HomeMy WebLinkAbout20001306.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR CORE SERVICES AND
AUTHORIZE CHAIR TO SIGN - ISLAND GROVE REGIONAL TREATMENT CENTER,
INC.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Child Protection Agreement for Core
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 Island
Grove Regional Treatment Center, Inc., commencing June 1, 2000, and ending May 31, 2001,
with further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the Child Protection
Agreement for Core 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 Island Grove Regional Treatment Center, Inc., 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 31st day of May, A.D., 2000.
BOARD OF COUNTY COMMISSIONERS
W LD COUNTY, COLO DO
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Barbara J. kmeyer, hair
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► into the Board
eorg E. Baxter
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Dale K. Hall
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2000-1306
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DEPARTMENT OF SOCIAL SERVICES
PO BOX A
CO
GREELEY,C 80632
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
MEMORANDUM
O Barbara J. Kirkmeyer, Chair Date: May 17, 2000
COLORADO Board of County Commissioners
FR: Judy A. Griego, Director, Social Services teL '°�
RE: Child Protection Agreement for Core Servic s Between the Weld
County Department of Social Services and Island Grove Regional
Treatment Center, Inc.
Enclosed for Board approval is a Child Protection Agreement for Core Services between
the Weld County Department of Social Services and the Island Grove Regional
Treatment Center, Inc.
The major provisions of the Agreement are as follows:
1. The term of the Agreement commences June 1, 2000, and ends May 31, 2001.
2. The Department agrees to reimburse Island Grove for services in an amount not to
exceed $52,398. The costs of these services are itemized in the Agreement.
3. Island Grove agrees to provide alcohol and drug services to families, children and
youth in child protection or Youth In Conflict. These services include:
assessments, treatment, women's services, youth services, residential services,
and other services.
If you have any questions, please telephone me at extension 6510.
2000-1306
5sOoz-7
CHILD PROTECTION AGREEMENT FOR CORE SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND THE ISLAND GROVE REGIONAL TREATMENT CENTER, INC.
This Agreement, made and entered into the th day of May 2000, by and
between the Board of Weld County Commissioners, on behalf of the Weld County
Department of Social Services, hereinafter referred to as "Social Services," and Island
Grove Regional Treatment Center an approved, Compass provider, referred to as "Island
Grove".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been
accomplished from and with appropriate agencies; and
WHEREAS, the Child Welfare Settlement Agreement requires, among other
things, Social Services to obtain outpatient core services for eligible clients who are at
imminent risk for out-of-home placement in the category of alcohol and drug services;
and
WHEREAS, the Colorado Department of Human Services has provided Family
Issues Cash Fund resources to Social Services for outpatient and residential core services
for families, children, and adolescents; and
WHEREAS, Social Services and Island Grove desire to enter into an agreement in
providing outpatient and residential services for families, children, and adolescents.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant
and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2000, upon proper execution of
this Agreement and shall expire May 31, 2001.
2. Scope of Services
Services shall be provided by Island Grove to any person(s) eligible for child
protection services in compliance with Exhibit A"Scope of Services," a copy of
which is attached by reference.
a«0 - ,30‘
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule,"
and Exhibit C, "Region I Core Services Fee Schedule," copies of which
are attached and incorporated by reference.
"Payment Schedule" shall establish the maximum reimbursement which
will be paid from Family Issues Cash Fund during the duration of this
Agreement.
b. Island Grove shall submit an itemized monthly bill to Social Services for
all costs incurred and services provided pursuant to Exhibit A of this
Agreement in accordance with criteria established by Social Services. The
Contractor shall submit all itemized monthly billings to Social Services no
later than the fifteenth(15) day of the month following the month the cost
was incurred.
Failure to submit monthly billings in accordance with the terms of this
agreement may result in Island Grove's forfeiture of all rights to be
reimbursed for such expenses. In the event of a forfeiture of
reimbursement, Island Grove may appeal such circumstance to the
Director of Social Services. The decision of the Director of Social
Services shall be final.
c. Payments of costs incurred pursuant to this Agreement is expressly
contingent upon the availability of Family Issues Cash Fund funds to
Social Services.
d. Social Services shall not be billed for, and reimbursement shall not be
made for time involved in activities outside of those defined in Exhibit A
or in the "Weld County Guidelines." Work performed prior to the
execution of this Contract shall not be reimbursed or considered part of
this Agreement.
4. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Island Grove shall provide proper monthly invoices and verification of
services performed for costs incurred in the performance of the agreement.
b. Social Services may withhold any payment if Island Grove has failed to
comply with the Financial Management Requirements, program
objectives, contractual terms, or reporting requirements. In the event of a
forfeiture of reimbursements, Island Grove may appeal such circumstance
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to the Director of Social Services. The decision of the Director of Social
Services shall be final.
5. Assurances
Island Grove shall abide by all assurances as set forth in the attached Exhibit D,
which is attached hereto and incorporated herein by reference.
