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HomeMy WebLinkAbout20011410.tiff RESOLUTION RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR OPTION B - HOME BASED SERVICES 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 Option B - Home Based 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 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 Option B - Home Based 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 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 1 Ell,, WELD CO TY, COLORADO ATTEST: Leilli� &Zi 1 =� M it e, CF�ir Weld County Clerk to th'� :o. � ��0 11O ,I�ftur ��. A �tLG 1 Glenn Vaacd, Pro-Tem Deputy Clerk to the Board i1-v f✓/,L,t William erke AP T ORM: David E. Long /county A rney Robert D. Mas en 2001-1410 105 SS0028 DEPARTMENT OF SOCIAL SERVICES PO BOX A GREELEY,CO 80632 ' WEBSITE:www.co.weld.co.us VI ge Administration and Public Assistance(970)352-1551 Child Support(970)352.6933., 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 of 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 TOM. 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-CORE-0010 Revision (FP-FYC-01010) Contract Award Period Name and Address of Contractor Beginning 06/01/2001 and North Colorado Medical Center-Youth Passages Ending 05/31/2002 Option B-Home Based Services 1801 16 Street Greeley, CO 80031 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance This program is based on a brief therapy Award is based upon your Request for Proposal(RFP). solution oriented model with an average length The RFP specifies the scope of services and conditions of treatment of 8-10 weeks. Two to four direct of award. Except where it is in conflict with this service hours per week per family.Yearly NOFAA in which case the NOFAA governs, the RFP capacity is 72 families. The program serves upon which this award is based is an integral part of the children and adolescents under the age of 18 and action. their families. The program serves new clients Special conditions in YP system, as well as being used as a step- 1) Reimbursement for the Unit of Services will be based down service for partial hospitalization program on a monthly rate per child or per family. clients. Clients can enter the home-based 2) The monthly rate will be paid for only direct face to program directly without being a YP day face contact with the child and/or family or as specified treatment client. Services are provided by a in the unit of cost computation. bilingual therapist who is experienced in 3) Unit of service costs cannot exceed the hourly and treatment of families with chemical dependency yearly cost per child and/or family. and domestic violence issues. 4) Payments will only be remitted on cases open with,and referrals made by the Weld County Department of Cost T.er n t of Service Social Services. Hourly Rate Per $ 82.00 5) Requests for payment must be an original submitted to Home visits include 30 minutes commute time @ the Weld County Department of Social Services by the $11.12 and 10 miles @ 3.25 end of the 25th calendar day following the end of the month of service. The provider must submit requests Unit of Service Based on Approved Plan for payment on forms approved by Weld County Enclosures: Department of Social Services. X Signed RFP:Exhibit A Supplemental Narrative to RFP: Exhibit B Recommendation(s) Conditions of Approval Appro als: Progra Official: By� Qrly By /l�►l M. J. Geile, Chair Judy . Gri o, Direc4or Board of Weld County Commissioners Wel County Department of Social Services Date: US/3042w Date: J5 2s (7 2001-1410 Signed RFP: Exhibit A North Colorado Medical Center/Youth Passages RFP: 01010-Option B-Home Based Services INVITATION TO BID DATE:February 28, 2001 BID NO: RFP-FYC-01010 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-01010) for:Family Preservation Program--Home Based Intensive Family Intervention 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 competing 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 Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK Jon Sewell TYPED OR PRINTED SIGNATURE VENDOR North Colorado Medical Center(Name) Handwritten Handwritten Signature By Authorized Officer or Agent of Vender 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 RFP-FYC-01010 Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2001-2002 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2001-2002 BID#RFP-FYC-01010 NAME OF AGENCY: North Colorado Medical renter ADDRESS: 1801 16th Street, Greeley, CO 80631 PHONE: (970 ) 352-1 056 CONTACT PERSON: Pam Johnson TITLE: Regional Dir. Behavioral Healt DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited.phased intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. 12-Month approximate Project Dates: x 12-month contract with actual time lines of: Start June 1. 2001 Start June 1 , 2001 End May 31.2002 End May 31 , 2002 TITLE OF PROJECT: Youth Passages Pam Johnson —ina.t.. achio y� .O44/ Name and Signature of Person Preparing cument Date Jon Sewell i .-----%)- 3_/7_ O ) Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2000-2001 to Program Fund year 2001-2002. Indicate No Change from FY 2000-2001 to 2001-2002 Project Description Pn Target/Eligibility Populations Types of services Provided Measurable Outcomes Service Objectives Workload Standards Staff Qualifications Unit of Service Rate Computation Program Capacity per Month Certificate of Insurance Page 26 of 32 RFP-FYC-01010 y Attached A Date of Meeting(s)with Social Services Division Supervisor: " 13 -o I} Comments by SSD Supervisor: 1 (it1 (,flea %/ f ��� % l.