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AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND AMANDA HARTSHORN DBA CREATIVE NURSING, LLC
h
This Agreement Amendment made and entered into I1i day of `1U,.nQ_ ,
2024 by and between the Board of Weld County Commissioners, on behalf of the Weld
County Department of Human Services, hereinafter referred to as the "Department", and
Amanda Hartshorn DBA Creative Nursing, LLC, hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Foster Parent Training, Life Skills
and Nurturing Program Services, (the "Original Agreement") identified by the Weld County
Clerk to the Board of County Commissioners as document No. 2024-1221, approved on May
15, 2024.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in
accordance with the terms of the Original Agreement and any previously adopted
amendment, which is incorporated by reference herein, as well as the terms provided herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and
agree as follows:
• The Original Agreement will end on May 31, 2027.
• This Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following additional changes are hereby
made to the current Agreement as of June 1, 2024:
1. Exhibit A, Scope of Services, is hereby amended as attached.
2. Exhibit B, Rate Schedule, is hereby amended as attached.
• All other terms and conditions of the Original Agreement remain unchanged.
Un
to/l-1/2
20Z-4- 1 221
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the
day, month, and year first above written.
COUNTY:
ATTEST: A,
Clerk to the Board
Deputy Clerk to th
BOARD OF COUNTY COMMISSIONERS
WELD COUtY COLORADO
Kevin D. Ross, Chair JUN 1 7 2024
ONTRACTOR:
Amanda Hartshorn
DBA Creative Nursing, LLC
33681 County Road 13
Windsor, Colorado 80550
e7si
By: Amanda Hartshorn, RN MSN (Jun 5, 202413)30 MDT)
Amanda Hartshorn, RN
Date: Jun 5, 2024
,o(1_%a'l
EXHIBIT A
SCOPE OF SERVICES
Contractor will provide Foster Parent Training, Life Skills and Nurturing Program Services, as
referred by the Department.
Program Area: Foster Parent Training
1. Foster Parent Training
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Over the counter medications (OTC).
ii. Medication concepts.
iii. Medication administration records (MAR).
iv. Medication administration procedure.
v. Medication errors.
vi. Medication storage safety.
vii. Seven (7) rights of medication administration.
viii. Six (6) components of a physician order.
ix. Common abbreviations and measurement equivalents.
x. RN will use developed syllabus and qualifications in alignment with the
State of Colorado Regulatory Agencies.
xi. Validation of competency will be obtained via quizzes throughout
educational sessions.
xii. This is not a Qualified Medication Administration Personnel (QMAP)
course.
xiii. A certificate of completion can be provided upon request.
b. Anticipated Frequency of Services:
i. Three (3) hours per each training.
c. Anticipated Duration of Services:
i. Course will be offered up to one (1) time per month.
ii. Course duration may be extended for large group sessions.
d. Goals of Services:
i. Assist foster parents in gaining skills for proper medication
administration.
ii. Educate on safety of medication storage.
iii. Understand over the counter medications and need for physician orders
for all administrated medications.
e. Outcomes of Services:
i. Safe medication administration of physician ordered medications.
ii. Understanding medication orders.
iii. Understanding how to obtain orders and administer medications
correctly and safely.
iv. How to use OTC medications.
v. How to use OTC medications correctly and safely with a physician order.
f. Target Population:
i. Foster Parents.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
Program Area: Life Skills
1. Family Time Support for Medically Complex Individuals
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Registered Nurse or licensed delegated medical professional will provide
family support during scheduled family time for complex or medically
fragile individuals.
ii. Short and long-term goal setting will be established pertinent to medical
and mental health needs.
iii. Skilled hands-on demonstration to caregivers regarding performance of
ordered medical tasks in a safe and competent manner.
iv. Demonstration of skilled nursing education to caregivers regarding
performance of ordered medical tasks in a safe and competent manner.
v. Demonstration of skilled nursing education around ordered
interventions.
vi. Hands-on nursing skilled education by directing and educating caregivers
on ordered interventions.
vii. Contractor will not provide ongoing nursing support as Home Health Care
Services.
b. Anticipated Frequency of Services:
i. One (1) to six (6) hours per week.
c. Anticipated Duration of Services:
i. One (1) to ninety (90) days with the option to extend upon request by
either party with approval of the Department.
d. Goals of Services:
i. Clinical staff will provide supervision and safety education regarding
medical needs during family time.
ii. Family time will be therapeutic and educational opportunity for
information specific to medical diagnoses or medical needs/skills ordered
by a provider with written orders.
iii. Medical interventions will be monitored for safety and correct
implementation.
iv. To free up visitation supervisors from needing to provide services to the
family at the same time, eliminating the need for two (2) professionals
during family time.
v. RN can request to have visitation supervisor present, if necessary, for
safety.
e. Outcomes of Services:
i. Improved medical understanding of child with complex medical needs.
ii. Safe and productive family time, ensuring understanding of education
regarding warnings, signs of impending urgent or emergent medical
needs, and the need to seek higher level of care.
iii. Increase providers resulting in more availability for family time to begin
promptly and safely with a medical professional present during family
time.
f. Target Population:
i. All ages.
ii. All genders.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
Program Area: Nurturing Program
1. Home -Based Nursing Assessments and Observations
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Information will be collected from the department, other professionals,
the client, and the caregivers to determine medical and mental health
care needs specific to each client. Contractors will work collaboratively
with all parties to gather and review all necessary information.
ii. Short and long-term goals setting will be established pertinent to medical
and mental health needs.
iii. Creating a Health Service Plan (HSP).
iv. Hands-on demonstration. The contractor will provide hands-on nursing
skilled education. The contractor will provide hands-on nursing skilled
education by directing and educating caregivers on ordered
interventions.
v. Contractor will NOT provide ongoing nursing support such as Home
Health Care Services.
b. Anticipated Frequency of Services:
i. One (1) to ten (10) hours per week.
c. Anticipated Duration of Services:
i. One (1) to ninety (90) days with the option to extend upon request by
either party with approval of the Department.
d. Goals of Services:
i. Education of client and/or caregivers regarding client specific medical
information to promote increased understanding and knowledge of
information regarding medical needs.
ii. Current assessments as indicated by type of referral (physical
assessment, weight check, monitoring of diabetic devices etc.).
iii. Hands-on skilled nursing demonstration of ordered medical interventions
to promote understanding and competency by client and/or caregiver.
iv. Hands-on education of client and/or caregiver regarding navigation of the
healthcare system to promote confidence and increase ability to navigate
the system successfully and independently.
e. Outcomes of Services:
i. Client and/or caregiver will demonstrate increased knowledge and
understanding of the client's medical and mental health information and
needs, including self -care, ongoing medical needs and requirements for a
safe environment.
ii. Client and/or caregiver will demonstrate increased understating and
competency regarding ordered medical interventions through hands-on
performance of interventions. Client will demonstrate safe, accurate and
confident performance of ordered interventions.
