
PsychCare's Family Continuing Care Group, a free service offered weekly at the
PsychCare/Family Recovery Center Building. Total number of families estimated
to be served per year is 60, monthly maximum program capacity is seven,
monthly average capacity is five, average stay in the program is six weeks,
average hours per week is two. Rate is$71.25 per hour. Group rate is$85 per
hour per group.
If you have any questions, please telephone me at extension 6510.
of
Page 2 of 2
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 FY01-PAC-10000
Revision (RFP-FYC-01006)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2001 and North Colorado Medical Center-Youth Passages
Ending 05/31/2007 Day Treatment Program
1801 16th Street
Greeley, CO 80631
Computation of Awards Descr tion
Unit of Service The issuance of the Notification of Financial Assistance
Adolescent Partial Hospitalization is a program Award is based upon your Request for Proposal(RFP).
designed to address the multifaceted needs of The RFP specifies the scope of services and conditions
adolescents experiencing significant emotional, of award. Except where it is in conflict with this
behavioral, educational, interpersonal, familial NOFAA in which case the NOFAA governs, the RFP
problems, and adolescents suffering from a wide upon which this award is based is an integral part of the
range of psychiatric disorders and chemical action.
dependency. 60 adolescents (10-18 years) per
year, and/or (range of 5-18 years) 12 monthly Special conditions
average capacity, 40 hours per week, for 6-10
weeks. Average hours in intensive outpatient 1) Reimbursement for the Unit of Services will be based
program is 12. on a monthly rate per child or per family.
2) The monthly rate will be paid for only direct face to
Cost Per Unit of Service face contact with the child and/or family, as specified
in the unit of costs computation.
Hourly Rate Per Unit of Service $ 19.00 3) Unit of service costs cannot exceed the hourly and
Monthly Rate $2.090.00 yearly cost per child and/or family.
Based on Approved Plan (Day-Treatment) 4) Payment will only be remitted on cases open with, and
referrals made by the Weld County Department of
Enclosures: Social Services.
X Signed RFP:Exhibit A 5) Requests for payment must be an original submitted to
Supplemental Narrative to RFP: Exhibit B the Weld County Department of Social Services by the
Recommendation(s) end of the 25th calendar day following the end of the
Conditions of Approval month of service. The provider must submit requests
for payment on forms approved by Weld County
Department of Social Services.
Approvals:ro� Program Official:
By/! Lla By O
M. J. eile, Chair JudyGkego, irect r
Board of Weld County Commissioners Weld County Department of Social Services
Date: c5/,3o//2cb l Date: 423/Q f
1 2001-1412
Signed RFP: Exhibit A
North Colorado Medical Center/Youth Passages
RFP: 01006-Day Treatment
INVITATION TO BID
DATE: February 28, 2001 BID NO: RFP-FYC-01006
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-01006) for:Family Preservation program Day Treatment Program Family
Issue's Cash Fund or Family Preservation Program Funds
Deadline: March 23, 2001, 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 Statewide Family Preservation Program (C.R.S. 26-5.5-101) and
Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement(C.R.S. 26-5.3-
101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1,
2001, through May 31, 2002, at specific rates for different types of service, the county will authorize approved
vendors and rates for services only. The Day Treatment Program Category must provide a comprehensive, highly
structured program alternative to placement or more restrictive placement that provides therapy and education
for children. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Jon Sewell
TYPED OR PRINTED SIGNATURE
VENDOR North Colorado Medical Center
(Name) Handwritten Signature By Authorized
Officer or Agent of Vendor
ADDRESS 1801 16th Street TITLE Administrator
Greeley, CO 80631
DATE
PHONE# ( 970) 352-1056
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
TtFP-FYC-01006 Attached A
DAY TREATMENT PROGRAM BID PROPOSAL
FAMILY PRESERVATION PROGRAM
2001/2001 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2001-2002
BID#RFP-FYC-01006
NAME OF AGENCY: North Colorado Medical Center
_ADDRESS: 1801 16th Street, Greeley, CO 80631
PHONE: (9701 352-1056
CONTACT PERSON: Pam'Johnson TITLE:Regional Dir. Behavioral Health
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: 1kv 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 ,Tune 1. 2001 Start June 1 , 2001
End May 31.2002 End May 3-1 , 2002
TITLE OF PROJECT: Youth Passages
Pam Johnson '763 .)-n- ,21E j-(.- -�/i/Pki
Name and Signature of Person Preparin ocument Date
Jon Sewell ---) „a- 3-/7- n e
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 2000-2001
to Program Fund year 2001-2002.