6. Compliance with Applicable Laws
At all times during the performance of this contract, Island Grove/Signal shall
strictly adhere to all applicable federal and state laws, orders, and all applicable
standards, regulations, interpretations or guidelines issued pursuant thereto. This
includes the protection of the confidentiality of all applicant/recipient records,
papers, documents, tapes and any other materials that have been or may hereafter
be established which relate to the Contract. Island Grove acknowledges that the
following laws are included:
- Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d—1 et.
seq. and its implementing regulation, 45 C.F.R. Part 80 el sea.: and
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
its implementing regulations, 45 C.F.R. Part 84; and
the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 el seq. and
its implementation regulations, 45 C.F.R. Part 91; and
Title VII of the Civil Rights Act of 1964; and
- the Age Discrimination in Employment Act of 1967; and
- the Equal Pay Act of 1963; and
- the Education Amendments of 1972; and
- Immigration Reform and Control Act of 1986, P.L. 99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of
race, color, national origin, and, sex, religion and handicap, including Acquired
Immune Deficiency Syndrome (AIDS) or AIDS related conditions, covered under
Section 504 of the Rehabilitation Act of 1973, as amended, cited above. Included
is 45 C.F.R. Part 74 Appendix G 9, which requires that affirmative steps be taken
to assure that small and minority businesses are utilized, when possible, as
sources of supplies, equipment, construction and services. This assurance is given
in consideration of and for the purpose of obtaining any and all federal and/or
state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file
a complaint either with the Colorado Department of Human Services or with the
U.S. Department of Health and Human Services, Office for Civil Rights.
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7. Certifications
Island Grove certifies that, at the time of entering into this Contract, it has
currently in effect all necessary licenses, approvals, insurance, etc. required to
properly provide the services and/or supplies covered by this contract.
8. Monitoring and Evaluation
Island Grove and Social Services agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by Island Grove and Social
Services. The results of the monitoring and evaluation shall be provided to the
Board of Weld County Commissioners and Island Grove.
Island Grove shall permit Social Services, and any other duly authorized agent to
governmental agency, to monitor all activities conducted by the contractor
pursuant to the terms of this Agreement. As the monitoring agency may in its
sole discretion deem necessary or appropriate, such program data, special
analyses, on-site checking, formal audit examinations, or any other reasonable
procedures. All such monitoring shall be performed in a manner that will not
unduly interfere with agreement work.
9. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
10. Remedies
The Director of Social Services or designee may exercise the following remedial
actions should s/he find Island Grove 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 Island
Grove. These remedial actions are as follows:
a. Withhold payment of Island Grove 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
Island Grove 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. Incorrect payment to Island Groves due to omission, error, fraud, and/or
defalcation shall be recovered from Contractor by deduction from
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subsequent payments under this Agreement or other agreements between
Social Services and Island Grove, or by Social Services as a debt due to
Social Services or otherwise as provided by law.
11. Representatives
For the purpose of this Agreement, the individuals identified below are hereby
designated representatives of the respective parties. Either party may from time
to time designate in writing a new or substitute representative(s):
For Social Services:
Franklin Aaron,MSW Social Services Administrator
Name Title
For Island Grove:
B.J. Dean Executive Director. Island Grove
Name Title
12. Notice
All notices required to be given by the parties hereunder shall be given by
certified or registered mail to the individuals at the addresses set forth below.
Either party may from time to time designate in writing a substitute person(s) or
address to whom such notices shall be sent:
To: Social Services To: Compass
Judy A. Griego. Director B.J. Dean. Director
P.O. Box A 1140 M Street
Greeley, CO 80632 Greeley, CO 80631
13. Litigation
Island Grove shall promptly notify Social Services in the event that Island Grove
learns of any actual litigation in which it is a party defendant in a case which
involves services provided under this Agreement. Island Grove, within five (5)
calendar days after being served with a summons, complaint, or other pleading
which has been filed in any federal or state court or administrative agency, shall
deliver copies of such document(s) to the Social Services Director. The term
"litigation"includes an assignment for the benefit of creditors, and filings in
bankruptcy, reorganization and/or foreclosure.
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14. Termination
This Agreement may be terminated at any time by either party given thirty (30)
days written notice and is subject to the availability of funding.
15. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire
understanding between the parties with respect to the subject matter hereof, and
may not be changed or modified except as stated in Paragraph 9 herein.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the
day, month, t' year f st i'o e 'tten.
ATTEST:
WELD COUNTY ,leo ' BOARD OF COUNTY
CLERK TO THE BO ' COMMISSIONERS WELD
COUNT}, CO ORADO/
By: .�i� �/�_n.- I)�r` c�� By: /,/7(I/ Llat V "tic
Deputy Clerk 'S ' ' Barbara Kir ,a er, Chair (/
p y (05/31/2000) y
APPROVED AS TO F RM: ISLAND GROVE REGIONAL
TREATMENT CENTER, INC.
Z / BY 6
unty Attorney BJ Dean, xecutive Director
APPROVED AS TO FORM:
WELD COUNTY DEPARTMENT COMPASS BEHAVIORAL
OF SOCIAL SERVICES HEALTH SYSTEMS, LLC
By: By dJ +--
ector B.J.