iii. Increased confidence and ability to navigate the healthcare system
independently and successfully, and confidence in accessing additional
resources as needed.
iv. Decreased child protection issues mitigated through increased
knowledge and understanding of client's medical issues, needs and
ordered interventions.
f. Target Population:
i. All ages.
ii. All genders.
g. Language:
i. English.
ii. Spanish, contingent upon ongoing subcontracted services with bilingual
Registered Nurse.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
2. Nursing Case Management/Education
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Evidence based research and professional experience.
ii. Family/ Caregiver education regarding medical diagnosis and treatment.
iii. Utilization of credible resources such as Children's Hospital Online and
Mayo Clinic as needed to enhance education.
iv. Setup and facilitation of home visits, medical appointments and hospital
record reviews providing required level of assistance needed specific to
referral with goal of independence.
v. Ongoing documentation and/or communication of objective observations
and interactions with the client to the caseworker via phone or email
vi. The contractor will serve as liaison between the client, caregiver,
Department and medical professionals for the purpose of setting up
and/or attending medical appointments.
vii. The contractor will work with the Department, other professionals, the
client and the caregiver to create an initial Health Service Plan (HSP) and
will obtain current provider and service information pertinent to medical
and mental health needs.
b. Anticipated Frequency of Services:
i. One (1) to three (3) hours per week.
c. Anticipated Duration of Services:
i. One (1) to ninety (90) days with the option to extend upon request by
either party and with approval of the Department.
d. Goals of Services:
i. Education of family / caregivers to gain a better understanding of medical
information and needs of identified clients.
ii. Education of caregivers to better assist caregivers in navigating the
healthcare system and understanding complex medical information
iii. Ongoing support to clients regarding facilitation/coordination of
appointments, navigation of healthcare systems and educational needs
as identified specific to all referrals.
iv. Case management support to the family / caregivers
v. Coordination and acquisition of medical supplies as identified by RN and
health care team.
e. Outcomes of Services:
i. Assessment of case -specific medical issues that may be creating child
protection concerns.
ii. Establishment of short-term and long-term goals for each individual
referral with collaboration of family.
iii. Increased understanding of medical information and healthcare system
navigation by the family supporting the caregivers and families in
mitigating or eliminating child protection concerns.
f. Target Population:
i. All ages.
ii. All genders.
g. Language:
i. English.
ii. Spanish, contingent upon ongoing subcontracted services with bilingual
Registered Nurse.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
3. Nursing Consultation
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Evidence based research and professional experience.
ii. Education regarding medical diagnosis and treatment.
iii. Utilization of credible resources such as Children's Hospital Online and
Mayo Clinic as needed to enhance education.
iv. Setup and facilitation of home visits, medical appointments, review of
medical records and discuss with/educate Department staff and clients
accordingly.
v. Meeting with Department staff and caseworkers regarding specific cases
to determine needs and goals.
vi. Ongoing documentation and/or communication of objective observations
and interactions with the client to the caseworker via phone or email.
vii. The contractor will serve as liaison between the client, caregiver,
Department and medical professionals for the purpose of setting up
and/or attending medical appointments.
viii. The contractor will work with the Department, other professionals, the
client and the caregiver to create an initial Health Services Plan (HSP) and
will obtain current provider and service information pertinent to medical
and mental health needs.
b. Anticipated Frequency of Services:
i. Four (4) hours per week.
c. Anticipated Duration of Services:
i. Services shall be for the term of the agreement.
d. Goals of Services:
i. Collaboration with Department staff to meet established goals specific to
each referral.
ii. Education of Department staff to gain a better understanding of medical
information and the needs of identified clients.
iii. Education of Department staff and caregivers to better assist caregivers
in navigating the healthcare system and understanding complex medical
information.
iv. Ongoing support to clients and staff regarding facilitation/coordination of
appointments, navigation of healthcare systems and educational needs
as identified specific to all referrals.
v. Case management support to the Department and clients.
e. Outcomes of Services:
i. Assessment of case -specific medical issues that may be creating child
protection concerns.
ii. Establishment of short-term and long-term goals for each individual
referral.
iii. Increased understanding of medical information and healthcare system
navigation by the Department staff, allowing the Department staff to
better assist caregivers and families in mitigating or eliminating child
protection concerns.
f. Target Population:
i. Department staff
ii. Clients as referred by Department.
iii. Adult and pediatric clients.
g. Language:
i. English.
ii. Spanish, contingent upon ongoing subcontracted services with bilingual
Registered Nurse.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
Terms
1. Contractor understands and will comply with all aspects of the referral authorization,
billing and tracking requirements as set forth by the Department. Failure to comply with
all aspects may result in a forfeiture of payment.
2. Contractor agrees to receive referrals for services through e-mail and will provide an
identified e-mail address prior to the start of this Agreement. Contractor acknowledges
that services are not authorized until the Contractor has received an authorized referral
form from the Department. Contractor further acknowledges that services provided
prior to the authorized start date or outside the scope of services on the referral form
will not be eligible for reimbursement.
3. Contractor will respond to the Mental Health and Support Services Team CWServiceReferral@weld.gov)Li&
within three (3) business days regarding the ability to
accept the received referral.
4. Upon acceptance of a referral, Contractor will offer an initial appointment within seven
(7) days of receiving the referral. The first attempt to contact the client will occur within
24 hours of receiving the referral (excluding weekends and holidays). Contractor will
document efforts to engage client in referred services. If the client does not respond
after three (3) attempts in the first seven (7) days of the referral period, the Contractor
will notify the caseworker and the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov.
5. Contractor acknowledges that any and all modifications to an existing referral must be
approved through the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov. No other Department staff or other partyto the case
may authorize services or modifications to services.
6. Contractor understands that "no shows" are defined as unexcused and
unplanned/uncommunicated absences for services. If a rate for "no shows" is not
specifically stated in Exhibit B, Rate Schedule, then Contractor understands that the
Department will not reimburse for "no-shows". Contractor understands that the
Department will only reimburse Contractor for up to two (2) "no-shows" on the part of
case participants who cancel without 24 -hour notice. After three (3) "no-shows",
Contractor will place client on a behavioral plan requiring attendance or discharge the
client from services. Contractor must inform the caseworker and the Mental Health and
Support Services Team HS-CWServiceReferral@weld.eov within three (3) days of when
the client is placed on a behavioral plan or discharged.
7. Contractor understands that the Department will not reimburse Contractor for
cancelled appointments either on the part of the client or the Contractor. If the
cancellation is generated from the Contractor, a "makeup" session/episode, to occur
within 30 days of the cancellation, will be offered to the client (excluding
session/episodes that fall on holidays). If the cancellation is generated from the client,
the Contractor must request a makeup session from the Department prior to the
makeup session occurring (excluding session/episodes that fall on holidays). After three
(3) cancellations, Contractor will inform the caseworker and the Mental Health and
Support Services Team HS-CWServiceReferral@weld.eov immediately via email, to
discuss service continuation.