Indicate No Change from FY 2000-2002
4 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
Page 26 of 32
RFP-FYC-01006 Attached A
Date of Meeting (s) with Social Services Division Supervisor: J -7- 0
Comments by SSD ySupervisor: yg4L Rk.ccRSc'c QMy T3-tu1"A-2-�-•-t Cerv-I 1 h ✓-e S
bit ` L a i4w..n R..,..: w.fs :5 to x ni.ec p S
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Name and Signature of SSD Supervisor ,
C ..- -' 0- Date
Page 27 of 32
RFP-FYC-01006
Attached A
Program Category Day Treatment Program Bid Category
Project Title Youth Passages
Vendor North Colorado Medical Center
PROJECT DESCRIPTION
Provide a brief one-page description of the project.
IL 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
RFP-FYC-01006 Attached A
E. Assessment and plan to meet the needs of child and family including:
1. Education through a certified teacher.
2. Vocational/Independent living for age appropriate children.
3. Individual and family therapy which includes all family members.
4. Physical health needs, i.e., nutrition, medical, dental, sex education, HIV, contraception,
etc.
5. Mental health needs such as psychotropic medications, etc.
F. Proactive planning for transition to public school setting or independent living:
1. Reintegration into public school.
2. Follow-up for individual and family therapy.
3. Completion of Day Treatment.
4. Identifies progress/outcomes.
5. Reinforces gains.
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
Provide a two page description of your expected measurable outcomes of the project. Please address the
following measurable outcomes:
A. The children completing the Day Treatment Program will be residing in their own homes 6
months after discharge from the program.
B. The children will enter public school upon graduation from Day Treatment.
Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and
monitor each quantitative measure.
V. SERVICE OBJECTIVES
Provide a one page description of your expected service objectives and quantitative measures. Address,
at a minimum, the following ways the project will:
A. The number of children placed within six months of Day Treatment graduation/discharge.
B. The number of children that were enrolled in public school from graduation/discharge from the
Day Treatment Program.
C. Improve ability to access resources - services shall assist parents to work with other sources in
the community and ahead the local, state, and federal governments.
Describe the methods you will use to measure, evaluate, and monitor each service objective.
Page 29 of 32
RFP-FYC-01006
Attached A
VI. WORKLOAD STANDARDS
Provide a one page description of the project's work load standards and quantitative measures. Address,
at a minimum, the following areas:
A. Total number of children and families served.
B. Duration/length of time in program.
C. Total number of hours per day/week/month.
D. Total number of individuals providing these services.
E. Insurance.
VII. STAFF QUALIFICATIONS
Please provide a one-page description of staff qualifications and address, at a minimum, the following:
A. Will your staff, including supervisors, who are providing direct services have the minimum
qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17,
and Section 7.000.6, Q, Colorado Department of Human Services. Describe.
B. Total number of staff, including supervisors, available for the project.
C. Total number of counselor and/or treatment leader(s) to the number of children ages 5 years to 13
years. (Minimum expectation is 1 staff member to 8 children.)
D. Total number of counselor and/or treatment leader(s) to the number of children ages 16 years and
over. (Minimum expectation is 1 staff member to 10 children.)
Page 30 of 33
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. As a
partial hospitalization program, 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). When indicated, psychotropic medications are
also administered. In addition, an accredited BOCES classroom staffed by an affective
needs teacher 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 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. 60 Total number of clients to be served in the 17-month 5 youth/month for 12 months
program or 12-month program.