Managing Partner of
APPROVED AS TO FORM BY SIGNAL Compass Behavioral Health
AUTHORIZED REPRESENTATIVE Systems, LLC
Bill Wendt, Executive Director
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EXHIBIT A
SCOPE OF SERVICES
Assessments
Alcohol and Drug Differential Assessment(2-Hours)
Assessment will evaluate alcohol/drug involvement as well as mental health
status, history of mental health issues, sexual history, legal history, and certain
standard tests (ASAP, ASAM PPC-2, ASI, SOCRATE, AODUI, Drinking
History Questionnaire, Family Environment Scale)may be given. Baseline
Urinalysis Testing (7-Panel) is included. Summary of assessment with
recommendations sent to referral agency.
The 7-Panel baseline urinalysis test for alcohol and drugs screens for the
following:
Tests determine what drugs are present in client.
THC Cutoff Level: 15 ng/ml Amphetamines Cutoff Level: 1000 bg/ml
Cocaine Cutoff Level: 30ong/ml Barbiturates Cutoff Level: 200 ng/ml
Benzodiazepines Cutoff Level: 200 ng/ml Opiates Cutoff Level: 300 ng/ml
PCP Cutoff Level: 25 ng/ml
3-Panel THC,Cocaine,Amphetamines
Domestic Violence Assessment (3-Hours)
Summary of assessment with recommendations sent to referring agency. The
following areas will be assessed:
Criminal History Profile of Client's Violent Behaviors
Mental Health Status Client's Potential for Violence
Medical History Substance Abuse History
Suicidal/Psychological/Cultural History Millon Test,if needed
Treatment Options
Domestic Violence Group Therapy (average length of treatment, 24 to 36 weeks)
Groups for both men and women are offered. The group addresses anger
management, healthy relationships, male and female roles, and boundaries. As
needed, a Millon Test may be given, a standardized psychological test which
measures functioning level in 22 personality disorders and clinical syndromes for
adults (8th grade reading level: > 18; available in Spanish).
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Family Therapy (average length of treatment. 8 to 16 sessions)
Involves two or more family members and provides therapeutic intervention to
improve family communications functioning and relationships. Length of
participation dependent on client goals and progress toward meeting goals.
Individual Counseling (average length of treatment. 6 to 12 sessions)
Primary client is seen on an individual basis. Length of participation dependent
on client goals and progress toward goals.
Biofeedback Sessions (average length of treatment. 4 to 8 sessions)
The client will be monitored individually through sensitive computerized
biofeedback instruments. The goal of biofeedback is self regulation—learning
how to regulate both mental and physical processes for health and improved
functioning. Biofeedback is used to reduce stress and to demonstrate control over
mental and physical impulses and develop deep relaxation techniques.
Substance Abuse Therapy (average length of treatment, 12 to 20 sessions)
A group to enhance positive coping skills by focusing on their lifestyle dealing
with use and abuse of chemicals.
Adult Intensive Outpatient(average length of treatment. 4 to 12 weeks)
An intensive outpatient group therapy track that offers groups every evening,
Monday through Friday, with a family program component. This program will
include medical aspects of addiction and adult relapse education components
focusing on understanding the relapse process as well as group process (focuses
on individual issues relating to their abuse of alcohol). The program length and
participation level will be individualized based on the presenting issues and other
factors.
Women's Group (average length of treatment. 12-20 session)
A gender-specific group addressing issues affecting women and their
relationships, such as family violence, co-dependency, self-esteem and stress
management.
Special Programs
Special Connections (through pregnancy and up to one year postpartum)
A gender-specific program that focuses on healthy babies, appropriate child care,
prenatal care, birth control, developmental stages of the baby, parenting skills,
relationship issues, and other issues as identified by the counselor. Services
include group and individual therapy, case management and family health
education.
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Miscellaneous Services
Case Aide
This position will assist in family visits to determine how the family is
functioning together while in the home, and to improve the family's ability to
access resources in the community. The case aide can take direction from the
primary therapist assigned to the family or the Social Services case worker.
Duties to be performed by the case aide include, but are not limited to, providing
transportation to therapy, doctors appointments and court, supervised visits, child
care while family is in treatment, run errands such as filling prescriptions,
shopping, and assisting in living skill development, assist the family in
developing other service links and miscellaneous functions to facilitate the
stabilization of the family. (Case Aide tasks will be mutually agreed upon
between counselor and case worker and identified in the "Services Plan".)
Fast Track Adolescent Program
The Fast Track Adolescent Program is an Intensive Outpatient Program with
supportive residential services if clinically necessary. The targeted population
ranges from 13 to 17 years of age who demonstrate substance abuse problems.
The goal is to have these adolescents discover positive alternatives to their
current use behavior.
The program consists of a comprehensive differential assessment compiling
personal and collateral information as well as data obtained from the Addiction
Severity Index (ASI), Substance Abuse Subtle Screening Inventory (SASSI) and
the Adolescent Self-Assessment Profile (ASAP) instruments. This data is
utilized to develop an individualized treatment plan. Clients receive a minimum
of three individual sessions with the focus on achieving their treatment goals and
attend three groups per week and three per day if in residential with the primary
focus on education and motivational topics. Family therapy is encouraged as a
part of the client's treatment. A discharge planning session will be implemented
focusing on appropriate referrals addressing the needs and motivation of the
adolescent and family.