8. Contractor will identify, in detail, areas of continued concern and make
recommendations to the caseworker in a monthly report regarding continuation of
services and/or the need for additional services.
9. Contractor will submit reports on a monthly basis for each active referral for ongoing
services. Reports will be submitted per the online format required by the Department,
unless otherwise directed by the Department.
10. Contractor will document in detail any and all observed or verbalized concerns
regarding any child whom the Contractor is working with under an active referral. Areas
of concern may include, but are not limited to, any physical, emotional, educational, or
behavioral issues. Areas of concern should be reported to the caseworker and the
Mental Health and Support Services Team HS-CWServiceReferral@weld.gov
immediately AND on the required monthly report.
11. Contractor agrees any change to an existing referral must be pre -approved through the
Clinical Care Coordinator or any member of the Mental Health and Support Services
Team. Any changes to Family Time referrals will be approved by a new referral signed
by the Child Welfare Supervisor. A change is defined as anything outside of the
approved documented service on the initial authorized referral form. This may include
an increase or decrease in services hours, change in frequency, change in location of
services, transportation needs, or any change to the initial referral or subsequent
authorizations.
12. Contractor agrees to attend meetings when available and as requested by the
Department. Such meetings include Court Facilitations, Bid Meetings, Professional
Staffings, Family Team Meetings and/or Team Decision Making meetings. The
Department will reimburse for actual participation in the meeting only so long as there
is written authorization from the Mental Health and Support Services Team, and the
facilitator documents in the meeting notes the timeframe that the provider attended
and when participation in the meeting is deemed appropriate and necessary by the
Department. The Facilitator will be responsible for filling out the time attended on the
meeting notes. Staffings and/or meetings other than those listed above are not
considered reimbursable unless otherwise approved by the Mental Health and Support
Services Team. Contractor may participate by phone or virtually, if approved by the
Department.
13. On a monthly basis, the Contractor will notify the Mental Health and Support Services
Team HS-CWServiceReferral@weld.gov of new staffwho will manage and/or
administer the services with the following information:
a. Staff member name and contact information
b. Education level/degree (if applicable)
c. Licensure/credentials (if applicable)
d. Department of Regulatory Authority (DORA) number (if applicable)
e. Supervisor name and contact information
The Department reserves the right to decline the new staff members managing
and/or administering services to Department clients.
14. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in
three areas: Safety, Permanency and Well Being of families. For each outcome, data
and performance indicators measure each state's performance according to national
standards and monitor progress over time. Following the review, a Program
Improvement Plan (PIP) will be implemented for the state to enhance services to
families.
Contractor agrees to continually strive for positive outcomes in the areas of Safety,
Permanency and Well Being. Contractor will ensure that any employee or subcontractor
of Contractor providing services under this Agreement will work towards positive
outcomes in the aforementioned three areas as outlined under the Child and Family
Services Review (CFSR) and will address the aforementioned three areas when
completing monthly reports as required by Paragraph 9 of this Exhibit.
15. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in
effect all necessary licenses, approvals, insurance, etc., required to properly provide the
services and/or supplies covered by this Agreement. Copies of all necessary licenses
shall be provided to the Department by the Contractor prior to the start of any
Agreement.
16. Training
Contractor may be required to attend training at the request of the Department specific
to services provided under this Agreement. The Department will not compensate the
Contractor for said training in the form of registration fees, time spent traveling to and
from training, attending the training or any other associated costs unless otherwise
agreed to by the Department.
17. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for
testimony from the Weld County Attorney's Office by e-mail and will return a waiver of
services within 72 business hours. For this purpose, Contractor will designate an e-mail
address prior to the start of this Agreement. If the Contractor receives a subpoena via
e-mail but will only accept personal service, the Contractor will contact the Weld County
Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be
personally served.
18. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by the Contractor and the
Department. The results of the monitoring and evaluation shall be provided to the
Board of Weld County Commissioners, the Department, and the Contractor.
Contractor will collaborate in a timely manner with the Department to resolve issues
pertaining to service delivery, service quality, documentation, and invoicing during
referral period and after services have concluded. The Contractor will require clients to
sign releases of information. Contractor understands that the Department will not
reimburse for services rendered to Department clients until releases of information are
obtained.
Contractor shall permit the Department, and any other duly authorized agent or
governmental agency, to monitor all activities conducted by the Contractor pursuant to
the terms of this Agreement. The monitoring agency may, if in its sole discretion deems
necessary or appropriate, have access to any program data, special analyses, on -site
checking, formal audit examinations, or any other reasonable procedures for purposes
of monitoring. All such monitoring shall be performed in a manner that will not unduly
interfere with the work conducted under this Agreement.
EXHIBIT B
RATE SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and
services performed under this Agreement at the rate(s) specified below in Paragraph 2,
Fees for Services.
Expenses incurred by the Contractor prior to the term of this Agreement are not eligible
Department expenditures and shall not be reimbursed by the Department.
For services funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month. If Contractor is not currently set up
with the State of Colorado to accept direct deposit, Contractor agrees to complete and
submit a State of Colorado direct deposit enrollment form, which will be provided by
the Department, with a voided check, deposit slip or bank letter. Failure to complete
and submit this form and voided check in a timely and accurate manner may result in a
delay of payment.
For services not funded through Core Services; Contractor agrees to accept payment
through County Warrant when funding source does not allow for direct deposit.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and
contingent upon the continuing availability of said funds for the purposes hereof. In the
event that said funds, or any part thereof, become unavailable as determined by the
Department, the Department may immediately terminate the Agreement or amend it
accordingly.
2. Fees for Services
Unit
Program Area
Rate
Type
Service Name
Foster Parent
Training/Adoption
Foster Parent Training: In Office/Video AND In Home
Support
$ 145.00
Hour
or Community
$ 0.67
Mile
Foster Parent Training: Mileage
$ 150.00
Each
Foster Parent Training: No Show
Family Time Support for Medically Complex
Individuals: In-Office/Video AND In -Home or
Life Skills
$ 145.00
Hour
Community
Family Time Support for Medically Complex
$ 82.00
Each
Individuals: No Show
Unit
Program Area Rate Type Service. Name
Life Skills
Family Time Support for Medically Complex
$ 102.00 Hour Individuals: FTM, TDM, Professional Staffing
0.67
Mile
Family Time Support for Medically Complex
Individuals: Mileage
H
Oa.
sFl
ni
se!
$ 143.00
Hour
Home Based Nursing Assessments & Observations:
Service with Transportation Provided
Lie
$ 113.00
Hour
Nursing Consultation: In-Office/Video AND In -Home or
Community
.67
ou
Mile
g
FTN(, T
Nurturing Program: Mileage
eng A
2
* Mileage for distances exceeding 20 roundtrip miles from 33681 County Road 13, Windsor,
Colorado 80550
3. Request for Reimbursement and Supporting Documentation
Contractor shall submit all Requests for Reimbursement and supporting documentation
to the Department by the 7th day of the month following the month of service, but no
later than 45 days from the date of service for each client receiving ongoing services.