B. 60 Total individual clients who are ages 10 through 18; and/or All Youth Passages participants are from 10 to 18 years old
(Range is 5 years to 18 years)
C. 60 Total family units as described as follows:
Immediate family and/or foster family
D. 0 Sub-total of individuals who will receive bicultural/
bilingual services
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 '01 & '02.
F. 12 The monthly maximum program capacity
G. 7 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 to 4:00 p.m.
treatment*** **Length of time is estimated for each program component.
12 Average hours per week in the program for intensive Children participating in both day treatment and intensive
outpatient program outpatient services will have length of stay up to 20 weeks.
2
Yes/No (Be Specific)
Explain How This Item
Will Be Met
3. TYPE OF SERVICE TO BE PROVIDED:
Will your project provide services as follows:
A. Site based services with a minimum of 5 hrs. per day? Yes M-F 8:00 a.m. - 4:00 p.m.
M-F 12:00 p.m.-4:00 p.m.
B. Community collaboration efforts among: 1) Continue collaboration with MD referrals from DSS.
1) The Department of Social Services? Yes 2) Continue collaboration with MD and referrals to-from
2) The Department of Mental Health? Yes NRBH
3) The Department of Education? Yes 3) Youth Passages provides education thru Centennial BOCES
4) Others (Please Describe)?
C. Program components of:
1) Educational? Yes 1) School 5 days per week
2) Therapeutic? Yes 2) Group treatment 5 days per week
Individual therapy as indicated
Family therapy a minimum of one time per week
3) Behavioral? Yes 3) Strong milieu management daily
4) Recreational? Yes 4) Provided 3 days per week
5) Substance Abuse Programming Yes 5) Minimum of 2 days per week
D. Parental/Caretaker involvement in all program components as indicated in the
case plan and as required? Yes Required; family signs family contract to participate in
family therapy and education
E. Assessment and plan to meet the needs of child and family including:
1) Education through a certified teacher? Yes 1) On-site school
2) Vocational/Independent living for age appropriate children? No 2) N/A
3) Individual and family therapy which includes all family members? Yes 3) Family therapy a minimum of one time per week
4) Physical health needs, i.e., nutrition, medical, dental, sex education, Yes 4) All attended by physician minimum of once per week
HIV, contraception, etc.? Nutritional consults available as needed via NCMC
Nutritionist
5) Mental health needs such as psychotropic medications, etc? Yes 5) Evaluated by physician weekly
3
Yes/No (Be Specific)
Explain How This Item
Will Be Met
3. TYPE OF SERVICE TO BE PROVIDED: (Continued)
F. Proactive planning for transition to public school setting or independent
living:
1) Reintegration into public school? Yes 1) Adolescents transitioned back into home school or viable
alternative
2) Follow-up for individual and family therapy? Yes 2) Follow-up via North Colorado PsychCare's Intensive
Outpatient Program and outpatient services or community
therapists
3) Completion of Day Treatment? Yes 3) Youth Passages will complete day treatment or intensive
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
QUANTITATIVE MEASURES
(Relate to previous described services)
Total Number to be served up to 12 continuous months plus completion of partial
semester the child is enrolled n Please refer to program description which defines Youth
Passages' role in the community in relation to other professional
Fl. 96 Services in the county.
F2. 96
F3. 80
F4. 96
F5. 96
4
Yes/No (Be Specific)
Explain How This Item
Will Be Met
4. MEASURABLE OUTCOMES
Will your project provide the measurable outcomes as follows:
a. The children completing the Day Treatment Program will be residing in their Yes *80% will be residing in their own homes
own homes 6 months after discharge from the program.
b. The children will enter public school upon graduation from Day Treatment. Yes *80% will enter public school; 20% will enter other forms of
education(ie: Homebound, home school, Aims, or work study)
Total = 100%
QUANTITATIVE MEASURES
(Relate to actual outcomes at time of discharge and to previous described
measurable outcomes) *These statistics are tracked through the utilization of PAC
Total Numbers follow-up questionnaire. Refer to 94-95 PAC Grant, page 5,
dated 1/7/94. If we do not receive appropriate information via
3a. 77 (rounded) this method phone calls will be made to families and DSS
caseworkers to assess current living situation.