Referral Process to Fast Track Program:
Contact Kristen Arnold at(970) 356-6664, extension 16. If she is not on duty,
inform the staff person that Social Services is referring a Fast Track adolescent
and give the youth's case worker's name so that the Fast Track staff can contact
the case worker when they return to duty.
On-Site Staff Services
The scope of the services offered to the local Social Services agency by ADAD
approved staff placed on site by the licensed ADAD program may include
performing alcohol and drug assessments,brief therapy (under 8 hours), case
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consultation, case management, and in-house training on pertinent alcohol/drug
issues as requested and training evaluation of care givers. In addition to this,
on-site staff may accompany Social Services staff on follow-up visits to perform a
behavioral health screening for the purpose of identifying clients who could
benefit from further assessments for alcohol/drug interventions or mental health
interventions.
Enhanced Services
Enhanced services as approved services that are requested by Social Services for
specific cases which fall outside of the definitions listed above in the description
of the ADAD menu of services. Enhanced services may be services not described
on the menu, services not included in the definition or due to lack of economy of
scale, or rural location, or result in additional costs to Island Grove. In order for
Island Grove to provide to enhanced service, the cost would be outside of the
approved rates. Any additional fees would be negotiated on a case by case basis.
An example of a service outside of the approved definitions would be a request
for a system evaluation. This would include collateral contacts as appropriate
with schools, parents,primary care giver, probation, and other significant persons
in the identified client's life. The information gathered from the collateral
contacts would be included in the assessment findings and treatment
recommendations. If additional service is needed in order to meet a request by a
local department such as parenting skills assessment, additional fees may be
added to the basic assessment fee. Psychological exams and psychiatric testing
are not included in the definition of the alcohol and drug evaluation. Normally
this type of assessment would be done with mental health dollars and not alcohol
and drug (ADAD) funding. Other services such as home based services which
have a designated core service funding source should be paid for out of those
funds. Island Grove could supplement the home based services with in-home
family alcohol and drug services as appropriate.
Island Grove can arrange for services outside of the approved definitions, but the
Social Service Department requesting the specialized service will be charged an
additional fee that would be negotiated on a case by case basis by the designated
representative listed in the contract. If the additional cost is recommended to be
reimbursed with the ADAD funds, the cost must be approved by Island Grove.
Another example of enhanced services which may be provided with higher fees
may be intensive outpatient services, or the use of a floater* or approved
subcontractor for a specific task. The additional cost would be negotiated with
the respective Social Services Department.
*Floater—a temporarily assigned staff or subcontractor to perform a time
specified alcohol or drug related approved task.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Social Services agrees to reimburse to Island Grove in consideration for the work
and Services performed, a total amount not to exceed Fifty-two Thousand Three
Hundred Ninety-eight Dollars ($52,398) under Fund Code 1889 and Object
Code 104.
Expenses incurred by Island Grove, in association with said project prior to the
term of this agreement, are not eligible Social Services expenditures and shall not
be reimbursed by Social Services.
Payment pursuant to this Contract, if Family Issues Cash funds, whether in whole
or in part, is subject to and contingent upon the continuing availability of Family
Issues Cash funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by Social Services, Social
Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services—as shown on the attached Exhibit C" Core Services Fee
Schedule"
Social Service referrals will not be sent to collections by Island Grove for default
of co-pay/fees. Services will be performed regardless of client's refusal or
inability to pay co-pay.
The Sliding Fee Schedule will only be applied to those services as noted on the
fee schedule, all other fees will be charged directly to Social Services.
Island Grove will collect any applicable sliding scale co-pays and credit Social
Services for any payments received on the monthly billing statements.
3. Submittal of Vouchers
Island Grove shall prepare and submit monthly the itemized voucher and certify
that the services authorized were provided on the date indicated and the charges
made were pursuant to the terms and conditions of Exhibit A.
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EXHIBIT C
Region 1
Core Services'Funds
Fee Schedule
1999-2000
Assessments
Alcohol and Drug Differential Assessment $ 150.00
(Includes baseline Urinalysis Test)
Domestic Violence $ 150.00
Vocational Assessment $ 175.00
Treatment Options
Domestic Violence Group Therapy $ 30.00/session
Co-pay/Sliding Fee
Family Therapy $ 80.00/session
Co-pay/Sliding Fee
Intensive Family Therapy $ 90.00/session
Co-pay/Sliding Fee
Individual Counseling $ 60.00/
session
Co-pay/Sliding Fee
Biofeedback $ 60.00/session
Co-pay/Sliding Fee
Substance Abuse Group Therapy $ 30.00/session
Co-pay/Sliding Fee
Adult Intensive Outpatient Group $ 50.00/session
Co-pay/Sliding Fee
Women's Services
Differential Assessment $150.00
Individual Counseling $ 60.00/session
Co-Pay/Sliding Fee
Group Counseling $ 30.00/session
Co-Pay/Sliding Fee
Health Education Services $ 15.00/session
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Special Connections —Treatment for pregnant women and postpartum women
(Medicaid reimbursement eligible)
• If on Medicaid, Compass will bill Medicaid directly.