Contractor shall prepare and submit monthly a Request for Reimbursement and
monthly report including other supporting documentation, if applicable, certifying that
services authorized were provided on the date(s) indicated and the charges were made
pursuant to the terms and conditions of Paragraph 3 of this Agreement. Monthly
reports will be submitted through the Department's online reporting system, unless
otherwise directed or agreed to by the Department. Monthly reports for ongoing
services must include the following information, entered in the "Narrative" box for each
date of service:
a. Time(s) of service (i.e. 2-4pm)
b. Location of where the service took place (i.e. clinician's office, client's home,
in the community.)
c. Clinician/therapist name
d. What interventions were used, recommendations and/or goals discussed,
progressions towards goals, and client engagement.
e. For mileage reimbursement, if applicable, the mileage accumulated minus
roundtrip mileage that is included in the rate, starting location, and ending
location.
f. Any and all safety concerns.
When submitting a Request for Reimbursement for a one-time service, the contractor
shall submit the first and last page of the evaluation/report to confirm proof of services
rendered. The full evaluation/report should be submitted by the contractor to the
caseworker.
For Monitored Sobriety services, proof of services rendered shall be the test result.
Requests for Reimbursement and/or supporting documentation received after the 7th
day of the month may delay payment. Requests for Reimbursement and/or supporting
documentation received after 45 days from the date of service may result in delay or
forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in
termination of the Agreement.
4. Payment
The Department and the Contractor agree that all benefits from private insurance
and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible
provider) or Victim's Compensation must be exhausted before Core Services or other
Department funds can be accessed for services. Exceptions to this Paragraph may
include, if approved by the Department, the following: The service being provided by
the contractor is not a Medicaid eligible service;
a. The service is not deemed medically necessary;
b. The Court with jurisdiction over the case has ordered that a non -Medicaid
provider or service be used;
c. A Medicaid provider is not available to provide the needed service;
d. Medicaid is exhausted for the needed service; or
e. Medicaid denied service.
f. The client is not eligible for Medicaid.
The Department may withhold reimbursement if Contractor has failed to comply with
any part of the Agreement, including the Financial Management requirements, program
objectives, contractual terms, or reporting requirements. In the event of forfeiture of
reimbursement, Contractor may appeal such circumstance in writing to the Director of
Human Services. The decision of the Director of Human Services shall be final.
5. Remedies
The Director of Human Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions
are as follows:
a. Withhold payment to the Contractor until the necessary services or
corrections in performance are satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables,
which have not been performed and which due to circumstances caused by
the Contractor cannot be performed or if performed would be of no value to
the Department. Denial of the amount of payment shall be reasonably
related to the amount of work or deliverables lost to the Department.
Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation
shall be recovered from Contractor by deduction from subsequent payments under this
Agreement or other agreements between the Department and Contractor, or by the
Department as a debt due to the Department or otherwise as provided by law.
6. Financial Management
At all times from the effective date of the Agreement until completion of the
Agreement, Contractor shall comply with the administrative requirements, cost
principles and other requirements set forth in the Financial Management Manual
adopted by the State of Colorado. The required annual audit of all funds expended
under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
SIGNATURE REQUESTED: Weld/Creative
Nursing Amendment #1
Final Audit Report
2024-06-05
Created: 2024-06-05
By: Windy Luna (wluna@weld.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAPwrXuhhzSKKJFsHDpu_EG0r44cMcvJwB
"SIGNATURE REQUESTED: Weld/Creative Nursing Amendmen
t #1" History
5 Document created by Windy Luna (wluna@weld.gov)
2024-06-05 - 7:28:10 PM GMT- IP address: 204.133.39.9
2. Document emailed to nurseconsult7@gmail.com for signature
2024-06-05 - 7:29:10 PM GMT
t Email viewed by nurseconsult7@gmail.com
2024-06-05 - 7:29:27 PM GMT- IP address: 66.102.7.114
4 Signer nurseconsult7@gmail.com entered name at signing as Amanda Hartshorn, RN MSN
2024-06-05 - 7:30:33 PM GMT- IP address: 174.198.144.46
4 Document e -signed by Amanda Hartshorn, RN MSN (nurseconsult7@gmail.com)
Signature Date: 2024-06-05 - 7:30:35 PM GMT - Time Source: server- IP address: 174.198.144.46
0 Agreement completed.
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Date: 2024-01-17
INSURANCE
CERTIFICATE OF INSURANCE
Your professional liability insurance is written on a claims made basis and provides coverage for those claims which are the result of medical incidents
occurring subsequent to the prior acts date stated and which are first made against you while this insurance is in force, Please discuss with your program
administrator.
Prior Acts Date: 2024-07-17
Purchasing Group
Certificate Number
Policy Period
Professional Services Purchasing Group
11807 Westheimer Road, Suite 550 PMB 990, Houston, TX 77077
UTA 233543-02D224
from: 12:01 AM Standard Time on: 2024-02-02
to: 12:01 AM Standard Time on: 2025-02-02
Named Insured and Address
Business Address
Program Administrator
Amanda Lee Hartshorn
33681 County Road 13 Windsor, Colorado 80550
33681 County Road 13
Windsor, Colorado 80550
NOW insurance Services
11807 Westheimer Road, Suite 550 PMB 990
Houston, TX 77077
Medical Specialty:
Registered Nurse (RN)
Insurance Provided by:
United Indemnity Inc
COVERAGE PARTS LIMITS OF LIABILITY
A.
PROFESSIONAL LIABILITY Deductible - $0
Professional Liability (PL)
$1,000,000 each claim
$6,000,000 aggregate
Good Samaritan Liability
included above
Personal Injury Liability
included above
Malplacement Liability
included above
B.
Coverage Extensions:
License Protection
$5,000 per proceeding
$10,000 aggregate
Deposition Representation
$5,000 per proceeding
$10,000 aggregate
First Ald
$2,500 per incident
$2,500 aggregate
Medical Payments
$2,500 per incident
$2,500 aggregate
Damage to Property of Others
$500 per incident
$2,500 aggregate
C.
GENERAL LIABILITY Deductible - $0
General Liability (GL)
$1,000,000 each occurrence
$6,000,000 aggregate
Fire & Water Legal Liability
included in the GL limit above
subject to
$10,000 sub -limit
Personal Liability
included in the GL limit
included in the GL limit
Policy toms and endorsements attached at inception:
GENERAL LIABILITY COVERAGE
SELF-EMPLOYED
Additional lnsured(s):
CREATIVE NURSING LLC, WELD COUNTY AND BOARD OF COUNTY COMMISSIONERS WELD COUNTY AND IT'S OFFICERS AND EMPLOYEES
Keep this document in a safe place. It is evidence of your insurance coverage.