� o / Name and Signature of SS Supervisor Date Page 27 of 32 RFP-FYC-01010 Attached A Program Category Home Based Intensive Family Intervention Program Bid Category Project Title Youth Passages Vendor North Colorado Medical Center PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of Individuals who will have access to 24 hour service. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Therapeutic Services - includes re-parenting, family therapy, support groups, problem solving, communication skills, parent-child conflict management, etc. B. Concrete Services -means concentrated assistance in the development and enhancement of parenting skills, stress reduction, problem solving, hands-on parenting, budget management, recreational activities, etc. C. Collateral Services - teaching families to work with other community agencies such as drug and alcohol, health care,job training, information and referral, advocacy, etc. D. Crisis Intervention Services - including in-home counseling and other interventions available on a 24-hour basis. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. Page 28 of 32 RFP-FYC-01010 Attached A IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Address the following measurable outcomes: A. Child remains in home at time case is closed. B. Improvements in parental competency,parent/child conflict management and household management competency as measured by pre and post placement functional tests. C. Children who are currently in their own home will remain in their own home 12 months after the completion of Home Based Intensive Family Intervention family preservation services. D. Children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out-of- home placement 12 months after completion of Home Based Intensive Family Intervention services. E. Families who receive either family preservation or reunification services will not have a substantiated abuse or neglect 12 months after completion of Home Based Intensive Family Intervention services. F. Cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure "LOW" on the risk assessment devise at service closure. 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. Improve Family Conflict Management- Mediation and counseling designed to resolve conflicts and disagreements between parents and their children contributing to child maltreatment, running away and other status offenses. B. Improve Parental Competency- capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Household Management Competency- capacity of parents to provide a safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. D. Improve Ability to Access Resources - services shall assist parents in learning to obtain help from other sources in the community and within 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-01010 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. Number of hours per day, week or month. (Minimum intensity of 3 hours per week per family.) B. Number of individuals providing the services. C. Maximum caseload per worker. (Minimum family caseload of 8-10.) D. Modality of treatment. E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. Insurance. VII. STAFF QUALIFICATIONS 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 in Staff Manual Volume VII, Section 7.303.17, and Section 7.0006,Q, Colorado Department of Human Services? Describe. B. Total number of staff, including supervisors, available for the project. C. Will your staff have received mandated new caseworker training? D. Will your staff have knowledge in risk assessment? E. Will your staff have completed the required State Home Based Intensive Family Services training component? Page 30 of 32 FYC PROPOSAL I. PROJECT DESCRIPTION Youth Passages has been an FYC provider for eight years. Throughout that time we have provided high quality intensive treatment to youths experiencing significant emotional, behavioral, psychiatric, educational, interpersonal, familial and chemical dependency problems. Treatment modalities that we specialize in include: milieu, individual, group, experiential, behavioral and family therapy. Our family therapy program is one of the strengths of our service delivery system. Youth Passages staff has consistently demonstrated the ability to develop positive relationships and facilitate growth with an unmotivated clientele. We feel this skill base will be an asset in working with the type of families referred for Home Based Intensive Family Therapy (IFT). The Youth Passages Home Based IFT program will consist of 2 to 4 hours of direct service per week per family. The therapist assigned to these cases is bilingual and experienced in the treatment of families with chemical dependency and domestic violence issues. The treatment will be based on a brief therapy solution oriented model with an average length of treatment of 8 to 10 weeks. Youth Passages Home Based IFT will serve children and adolescents under age 18 and their families. This program will serve new clients in our system as well as being used as step down services for our partial hospitalization program clients. It should be noted that clients and their families can enter the Home Based Intensive Family Therapy program directly without having been a Youth Passages Day Treatment client. An individual treatment plan will be developed for each family to specify appropriate and attainable goals. Input from referring agencies will be utilized in the formulation of these plans. Youth Passages staff will communicate progress toward treatment goals via biweekly phone reports to WCDSS caseworkers and a written discharge summary at the end of treatment. Families who successfully complete the Intensive Family Therapy Program are invited to participate in North Colorado PsychCare"s Family Continuing Care Group. This free of charge service is offered on Thursdays from 6:00 pm to 8:00 pm at the PsychCare/Family Recovery Center building. 