▪ If not on Medicaid, fees are as stated above in Women's Services.
Youth Services
Adolescent Detox $185.00 per/day
Adolescent IOP (Fast Track) $ 50.00/session
Adolescent Residential Support Services TOP $115.00/day
Assessment $150.00
Family Counseling $ 80.00/session
Co-Pay/Sliding Fee
Individual Counseling $ 60.00/session
Outpatient Group Counseling $ 30.00/
session
Miscellaneous Services
Case Aide/Case Management Services $ 35.00/hour
Expert Testimony $150.00/day
or any part of a day
Case Consultation $ 40.00/hour
(Interdisciplinary Assessment Process)
On-Site Staff Services $ 55.00/hour
Enhanced Services (negotiated on a case by case basis)
Residential Services
Adult Residential Services (Compass) $115.00/day
Co-Pay/Sliding Fee
Out-of-Area Residential Services (negotiated on individual basis)
Methadone (negotiated on individual basis)
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Other Services
Breathalyser Testing $ 2.00/test
Urinalysis Testing (7-Panel) $ 25.00/test
(3-Panel) $ 15.00/test
THC Only $ 10.00/test
Monitored Antabuse $ 2.00/monitor
(If client is not currently enrolled in weekly counseling program(s) of Island Grove Center)
Patch Monitoring $ 40.00/each
patch
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Weld County Guidelines
On-Site Staff Services
Child Welfare Section: Minimum of 15 hours per week, maximum of 28 —Weld
County will pay for 15 hours per week from Core service dollars regardless of
utilization of on-site staff person by Social Services. Island Grove will bill the
additional on-site staff time to the AFS contract on an "as used"basis. Weld
County will not be billed for hours that the staff person is not on site (due to
illness, vacation, educational leave etc.) during the 15 hour minimum.
Case Aide/Case Management:
Youth in Conflict Section: Minimum of 16 hours per week, a maximum of 24.
Compass will bill the minimum weekly amount to the AFS contract regardless of
utilization of the on-site case aide/case management by Social Services. Any
hours above the 16 per week would also be billed to the AFS contract on an "as
used"basis. Island Grove will not bill AFS for hours that the staff person is not
on-site (due to illness, vacation, educational leave etc.) during the 16-hour
minimum.
Residential
Adult residential services for eligible persons may be paid from AFS the ADAD
Additional Family Services (AFS) allocations. Youth residential services will be
billed to core or AFS or a combination of funding streams.
Ongoing Treatment
On going treatment services will be assigned to funding streams according to
usage.
Youth Services
If Weld County does not approve Youth in Conflict (YIC) cases eligible for
services through Core Service dollars then all on-going YIC adolescent services
will be paid for from the ADAD AFS funding stream.
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EXHIBIT D
ASSURANCES
1. Island Grove agrees it is an independent contractor and that its officers and
employees do not become employees of Weld County, nor are they entitled to any
employee benefits as Weld County employees, as the result of the execution of
this Agreement.
2. Weld County, the Board of County Commissioners of Weld County, its officers
and employees, shall not be held liable for injuries or damages caused by any
negligent acts or omissions of Island Grove or its employees, volunteers, or agents
while performing duties as described in this Agreement. Island Grove shall
indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. Island
Grove shall provide adequate liability and worker's compensation insurance for
all its employees, volunteers, and agents engaged in the performance of the
Agreement upon request, Island Grove shall provide Social Services with the
acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any
immunities the parties or their officers or employees may possess, not shall any
portion of this Agreement be deemed to have treated a duty of care with respect to
any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of
the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract
is for any reason held or decided to be unconstitutional, such decision shall not
effect the validity of the remaining portions. The parties hereto declare that they
would have entered into this Contract and each and every section, subsection,
paragraph, sentence, clause, and phrase thereof irrespective of the fact that any
one or more sections, subsections, paragraphs, sentences, clauses, or phrases
might be declared to be unconstitutional or invalid.
6. No officer, member or employee of Weld County and no member of their
governing bodies shall have any pecuniary interest, direct or indirect, in the
approved Agreement or the proceeds thereof.
7. Island Grove assures that they will comply with the Title VI of the Civil
Rights Act of 1986 and that no person shall, on the grounds of race, creed, color,
sex, or national origin, be excluded from participation in, be denied the benefits
of, or be otherwise subjected to discrimination under this approved Contract.
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8. Island Grove assures that sufficient, audit able, and otherwise adequate records
that will provide accurate, current, separate, and complete disclosure of the status
of the funds received under the Contract are maintained for three (3) years or the
completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors and representatives to audit and
monitor Island Grove.
9. All such records, documents, communications, and other materials shall be the
property of Social Services and shall be maintained by Island Grove, in a central
location and custodian, in behalf of Social Services, for a period of three (3) years
from the date of final payment under this Contract, or for such further period as
may be necessary to resolve any matters which may be pending, or until an audit
has been completed with the following qualifications: If an audit by or on behalf
of the federal and/or state government has begun but is not completed at the end
of the (3) year period, or if audit findings have not been resolved after a three (3)
year period, the materials shall be retained until the resolution of the audit finding.