Master Policy #UTA-09122023-01
Authome d`fiepresentative
Philip G. Cabaud
Please Note: All inquiries regarding this Certificate of Insurance should be addressed to the following Correspondent:
NOW Insurance
Email: InfatS nowlnsu raase.cotn
Phone: (888) 585-2075
Contract Form
Entity Information
Entity Name *
CREATIVE NURSING LLC
Entity ID*
@00045193
Contract Name *
CREATIVE NURSING, LLC (PROFESSIONAL SERVICES
AGREEMENT AMENDMENT #1)
Contract Status
CTB REVIEW
Q New Entity?
Contract ID
8309
Contract Lead *
WLUNA
Contract Lead Email
wluna@weldgov.com;cob
bxxlk@weldgov.com
Parent Contract ID
20241221
Requires Board Approval
YES
Department Project #
Contract Description *
(CONSENT) CREATIVE NURSING, LLC - PROFESSIONAL SERVICES AGREEMENT AMENDMENT #1. TERM
06/01/2024 THROUGH 05/31/2027.
Contract Description 2
PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 04/10/2024.
Contract Type*
AMENDMENT
Amount*
$0.00
Renewable*
YES
Automatic Renewal
Grant
IGA
Department
HUMAN SERVICES
Department Email
CM-
Human5ervices@weldgov.
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Requested BOCC Agenda
Date *
06/19/2024
Due Date
06/15/2024
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
03/31/2025
Renewal Date*
06/01/2025
Committed Delivery Date Expiration Date
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
CONSENT 06/10/2024
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CONSENT CONSENT
DH Approved Date Finance Approved Date Legal Counsel Approved Date
06/10/2024 06/10/2024 06/10/2024
Final Approval
BOCC Approved Tyler Ref #
AG 061 724
BOCC Signed Date Originator
WLUNA
BOCC Agenda Date
06/17/2024
C,onkvac sf15
PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND
AMANDA HARTSHORN DBA CREATIVE NURSING LLC
THIS AGREEMENT is made and entered into this t Uday of Mun, 204, by and
between the Board of Weld County Commissioners, on behalf of the Weld County Department
of Human Services, hereinafter referred to as "County," and Amanda Hartshorn DBA Creative
Nursing LLC, hereinafter referred to as "Contractor".
WHEREAS, County desires to retain Contractor to perform services as required by County
and set forth in the attached Exhibits; and
WHEREAS, Contractor is willing and has the specific ability, qualifications, and time to
perform the required services according to the terms of this Agreement; and
WHEREAS, Contractor is authorized to do business in the State of Colorado and has the
time, skill, expertise, and experience necessary to provide the services as set forth below; and
WHEREAS, the Colorado Department of Human Services has provided Core and Non -
Core or other funding to the Department for Foster Parent Training and Nurturing Program
Services.
NOW, THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree as follows:
1. Introduction. The terms of this Agreement are contained in the terms recited in this
document and in the attached Exhibits, each of which forms an integral part of this Agreement
and are incorporated herein. The parties each acknowledge and agree that this Agreement,
including the attached Exhibits, define the performance obligations of Contractor and
Contractor's willingness and ability to meet those requirements (the "Work"). If a conflict occurs
between this Agreement and any Exhibit or other attached document, the terms of this
Agreement shall control, and the remaining order of precedence shall based upon order of
attachment.
Exhibit A consists of the Scope of Services.
Exhibit B consist of the Rate Schedule.
Exhibit C consists of County's Request for Proposal (RFP) as set forth in Bid Package No.
B2400040 which is incorporated into this agreement by reference and will be provided
upon request to the Department.
Exhibit D consists of Contractor's Response to County's Request.
Cunt-,ll-"ice.(tdok
5A 5/2,4
6C: ati64,./-410)
67//ov
2024-1221
2. Service or Work. Contractor agrees to diligently provide all services, labor, personnel
and materials necessary to perform and complete the Work described in the attached Exhibits.
Services shall be provided by the Contractor to any person(s) eligible for services in compliance
with Exhibits A, Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal.
Contractor shall further be responsible for the timely completion and acknowledges that a failure
to comply with the standards and requirements of Work within the time limits prescribed by
County may result in County's decision to withhold payment or to terminate this Agreement.
3. Term. The term of this Agreement shall be from June 1, 2024, through May 31,
2027, unless sooner terminated as provided herein, and is subject to continued budget
appropriations.
4. Termination; Breach; Cure. County may terminate this Agreement for its own
convenience upon thirty (30) days written notice to Contractor. Either Party may immediately
terminate this Agreement upon material breach of the other party, however the breaching party
shall have fifteen (15) days after receiving such notice to cure such breach. If this Agreement is
terminated by County, Contractor shall be compensated for, and such compensation shall be
limited to, (1) the sum of the amounts contained in invoices which it has submitted and which
have been approved by the County; (2) the reasonable value to County of the services which
Contractor provided prior to the date of the termination notice, but which had not yet been
approved for payment; and (3) the cost of any work which the County approves in writing which
it determines is needed to accomplish an orderly termination of the work. County shall be
entitled to the use of all material generated pursuant to this Agreement upon termination. Upon
termination of this Agreement by County, Contractor shall have no claim of any kind whatsoever
against the County by reason of such termination or by reason of any act incidental thereto,
except for compensation for work satisfactorily performed and/or materials described herein
properly delivered.
5. Extension or Amendment. Any amendments or modifications to this agreement shall
be in writing signed by both parties. No additional services or work performed by Contractor shall
be the basis for additional compensation unless and until Contractor has obtained written
authorization and acknowledgement by County for such additional services. Accordingly, no
claim that the County has been unjustly enriched by any additional services, whether or not there
is in fact any such unjust enrichment, shall be the basis of any increase in the compensation
payable hereunder. In the event that written authorization and acknowledgment by the County
for such additional services is not timely executed and issued in strict accordance with this
Agreement, Contractor's rights with respect to such additional services shall be deemed waived
and such failure shall result in non-payment for such additional services or work performed. Any
claims by the Contractor for adjustment hereunder must be made in writing prior to performance
of any work covered in the anticipated Amendment, unless approved and documented otherwise
by the County Representative. Any change in work made without such prior Amendment shall
be deemed covered in the compensation and time provisions of this Agreement, unless approved
and documented otherwise by the County Representative.
2
6. Compensation. County agrees to pay Contractor through an invoice process during
the course of this Agreement in accordance with the Rate Schedule as described as Exhibit B.