1 X 12 Mo Program Name of 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. 72 Total number of clients to be served in the 17-month 6 kids/month for 12 months program or 12-month program. B. 72 Total individual clients who are children under age 18 With younger children(under age 4)the parents may be the primary client C. 72 Total family units as described as follows: Immediate family and/or foster family D. 36 Sub-total of individuals who will receive bicultural/ Youth Passages will employ one full time bilingual therapist to provide services for this bilingual services program. E. 12 Sub-total of individuals who will receive services in Youth Passages does not prohibit south Weld County residents from attending our clinic South Weld County based services(i.e. IFT,Network Intervention and Multiple Impact Family Therapy). We will accept a limited percentage of cases for which we will provide services in the client's home in South Weld County. F. 72 Subtotal of individuals who will have access to PsychCare/FRC is staffed with licensed professionals 24 hours per day,365 days 24-hour services per year. These staff members will collect relevant case information and communicate it to the direct service provider as soon as possible. G. 10 The monthly maximum program capacity H.6 The monthly average capacity I. 8-10 Average stay in the program(weeks)for Home Based IFT J. 2-4 Average hours per week in the program 2 III. TYPE OF SERVICES TO BE PROVIDED A. Youth Passages Home Based IFT Program will include family therapy interventions which provide re-parenting, problem solving, communication skill building and parent-child conflict management. Families that successfully complete the program are invited to participate in North Colorado PsychCare's Family Continuing Care Group. This free of charge service is offered on Thursdays from 6:00 P.M. to 8:00 P.M. at the PsychCare/Family Recovery Center building. B. Youth Passages Home Based IFT Program will provide concentrated assistance in the development and enhancement of parenting skills, stress reduction, problem solving, "hands-on"parenting, budget management and prosocial recreational activities. C. Youth Passages Home Based IFT Program will provide education and training which enables families to improve their ability to access services from other community agencies such as drug and alcohol, health care,job training, information and referral and client advocacy. D. Youth Passages Home Based IFT Program will include in-home counseling for referred clients. PsychCare/FRC is staffed with licensed professionals 24 hours per, 365 days per year. These staff members will collect relevant case information and communicate it to the direct service provider as soon as possible. Quantitative Measures A. 100% of clients will receive family therapy services that include re-parenting, problem solving, communication skill building and parent-child conflict management. B. 100% of clients will receive therapy services that assist in the development and enhancement of parenting skills, stress reduction, problem solving, "hands-on"parenting, budget management and prosocial recreational activities. C. 100% of clients will receive collateral services which include teaching families to work with other community agencies. D. 100% of clients will receive in-home family therapy services and clients will be able to call in to speak with a licensed professional 24 hours a day, 365 days a year. This professional will pass on the relevant information to the assigned therapist as soon as the therapist is available. 3 North Colorado PsychCare/Family Recovery Center deals daily with patient funding issues which include mental health capitation, ADAD and private insurance. We will not utilize FYC funds when other payer sources are available. IV. MEASURABLE OUTCOMES A. 80% of children remain in the home at time the case is closed. This will be tracked by gathering relevant information at discharge. B. 80% of clients will demonstrate improvements in parental competency, parent/child conflict management and household management competency as measured by pre and post placement functional tests. This will be measured via an approved parenting skills inventory administered at admission and discharge. C. 75% of children who are currently in their own homes will remain at least 12 months after the completion of Home Based Intensive Family Intervention family preservation services. This will be measured via FYC follow-up questionnaire administered 12 months after discharge. D. 70% of children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out-of-home placement 12 months after completion of Home Based Intensive Family Intervention services. This will be measured via: 1) gathering relevant info at discharge; and 2) FYC follow-up family questionnaires administered 12 months after discharge. E. 75% of families who receive either family preservation or reunification services will not have a substantiated abuse or neglect case 12 months after completion of Home Based Intensive Family Intervention services. This will be measured via a follow-up phone call to the assigned WCDSS caseworker. F. 75% of cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure "LOW" on the risk assessment devise at service closure. 