10. Island Grove assures that authorized local, federal and state auditors and
representatives shall, during business hours, have access to inspect any copy
records, and shall be allowed to monitor and review through on-site visits, all
contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by
appropriate funding sources. The results of the monitoring and evaluation
activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. Island Grove or Social Services may not assign
any of its rights or obligations hereunder without the prior written consent of both
parties.
12. Island Grove certifies that Federal appropriated funds have not been paid or will
be paid, by or on behalf of Island Grove, to any person for influencing or
attempting to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of
any federal grant, the making of any federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, loan, grant, or cooperative agreement.
13. Island Grove assures that it will fully comply with all other applicable federal and
state laws. Island Grove/Signal understands that the source of funds to be used
under this Contract is: Family Issues Cash Funds.
14. Island Grove assures and certifies that is and its principals:
17
a. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transaction by a federal
department of agency.
b. Have not, within a three-year period of preceding this Agreement, been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (federal, state, or local)
transaction or contract under a public transaction; violation of federal or
state antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or
receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by
a government entity (federal, state, or local)with commission of any of the
offenses enumerated in paragraph 11(b) of this certification; and
d. Have not with a three-year period preceding this Contract, had one or
more public transactions (federal, state, and local) terminated for cause or
default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor
with Social Services when Island Grove also maintains a relationship with a third
party and the two relationships are in opposition. In order to create the
appearance of a conflict of interest, it is not necessary for the contractor to gain
from knowledge of these opposing interests. It is only necessary that the
contractor know that the two relationships are in opposition.
During the term of the Contract, Island Grove shall not enter any third party
relationship that gives the appearance of creating a conflict of interest. Upon
learning of an existing appearance of a conflict of interest situation, Island Grove
shall submit to Social Services, a full disclosure statement setting forth the details
that create the appearance of a conflict of interest. Failure to promptly submit a
disclosure statement required by this paragraph shall constitute grounds for Social
Services' termination, for cause, of its contract with Island Grove.
16. Island Grove shall protected the confidentiality of all applicant records and other
materials that are maintained in accordance with this Contract. Except for
purposes directly connected the administration of the Child Protection, no
information about or obtained from any applicant/recipient in possession of Island
Grove shall be disclosed in a form identifiable with the applicant/recipient in
possession of Island Grove shall be disclosed in a form identifiable with the
applicant/recipient or a minor's parent or guardian unless in accordance with
Island Grove written policies governing access to, duplication and dissemination
of, all such information. Island Grove shall advise its employees, agents, and
subcontractors, if any, that they are subject to these confidentiality requirements.
Island Grove shall provide its employees, agents, and subcontractors, if any, with
18
a copy or written explanation of these confidentiality requirements before access
to confidential data is permitted.
17. Proprietary information for the purposes of this contract is information relating
to a party's research, development, trade secrets, business affairs, internal
operations and management procedures and those of its customers, clients or
affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or(3) that which is developed
independently.
Neither party shall use or disclose directly or indirectly without prior written
authorization any proprietary information concerning the other party obtained
as a result of this Contract. Any proprietary information removed from the
State's site by Island Grove in the course of providing services under this
Contract will be accorded at least the same precautions as are employed by
Island Grove for similar information in the course of its own business.
19
EXHIBIT I
COLORADO STATE DEPARTMENT OF SOCIAL SERVICES
AUTHORIZATION FOR CON IRACTUAL CASE SERVICES
1. WELD County DATE:
2. Island Grove Regional Treatment Center
1140 'M'Street
Greeley,CO 80631
THE DESCRIBED SERVICE IS AUTHORIZED FOR THE CLIENT INDICATED:
5. SEE ATTACHED LIST
(Name of Client) Household No. (CAT.) (CAT. GRP.)
6. SERVICE:
(Description) (SV.CODE)
7. APPROVAL:
/ / / /
(Caseworker) (Date) (Co. Director or Supervisor) (Date)
8. TO BE COMPLETED BY PROVIDER
Month of Service:
Charges: $
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED AND THE
CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE
COUNTY DEPARTMENT OF SOCIAL SERVICES INDICATED.
Accountant
Typed Name
PREPARE IN TRIPLICATE,ORIGINAL AND ONE COPY TO PROVIDER,ONE COPY FOR PENDING FILE.
COMPLETED PROVIDERS FORMS.ORIGINAL TO COUNTY FINANCE OFFICE.COPY TO CASE RECORD
C\KATHR VMC0MPASS\F0RMS\DSSUmhContCseSvs.D0C
SOCIAL SERVICES
CORE SERVICES / 205
1999-00
REMIT TO:COMPASS BEHAVIORAL HEALTH SYSTEMS FROM: I CERTIFY THAT THE FOLLOWING SERVICES WERE PROVIDED IN ACCORDANCE WITH THE
1 1 40 M STREET Provider Name - Dept. ABOVE CONTRACT AND AM SUBMITTING STATEMENTS REGARDING TIME SPENT FOR THE
GREELEY, CO 80631 SAME.