Contractor agrees to submit invoices which detail the work completed by Contractor. The County
will review each invoice and if it agrees Contractor has completed the invoiced items to the
County's satisfaction, it will remit payment to the Contractor. No payment in excess of that set
forth in the Exhibits will be made by County unless an Amendment authorizing such additional
payment has been specifically approved by Weld County as required pursuant to the Weld
County Code. If, at any time during the term or after termination or expiration of this Agreement,
County reasonably determines that any payment made by County to Contractor was improper
because the service for which payment was made did not perform as set forth in this Agreement,
then upon written notice of such determination and request for reimbursement from County,
Contractor shall forthwith return such payment(s) to County. Upon termination or expiration of
this Agreement, unexpended funds advanced by County, if any, shall forthwith be returned to
County. County will not withhold any taxes from monies paid to the Contractor hereunder and
Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes
related to payments made pursuant to the terms of this Agreement. Unless expressly
enumerated in the attached Exhibits, Contractor shall not be entitled to be paid for any other
expenses (e.g. mileage). Notwithstanding anything to the contrary contained in this Agreement,
County shall have no obligations under this Agreement after, nor shall any payments be made to
Contractor in respect of any period after December 31 of any year, without an appropriation
therefore by County in accordance with a budget adopted by the Board of County Commissioners
in compliance with Article 25, Title 30 of the Colorado Revised Statutes, the Local Government
Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article
X, Sec. 20).
7. Independent Contractor. Contractor agrees that it is an independent contractor and
that Contractor's officers, agents or employees will not become employees of County, nor
entitled to any employee benefits (including unemployment insurance or workers' compensation
benefits) from County as a result of the execution of this Agreement. Contractor shall be solely
responsible for its acts and those of its agents and employees for all acts performed pursuant to
this Agreement. Contractor, its employees and agents are not entitled to unemployment
insurance or workers' compensation benefits through County and County shall not pay for or
otherwise provide such coverage for Contractor or any of its agents or employees.
Unemployment insurance benefits will be available to Contractor and its employees and agents
only if such coverage is made available by Contractor or a third party. Contractor shall pay
when due all applicable employment taxes and income taxes and local head taxes (if
applicable) incurred pursuant to this Agreement.
8. Subcontractors. Contractor acknowledges that County has entered into this
Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor
shall not enter into any subcontractor agreements for the completion of the Work without
County's prior written consent, which may be withheld in County's sole discretion. County shall
have the right in its reasonable discretion to approve all personnel assigned to the Work during
the performance of this Agreement and no personnel to whom County has an objection, in its
3
reasonable discretion, shall be assigned to the Work. Contractor shall require each
subcontractor, as approved by County and to the extent of the Work to be performed by the
subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward
Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes
toward County. County shall have the right (but not the obligation) to enforce the provisions of
this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in
such process. The Contractor shall be responsible for the acts and omissions of its agents,
employees and subcontractors.
9. Ownership. All work and information obtained by Contractor under this Agreement or
individual work order shall become or remain (as applicable), the property of County. In addition,
all reports, documents, data, plans, drawings, records, and computer files generated by
Contractor in relation to this Agreement and all reports, test results and all other tangible
materials obtained and/or produced in connection with the performance of this Agreement,
whether or not such materials are in completed form, shall at all times be considered the
property of the County. Contractor shall not make use of such material for purposes other than
in connection with this Agreement without prior written approval of County.
10. Confidentiality. Confidential information of the Contractor should be transmitted
separately from non -confidential information, clearly denoting in red on the relevant document
at the top the word, "CONFIDENTIAL." However, Contractor is advised that as a public entity,
Weld County must comply with the provisions of the Colorado Open Records Act (CORA), C.R.S.
24-72-201, et seq., with regard to public records, and cannot guarantee the confidentiality of all
documents. Contractor agrees to keep confidential all of County's confidential information.
Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to
any other person or entity without seeking written permission from the County. Contractor
agrees to advise its employees, agents, and consultants, of the confidential and proprietary
nature of this confidential information and of the restrictions imposed by this Agreement.
11. Warranty. Contractor warrants that the Work performed under this Agreement will
be performed in a manner consistent with the standards governing such services and the
provisions of this Agreement. Contractor further represents and warrants that all Work shall be
performed by qualified personnel in a professional manner, consistent with industry standards,
and that all services will conform to applicable specifications.
12. Acceptance of Services Not a Waiver. Upon completion of the Work, Contractor
shall submit to County originals of all test results, reports, etc., generated during completion of
this work. Acceptance by County of reports and incidental material(s) furnished under this
Agreement shall not in any way relieve Contractor of responsibility for the quality and accuracy
of the project. In no event shall any action by County hereunder constitute or be construed to
be a waiver by County of any breach of this Agreement or default which may then exist on the
part of Contractor, and County's action or inaction when any such breach or default exists shall
not impair or prejudice any right or remedy available to County with respect to such breach or
default. No assent, expressed or implied, to any breach of any one or more covenants, provisions
4
or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach.
Acceptance by the County of, or payment for, the Work completed under this Agreement shall
not be construed as a waiver of any of the County's rights under this Agreement or under the law
generally.
13. Insurance. Contractor must secure, before the commencement of the Work, the
following insurance covering all operations, goods, and services provided pursuant to this
Agreement, and shall keep the required insurance coverage in force at all times during the term of
the Agreement, or any extension thereof, and during any warranty period. For all coverages,
Contractor's insurer shall waive subrogation rights against County.
a. Types of Insurance.
Workers' Compensation / Employer's Liability Insurance as required by state statute,
covering all of the Contractor's employees acting within the course and scope of their
employment. The policy shall contain a waiver of subrogation against the County. This
requirement shall not apply when a Contractor or subcontractor is exempt under
Colorado Workers' Compensation Act., AND when such Contractor or subcontractor
executes the appropriate sole proprietor waiver form.
Commercial General Liability Insurance including public liability and property damage,
covering all operations required by the Work. Such policy shall include minimum limits as
follows: $1,000,000 each occurrence; $1,000,000 general aggregate; $1,000,000
Personal injury; $5,000 Medical payment per person.
Automobile Liability Insurance: Contractor shall maintain limits of $1,000,000 for bodily
injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for
property damage applicable to all vehicles operating both on County property and
elsewhere, for vehicles owned, hired, and non -owned vehicles used in the performance
of this Contract.
Professional Liability (Errors and Omissions Liability). The policy shall cover professional
misconduct or lack of ordinary skill for those positions defined in the Scope of Services of
this contract. Contractor shall maintain limits for all claims covering wrongful acts, errors
and/or omissions, including design errors, if applicable, for damage sustained by reason
of or in the course of operations under this Contract resulting from professional services.
In the event that the professional liability insurance required by this Contract is written
on a claims -made basis, Contractor warrants that any retroactive date under the policy
shall precede the effective date of this Contract; and that either continuous coverage will
be maintained or an extended discovery period will be exercised for a period of two (2)
years beginning at the time work under this Contract is completed. Minimum Limits:
$1,000,000 Per Loss; $2,000,000 Aggregate.