4 This will be measured by an approved questionnaire at the time of discharge. V. SERVICE OBJECTIVES A. 80% of our clients will demonstrate improved family conflict management which will lead to decreased child maltreatment, running away and other offenses. This will be measured via an approved parenting skills and family functioning inventory administered at admission and discharge. B. 80% of our clients will demonstrate improved parental competency as based on their capacity to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions and supervision. This will be measured via an approved parenting skills inventory administered at admission and discharge. C. 80% of the parents will demonstrate an improved capacity to provide a safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. This will be measured via an approved parenting skills inventory administered at admission and discharge. D. 100% of our clients will have increased their knowledge of and ability to access other resources in the community and those offered by the local, state and federal governments. This will be measured via an approved parenting skills inventory administered at admission and discharge. VI. WORKLOAD STANDARDS A. The person providing this service for North Colorado PsychCare will be a fulltime bilingual therapist who will not work more than 40 hours per week, 173 (on average) per month, and 2080 per year. One per diem Master's Level therapist will be available to assist in high census periods. B. Youth Passages plans on treating no more than 10 families concurrently at its maximum capacity. This caseload will be handled by Master's Level therapist(s). 5 C. Maximum caseload per therapist - 7 D. The treatment modality is a systems based approach to family therapy. The treatment philosophy is brief therapy with solution oriented interventions. Anticipated duration of treatment is 8 to 10 weeks. E. Total Number of Hours of Service - 2 hours per day of family therapy (on days clients are seen) 4 hours per week of family therapy 16 hours per month of family therapy F. Total number of individuals providing these services- 1 fulltime bilingual therapist 1 per diem therapist for high census G. Maximum caseload per supervisor- 10 H. Insurance - See attached certificate of insurance VII. STAFF QUALIFICATIONS A. The Behavioral Health Therapist(s) providing services will have a minimum of a Master's Degree in psychology, counseling, social work or a related field and work experience treating children, adolescents and families. B. Two staff members will be available for the direct service phase of this project with one additional staff member providing supervision. Additional direct service staff is available on a per diem basis if census dictates. C. Youth Passages staff members will participate in mandated orientation and training as required by NCMC. Our providers are not employees of DSS and should not require the 12 days of training mandated for new caseworkers. We are open to discussing orientation and short term training for our therapists in order for them to become more familiar with DSS rules and regulations. D. The therapists providing services to this program will be fully trained to cover all aspects of the Behavioral Health Therapist II position at North Colorado Medical Center. This includes providing assessment coverage at the Emergency Department as well as providing care to involuntary patients on our locked psychiatric unit. A significant portion of the 6 training for this position includes risk assessment, involuntary treatment and legal reporting requirements. E. Our staff members are not employees of the State of Colorado and should not be subject to state training requirements. As previously mentioned, our therapists possess a minimum of a Master's Degree in psychology, counseling, social work or related field. They also possess direct service experience providing family therapy to at risk children and adolescents. We are open to discussing an orientation period for our therapists to become more familiar with the requirements and requests of DSS. 7 Computation of Direct Service Rate IFT Option B-Home Based Total hours of Direct Service/Client 40 Hours A _ Total Clients to be served I 60 Clients B Total Hours of Direct Service For year line A X B 2400 Hours C Cost/hour of Direct Service $ 40.37 Per Hour D Total Direct Service Costs C X D $ 96,888.00 E Administrative Costs $ 43,600.00 F Costs—r- Overhead Cost s 45,992.00 G Total Costs direct/allocated E+F +G $ 186,480.00 H Anticipated Profits $ 10,320.00 I Total Costs/Profits H + I $ 196,800.00 J Total Hours of Direct Service for Year must equal C 2400 K Rate per Hour of direct face to face se $ 82.00 L Note: Home visit includes: 30 minutes commute time O1112 10 miles @ $3.25 RFP-FYC-01010 Attached A Day Treatment Programs Only: Direct Service House Per Client Per Month [M] Monthly Direct Service Rate $ [N] [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, 2001. [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. [O] 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 °*ad' • 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,‘ ✓vu9k, Philip B. Holt Insurance Manager 1801 16th St. • Greeley,CO 80631 • 970-352-4121 • Fax 970-350-6644 • ncmcgreeley.com Hello