3b. 96
3c. Other
5
Yes/No (Be Specific)
Explain How This Item
Will Be Met
5. SERVICE OBJECTIVES
Will your project provide the service objectives as follows:
a. The number of children placed within six months of Day Treatment graduation/ Yes 20% of Youth Passages graduates may be placed in out-of-home
discharge. placement by DSS within 6 months of graduation from Youth
Passages.
b. The number of children that were enrolled in public school from graduation/ Yes 100% of children are enrolled in public school or other
discharge from the Day Treatment Program. education (ie: Homebound, workstudy, Aims).
c. Improve parents' ability to access full range of community services. 100% of parents, guardians, foster parents or residential
Yes 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.
QUANTITATIVE MEASURES
(Relate to previously described service objectives)
Total Number How will these services be measured? Utilization of PAC follow-up questionnaire. Refer to 94-95
PAC grant, page 5, dated 1/7/94. Phone calls to families and
DSS caseworkers will be utilized to gather data if necessary.
5a. 19
5b. 96
5c. 96
nrbh
6
Yes/No
(Be Specific)
Explain How This Item
Will Be Met
6. WORKLOAD STANDARDS
Will your project be measured by:
Yes
a. Total number of children and families served. 96 youth per year and their families.
b. Duration/length of time in program. Anticipated average length of stay in treatment is 12-20 weeks.
c. Total number of hours per day/week/month Youth Passages: 8 hours per day, 40 hours per week; 160
hours per month.
Intensive Outpatient Program: 4 hours per day M,W,F
12 hours per week; 48 hours per month.
Outpatient Program: Individual and family therapy scheduled
in one-hour increments as needed. Group therapy scheduled
in two-hour increments as needed.
d. Total number of individuals providing these services. Five full-time staff members dedicated solely to adolescent
services with per diem therapists and staff available as
needed. MD contracted to see patients a minimum once per
week.
e. Insurance
See attached insurance certificate
7
Yes/No (Be Specific)
Explain How This Item
Will Be Met
7. STAFF QUALIFICATIONS
A. Will your staff who are providing direct services have the minimum qualifications Yes Personnel staffing at Youth Passages meets or exceeds standards
as enumerated in Volume VII(7.303)? enumerated in Vol. VII(7.303).
B. Total number of staff(5 full time, MD part time) 1 Teacher
available for project based on projected average daily census of 10. 2 Behavioral Health Therapists
(per diem therapists and team assistants if census dictates) 1 Behavioral Health Team Assistant
1 Behavioral Health Youth Clinical Coordinator
C.. 2 staff member to 5 children ages 5 years to 13 years
(minimum is 1 staff member to 8 children)? All participants of Youth Passages are between 10 and 18 years
old
D. 2 staff member to 6 children ages 16 years and over
(minimum is 1 staff member to 10 children)? A full census is 18 and the number of kids at each age varies
week to week. We will increase our staffing pattern per
guidelines outlined in sections c and d when census is greater
than 11.
8
RFP-FYC-01006 Attached A
VIII. COMPUTATION OF DIRECT SERVICE RATE
This form is to be used to provide detailed explanation of the hourly rate your
organization will charge the Core Services Program for the services offered in this
Request for Proposal. This rate may only be used to bill the Weld County Department of
Social Services for direct, face-to-face services provided to clients referred for
these services by the Department. Requests for payment based on units of service such
as telephone calls, no shows, travel time, mileage reimbursement, preparation,
documentation, and other costs not involving direct face-to-face services will not be
honored. Likewise, billings must be for hours of direct service to the client,
regardless of the number of staff involved in providing those services. Therefore, it
is imperative that this rate be sufficient to cover all costs associated with this
client, regardless of the number of staff involved in providing these services.