Mailing Address
BILLING FOR MONTH OF:
City County
COUNTY OF: SIGNATURE TITLE DATE
SERVICE _ ,�.I)ESCRIPIION OF SERVJ . . ..... Na OF RATE PER __:'-Ann FEE.=DATES :-:- _.___ - .. . .,..... :-'; UNITS
A. MANAGEMENT FEE ASSESSMENT
B.ON-SITE STAFF SERVICES
SERVICE CLIENT NAME : HOUSEHOLD APPROVED _ _.
RF.FF.RRAL- - APt7tQVED '. _
.. .oDUN-. CORE NO.OF Sai'fE 'FoFAT,FEE
DATES .. NUMBER _NUMBER .. ..-.ENTRIE _ .`.:.-EXIT -5ELOR SERVICES.. UNITS PERT NIT COMMENT ErC -
._ DATE= _ _. DATE - ID (BELOW):. BILLED -
PAGE _OF PAGE TOTAL
TOTAL DUE FOR BILLING MONTH:
ASSESSMENTS(A/O,SWS, YOUTH, DV) A) CASE-AIDE/CASE MANAGEMENT SERVICES (CM) URINALYSIS TEST-7 PANEL (uA7)
GROUP SESSIONS(A/D,SWS,YOUTH,DV) (GS) VOCATIONAL ASSESSMENT (VA) URINALYSIS TEST- 3 PANEL (UA3)
FAMILY SESSIONS(A/D,YOUTH) . (FS) INOIVIDUALSESSIONS(AID,SINS;YOUTH,DV) (IS) BIOFEEDBACK (BIO)
INTENSIVE FAMILY SESSIONS OFT) INTENSIVE OP SESSIONS(ADULT/YOUTH) (IOP) BREATHALYSER TESTING (BAC)
ADOLESCENT DETOX (AOT) TRANSITIONAL RESIDENTIAL'SERV. (ADULT) (TRT) MONITORED ANTABUSE (MA)
HEALTH EDUCATION SERVICES (HES) ADOLESCENT RES SUP SVS(YOUTH) (ARS) PATCH MONITORING (PM)
CASE CONSULTATION (CC) EXPERT TESTIMONY (ET)
C:\KATHRYN\AGENCY\Forms\DSS\CORE Sys.doc 10/99
SOCIAL SERVICES
UA SERVICES
1999-00
REMIT TO: ISLAND GROVE TREATMENT CENTER FROM: I CERTIFY THAT THE FOLLOWING SERVICES WERE PROVIDED IN ACCORDANCE WITH THE
1 140 M STREET Provider Name-Dept. ABOVE CONTRACT AND AM SUBMITTING STATEMENTS REGARDING TIME SPENT FOR THE
GREELEY, CO 80631 SAME.
Mailing Address
BILLING FOR MONTH OF:
City County
COUNTY OF: SIGNATURE TITLE DATE
SERVICE �.. DI;SCRPTION OF SERVICES:; RD.OF T RATE PER -':TOTAL FEE'
A. MANAGEMENT FEE ASSESSMENT
B. ON-SITE STAFF SERVICES
SERVICE CLiENTNAME 'HOUSEHOLD REFERRAL APPROVER, APPROVED COON-( -?ORE,. NO OP +:ILflE ,TOTAL E_
DATES ' NUMBER NUMBER'. EMERY'—",-EXIT SELOR StRVI,,E UNiIS . PER UNIT •3� • COMMENT ETC' :_
_ DATE DATE ID (BELOW),f: BILLED - ;. .._ s ... .
r
>.' PAGE'_OF PAGETOTAL -S
TOTAL DUE FOR BILLING MONTH: V 1 $
ASSESSMENTS(A/D;SWS,.YOUTH,"DV) )(A I ' CASE AIDE/CASE MANAGEMENT SERVICES (CML URINALYSIS TEST-7 PANEL (UA7)
GROUP SESSIONS(A/D,SWS,YOUTH,DV) (GS) VOCATIONAL ASSESSMENT (VA) URINALYSIS TEST- 3 PANEL (UA3)
FAMILY SESSIONS(AID,,?YOUTH) ' `(FS) 'INDIVIDUAL:SESSIONS(A/D,SWS,YOUTH DV) (IS) 1' BIOFEEDBACK (RIO)
INTENSIVE FAMILY SESSIONS OFT) INTENSIVE OP SESSIONS(ADULT/YOUTH) (IOP)__ BREATHALYSER TESTING (BAC) _
ADOLESCENT DETOX =- (ADT) '-TRANSITIONAL RESIDENTIAL SERV: (ADULT) (TRT)J MONITORED ANTABUSE (MA) s
HEALTH EDUCATION SERVICES (HES) ADOLESCENT RES SUP SVS(YOUTH) (ARS)_ PATCH MONITORING (PM)
CASE CONSULTATION (CC) !EXPERT TESTIMONY 1ET) -
C:\KATHRYN\AGENCY\Forms\DSS\UA SVS.doc 10/99
SOCIAL SERVICES
PATCH MONITORING SERVICES
1999-00
REMIT TO: ISLAND GROVE TREATMENT CENTER FROM: I CERTIFY THAT THE FOLLOWING SERVICES WERE PROVIDED IN ACCORDANCE WITH THE
1140 M STREET Provider Name- Dept. ABOVE CONTRACT AND AM SUBMITTING STATEMENTS REGARDING TIME SPENT FOR THE
GREELEY, CO 80631 SAME.