5
b. Proof of Insurance. Upon County's request, Contractor shall provide to County a
certificate of insurance, a policy, or other proof of insurance as determined in County's
sole discretion. County may require Contractor to provide a certificate of insurance
naming Weld County, Colorado, its elected officials, and its employees as an additional
named insured.
c. Subcontractor Insurance. Contractor hereby warrants that all subcontractors
providing services under this Agreement have or will have the above -described insurance
prior to their commencement of the Work, or otherwise that they are covered by the
Contractor's policies to the minimum limits as required herein. Contractor agrees to
provide proof of insurance for all such subcontractors upon request by the County.
d. No limitation of Liability. The insurance coverages specified in this Agreement are the
minimum requirements, and these requirements do not decrease or limit the liability of
Contractor. The County in no way warrants that the minimum limits contained herein are
sufficient to protect the Contractor from liabilities that might arise out of the performance
of the Work under by the Contractor, its agents, representatives, employees, or
subcontractors. The Contractor shall assess its own risks and if it deems appropriate
and/or prudent, maintain higher limits and/or broader coverages. The Contractor is not
relieved of any liability or other obligations assumed or pursuant to the Contract by
reason of its failure to obtain or maintain insurance in sufficient amounts, duration, or
types. The Contractor shall maintain, at its own expense, any additional kinds or amounts
of insurance that it may deem necessary to cover its obligations and liabilities under this
Agreement.
e. Certification of Compliance with Insurance Requirements. The Contractor stipulates that
it has met the insurance requirements identified herein. The Contractor shall be
responsible for the professional quality, technical accuracy, and quantity of all services
provided, the timely delivery of said services, and the coordination of all services
rendered by the Contractor and shall, without additional compensation, promptly remedy
and correct any errors, omissions, or other deficiencies.
14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its
officers, agents, and employees, from and against any and all injury, loss, damage, liability, suits,
actions, claims, or willful acts or omissions of any type or character arising out of the Work done
in fulfillment of the terms of this Agreement or on account of any act, claim or amount arising or
recovered under workers' compensation law or arising out of the failure of the Contractor to
conform to any statutes, ordinances, regulation, judicial decision, or other law or court decree.
The Contractor shall be fully responsible and liable for any and all injuries or damage received or
sustained by any person, persons, or property on account of its performance under this
Agreement or its failure to comply with the provisions of the Agreement. It is agreed that the
Contractor will be responsible for primary loss investigation, defense and judgment costs where
this contract of indemnity applies. In consideration of the award of this contract, the Contractor
agrees to waive all rights of subrogation against the County its associated and/or affiliated
6
entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers
for losses arising from the work performed by the Contractor for the County. A failure to comply
with this provision shall result in County's right to immediately terminate this Agreement.
15. Non -Assignment. Contractor may not assign or transfer this Agreement or any
interest therein or claim thereunder, without the prior written approval of County. Any attempts
by Contractor to assign or transfer its rights hereunder without such prior approval by County
shall, at the option of County, automatically terminate this Agreement and all rights of Contractor
hereunder. Such consent may be granted or denied at the sole and absolute discretion of County.
16. Examination of Records. To the extent required by law, the Contractor agrees that
an
duly authorized representative of County, including the County Auditor, shall have access to and
the right to examine and audit any books, documents, papers and records of Contractor, involving
all matters and/or transactions related to this Agreement. Contractor agrees to maintain these
documents for three years from the date of the last payment received.
17. Interruptions. Neither party to this Agreement shall be liable to the other for delays in
delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where
such failure is due to any cause beyond its reasonable control, including but not limited to Acts
of God, fires, strikes, war, flood, earthquakes or Governmental actions.
18. Notices. County may designate, prior to commencement of Work, its project
representative ("County Representative") who shall make, within the scope of his or her
authority, all necessary and proper decisions with reference to the project. All requests for
contract interpretations, change orders, and other clarification or instruction shall be directed to
County Representative. All notices or other communications made by one party to the other
concerning the terms and conditions of this contract shall be deemed delivered under the
following circumstances:
(a) personal service by a reputable courier service requiring signature for receipt; or
(b) five (5) days following delivery to the United States Postal Service, postage prepaid
addressed to a party at the address set forth in this contract; or
(c) electronic transmission via email at the address set forth below, where a receipt or
acknowledgment is required and received by the sending party; or
Either party may change its notice address(es) by written notice to the other. Notice may be sent
to:
TO CONTRACTOR:
Name: Amanda Hartshorn
Position: Registered Nurse
Address: 33681 County Road 13
Address: Windsor, Colorado 80550
E-mail: amanda.hartshorn@creativenursing.org
Phone: (970) 980-9506
7
TO COUNTY:
Name: Jamie Ulrich
Position: Director
Address: P.O. Box A
Address: Greeley, Colorado 80632
E-mail: iulrich@weld.gov
Phone: (970) 400-6510
19. Compliance with Law. Contractor shall strictly comply with all applicable federal and
State laws, rules and regulations in effect or hereafter established, including without limitation,
laws applicable to discrimination and unfair employment practices.
20. Non -Exclusive Agreement. This Agreement is nonexclusive, and County may engage or
use other Contractors or persons to perform services of the same or similar nature.
21. Entire Agreement/Modifications. This Agreement including the Exhibits attached
hereto and incorporated herein, contains the entire agreement between the parties with respect
to the subject matter contained in this Agreement. This instrument supersedes all prior
negotiations, representations, and understandings or agreements with respect to the subject
matter contained in this Agreement. This Agreement may be changed or supplemented only by
a written instrument signed by both parties.
22. Fund Availability. Financial obligations of the County payable after the current fiscal
year are contingent upon funds for that purpose being appropriated, budgeted and otherwise
made available. Execution of this Agreement by County does not create an obligation on the part
of County to expend funds not otherwise appropriated in each succeeding year.
23. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-
50-507. The signatories to this Agreement state that to their knowledge, no employee of Weld
County has any personal or beneficial interest whatsoever in the service or property which is the
subject matter of this Agreement. Contractor agrees that if Contractor employs a former
employee of the Department of Human Services, Contractor will notify the County within 30 days
of employment. The Contractor will also abide by applicable requirements under C.R.S. 24-18-
201 et seq.
24. Survival of Termination. The obligations of the parties under this Agreement that by their
nature would continue beyond expiration or termination of this Agreement (including, without
limitation, the warranties, indemnification obligations, confidentiality and record keeping
requirements) shall survive any such expiration or termination.
25. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed
8
and enforced without such provision, to the extent that this Agreement is then capable of
execution within the original intent of the parties.
26. Governmental Immunity. No term or condition of this Agreement shall be construed
or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits,
protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et
seq., as applicable now or hereafter amended.
27. No Third -Party Beneficiary. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of action relating to
such enforcement, shall be strictly reserved to the undersigned parties and nothing in this
Agreement shall give or allow any claim or right of action whatsoever by any other person not
included in this Agreement. It is the express intention of the undersigned parties that any entity
other than the undersigned parties receiving services or benefits under this Agreement shall be
an incidental beneficiary only.
28. Board of County Commissioners of Weld County Approval. This Agreement shall
not be valid until it has been approved by the Board of County Commissioners of Weld County,
Colorado or its designee.