(Explanations for these Lines are Provided on the Following Page)
Total Hours of Direct Service per Client 640 Hours [A]
Total Clients to be Served 96 Clients [B]
Total Hours of Direct Service for Year 61 , 440 Hours [C]
(Line [A] Multiplied by Line [B]
Cost per Hour of Direct Services $ 13 . 95 Per Hour [D]
Total Direct Service Costs $ 857, 088 . 00 [E]
(Line [C] Multiplied by Line [D] )
Administration Costs Allocable to Program $ 47, 000. 00 [F]
Overhead Costs Allocable to Program $ 260, 000 .00 [0]
Total Cost, Direct and Allocated, of Program$1 , 164 , 088 .00 [H]
Line [E] Plus Line [F] Plus Line [O] )
Anticipated Profits Contributed by this Program $ 3 , 272 . 00 [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line [I] ) $1 , 167. 360 . 00 [,I]
Total Hours of Direct Service for Year 61440 [K]
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 19 .00 [L]
Page 31 of 32
RFP-FYC-01006 Attached A
Day Treatment Programs Only:
Direct Service House Per Client Per Month 110 [M]
Monthly Direct Service Rate $ 2, 090 . 00 EN]
[A] This is an estimate of the total hours of direct, face-to-face service each client will
receive from the time he or she enters the program until completing the program.
[B] This is an estimate of the number of clients who will be served during the period from
June 1, 2001, through May 31, 2002 .
[D] This represents the average hourly salary and benefits that your organization pays its
direct service providers plus any costs which are directly attributable to the face-to-
face session with the client.
[F] This represents the salary and benefits of direct service, supervisory, and clerical
personnel which are not incurred in providing direct, face-to-face service to the
client, but can be allocated to this program for time spent on the program for
activities such as travel, phone conversations, "no-shows, " discussions with involved
parties, meeting preparation, and report completion.
[C] This represents the Agency Overhead costs, such as Rent, Utilities, Supplies, Postage,
Travel Reimbursement, Telephone Charges, Equipment, and Data Processing which are not
incurred in providing direct, face-to-face service to the client, but can be allocated
to this program for time spent on the program for activities such as travel, phone
conversations, "no-shows," discussions with involved parties, meeting preparation, and
report completion.
[H] This represents the Grand Total Costs directly attributable or allocable to this
program. It should be a reasonable assumption that if you decided to discontinue this
program, your agency would realize a reduction in costs approximately equal to this
amount.
[I] This represents the total amount of profit your firm expects to realize as a result of
operating this program. Any difference between Lines [H] and [J] must be substantiated
by an amount indicated on this line.
[L] This is the actual direct, face-to-face hourly service rate at which you will be
requesting payment for the services provided under the conditions of this Request for
Proposal.
[M] To be completed by prospective providers of the Day Treatment Program only, this line
represents the estimated number of hours per month your organization will provide
direct, face-to-face services per client.
[N] To be completed by prospective providers of the Day Treatment Program services only,
this line represents the actual direct, face-to-face monthly service rate at which you
will be requesting payment for the services provided under the conditions of this
Request for Proposal. Calculated by multiplying Line [L] by Line [M] .
Page 32 of 32
North Colorado Medical Center
Banner Health Colorado
March 14, 2001
TO WHOM IT MAY CONCERN:
RE: BANNER HEALTH SYSTEM
This is to advise that Banner Health System, along with its subsidiary operations, are self-insured
through the BHS Self-Insured Liability Trust. The coverage is continuous. This coverage
extends to all corporate entities as well as any employee working within the scope of their
employment. The limits provided by the BHS Self-Insured Liability Trust are at least $2,000,000
per occurrence/$15,000,000 in the aggregate.
Excess liability limits of$25,000,000 are provided through the American Healthcare System
Risk Retention Group.
If additional information is necessary, please contact Philip Holt, Insurance Manager at Banner
Health System, Post Office Box 6200, Fargo, North Dakota 58106-6200 (701/277-7577) (FAX
701/277-7636).
Sincerely,
Ph,i \�a�T pA,cc,
Philip B. Holt
Insurance Manager
1801 16th St. • Greeley,CO 80631 • 970-352-4121 • Fax 970-350-6644 • ncmcgreeley.com
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