Mailing Address
BILLING FOR MONTH OE
City County
COUNTY OF: SIGNATURE TITLE DATE
SERVICE RFSGRIPNON OF SERVICES N0�OF RAZE FER.:� TOIXL FEE
-DATES ;UNITS UNR
A. MANAGEMENT FEE ASSESSMENT
B. ON-SITE STAFF SERVICES
SERVICE CI,IINTNAME - UOUSERO7D REFERRAL APPROV _ APPROVED "COUx CORE No.of RATE.'; TOtALFEE
DAIFS NUMBER" 'NUMBER ENTRY EXIT _$F�19A- SERVICES UNITS PER UNfI WMMEN1'S, _ £.
TOTAL DUE FOR BILLING MONTH: $
ASSESSMENTS(A/D, SWS,YOUTH/by) (lA) CASE AIDE/CASE MANAGEMENT SERVICES s,(CM) ° URINALYSIS TEST 7 PANEL ,-(UA7)
GROUP SESSIONS(A/D,SWS,YOUTH,DV) (GS) VOCATIONAL ASSESSMENT (VA) URINALYSIS TEST- 3 PANEL (UA3)
FAMILY SESSIONS(A/O, YOUTH) -IFS) INDIVIDUAL SESSIONS(A/D,SWS,YOUTH,DV) =(IS)- BIOFEEDBACK IMO)
INTENSIVE FAMILY SESSIONS _ (IFT) INTENSIVE OP SESSIONS(ADULT/YOUTH) OOP) BREATHALYSER TESTING (BAC)
ADOLESCENT bETOX (ADT) TRANSITIONAL RESIDENTIAL SEAV. (ADULT) :•(TRT) " MONITORED ANTASUSE (MA)
HEALTH EDUCATION SERVICES (HES) ADOLESCENT RES SUP SVS(YOUTH) (ARS) PATCH MONITORING (PM)
CASE CONSULTATION. - !(CC) EXPERT TESTIMONY + ''(ET}
C:\KATHRYN\AGENCY\Forms\DSS\Patch Svs.DOC 10/99
SOCIAL SERVICES
BAC SERVICES
1999-00
REMIT TO: ISLAND GROVE TREATMENT CENTER FROM: I CERTIFY THAT THE FOLLOWING SERVICES WERE PROVIDED IN ACCORDANCE WITH THE
1 140 M STREET Provider Name- Dept. ABOVE CONTRACT AND AM SUBMITTING STATEMENTS REGARDING TIME SPENT FOR THE
GREELEY, CO 80631 SAME.
Mailing Address
BILLING FOR MONTH OF:
City County
COUNTY OF: SIGNATURE TITLE DATE
_...
SERVICE = DESCRIPTION OFSERVICES NO.OF RATE PER. : TOTAL FEE
DATES .. UNfrS UNIT
A. MANAGEMENT FEE ASSESSMENT
B. ON-SITE STAFF SERVICES
SERVICE CLIENT NAME HOUSEHOLD REFERRAL APPROVED APPROVED -;WUN CORE NOi OF RATE TOTAL FEE
DATES NUMBER NUMBER ENTRY EXIT SELOR SERVICES UNITS PER UNIT COMMENTS,ETC
:,DATE DATE .. ID (BEWW) BILLED _.
•
PAGE OF PAGE TOTAL $ _.
TOTAL DUE FOR BILLING MONTH: 5
ASSESSMENTS(AID, SWS, YOUTH, DV) ( A) CASE AIDE/CASE MANAGEMENT SERVICES (CM) URINALYSIS TEST.-7 PANEL (UA7)
GROUP SESSIONS(A/D,SWS,YOUTH,DV) (GS) VOCATIONAL ASSESSMENT (VA) URINALYSIS TEST- 3 PANEL (UA3)
FAMILY SESSIONS(A/D,YOUTH) (ES) INDIVIDUAL SESSIONS(A/D,SWS,YOUTH,DV) f OS) BIOFEEDBACK (BIO)
INTENSIVE FAMILY SESSIONS OFT) INTENSIVE OP SESSIONS(ADULT/YOUTH) (LOP) BREATHALYSER TESTING (BAC)
ADOLESCENT DETOX (ADT) TRANSITIONAL RESIDENTIAL SERVl (ADULT) (TRT) MONITORED ANTABUSE (MA)
HEALTH EDUCATION SERVICES (HES) ADOLESCENT RES SUP SVS(YOUTH) (ARS) PATCH MONITORING (PM)
CASE CONSULTATION '(CC) EXPERT TESTIMONY (ET)
C:\KATHRYN\AGENCY\Forms\DSS\BAC Svs.doc 10/99
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