29. Choice of Law/Jurisdiction. Colorado law, and rules and regulations established
pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this
Agreement. Any provision included or incorporated herein by reference which conflicts with said
laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the
parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to
resolve said dispute.
30. Attorney's Fees/Legal Costs. In the event of a dispute between County and Contractor
concerning this Agreement, the parties agree that each party shall be responsible for the
payment of attorney fees and/or legal costs incurred by or on its own behalf.
31. Binding Arbitration Prohibited. Weld County does not agree to binding arbitration by any
extra -judicial body or person. Any provision to the contrary in this Agreement or incorporated
herein by reference shall be null and void.
32. Acknowledgment. County and Contractor acknowledge that each has read this
Agreement, understands it and agrees to be bound by its terms. Both parties further agree that
this Agreement, with the attached Exhibits, is the complete and exclusive statement of
agreement between the parties and supersedes all proposals or prior agreements, oral or
written, and any other communications between the parties relating to the subject matter of this
Agreement.
9
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
COUNTY:
ATTEST: 've.
BY:
rk to the Board
Deputy CI
10
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Kevin D. Ross, Chair
MAY 1 5 2024
ONTRACTOR:
Amanda Hartshorn
DBA Creative Nursing LLC
33681 County Road 13
Windsor, Colorado 80550
reoldha
Amanda Hartshorn, RN
1, 2024
Date: May
a?`/, /-1
EXHIBIT A
SCOPE OF SERVICES
Contractor will provide Foster Parent Training and Nurturing Program Services, as referred by
the Department.
Program Area: Foster Parent Training
1. Foster Parent Training
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Over the counter medications (OTC).
ii. Medication concepts.
iii. Medication administration records (MAR).
iv. Medication administration procedure.
v. Medication errors.
vi. Medication storage safety.
vii. Seven (7) rights of medication administration.
viii. Six (6) components of a physician order.
ix. Common abbreviations and measurement equivalents.
x. RN will use developed syllabus and qualifications in alignment with the
State of Colorado Regulatory Agencies.
xi. Validation of competency will be obtained via quizzes throughout
educational sessions.
xii. This is not a Qualified Medication Administration Personnel (QMAP)
course.
xiii. A certificate of completion can be provided upon request.
b. Anticipated Frequency of Services:
i. Three (3) hours per each training.
c. Anticipated Duration of Services:
i. Course will be offered up to one (1) time per month.
ii. Course duration may be extended for large group sessions.
d. Goals of Services:
i. Assist foster parents in gaining skills for proper medication
administration.
ii. Educate on safety of medication storage.
iii. Understand over the counter medications and need for physician orders
for all administrated medications.
e. Outcomes of Services:
i. Safe medication administration of physician ordered medications.
ii. Understanding medication orders.
iii. Understanding how to obtain orders and administer medications
correctly and safely.
iv. How to use OTC medications.
v. How to use OTC medications correctly and safely with a physician order.
f. Target Population:
i. Foster Parents.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
Program Area: Nurturing Program
2. Family Time Support for Medically Complex Individuals
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Registered Nurse or licensed delegated medical professional will provide
family support during scheduled family time for complex or medically
fragile individuals.
ii. Short and long-term goal setting will be established pertinent to medical
and mental health needs.
iii. Skilled hands-on demonstration to caregivers regarding performance of
ordered medical tasks in a safe and competent manner.
iv. Demonstration of skilled nursing education to caregivers regarding
performance of ordered medical tasks in a safe and competent manner.
v. Demonstration of skilled nursing education around ordered
interventions.
vi. Contractor will not provide ongoing nursing support as Home Health Care
Services.
vii. Hands-on nursing skilled education by directing and educating caregivers
on ordered interventions.
b. Anticipated Frequency of Services:
i. One (1) to six (6) hours per week.
c. Anticipated Duration of Services:
i. One (1) to ninety (90) days with the option to extend upon request by
either party with approval of the Department.
d. Goals of Services:
i. Clinical staff will provide supervision and safety education regarding
medical needs during family time.
ii. Family time will be therapeutic and educational opportunity for
information specific to medical diagnoses or medical needs/skills ordered
by a provider with written orders.
iii. Medical interventions will be monitored for safety and correct
implementation.
iv. To free up visitation supervisors from needing to provide services to the
family at the same time, eliminating the need for two (2) professionals
during family time.
v. RN can request to have visitation supervisor present, if necessary, for
safety.
e. Outcomes of Services:
i. Improved medical understanding of child with complex medical needs.
ii. Safe and productive family time, ensuring understanding of education
regarding warnings, signs of impending urgent or emergent medical
needs, and the need to seek higher level of care.
iii. Increase providers resulting in more availability for family time to begin
promptly and safely with a medical professional present during family
time.
f. Target Population:
i. All ages.
ii. All genders.
g. Language:
i. English.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
3. Home -Based Nursing Assessments and Observations
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Information will be collected from the department, other professionals,
the client, and the caregivers to determine medical and mental health
care needs specific to each client. Contractors will work collaboratively
with all parties to gather and review all necessary information.
ii. Short and long-term goals setting will be established pertinent to medical
and mental health needs.
iii. Creating a Health Service Plan (HSP).
iv. Hands-on demonstration.
v. The contractor will provide hands-on nursing skilled education. The
contractor will provide hands-on nursing skilled education by directing
and educating caregivers on ordered interventions. Contractor will NOT
provide ongoing nursing support such as Home Health Care Services.
b. Anticipated Frequency of Services:
i. One (1) to ten (10) hours per week.
c. Anticipated Duration of Services:
i. One (1) to ninety (90) days with the option to extend upon request by
either party with approval of the Department.
d. Goals of Services:
i. Education of client and/or caregivers regarding client specific medical
information to promote increased understanding and knowledge of
information regarding medical needs.
ii. Current assessments as indicated by type of referral (physical
assessment, weight check, monitoring of diabetic devices etc.).
iii. Hands-on skilled nursing demonstration of ordered medical interventions
to promote understanding and competency by client and/or caregiver.
iv. Hands-on education of client and/or caregiver regarding navigation of the
healthcare system to promote confidence and increase ability to navigate
the system successfully and independently.
e. Outcomes of Services:
i. Client and/or caregiver will demonstrate increased knowledge and
understanding of the client's medical and mental health information and
needs, including self -care, ongoing medical needs and requirements for a
safe environment.
ii. Client and/or caregiver will demonstrate increased understating and
competency regarding ordered medical interventions through hands-on
performance of interventions. Client will demonstrate safe, accurate and
confident performance of ordered interventions.
iii. Increased confidence and ability to navigate the healthcare system
independently and successfully, and confidence in accessing additional
resources as needed.
iv. Decreased child protection issues mitigated through increased
knowledge and understanding of client's medical issues, needs and
ordered interventions.
f. Target Population:
i. All ages.
ii. All genders.
g. Language:
i. English.
ii. Spanish, contingent upon ongoing subcontracted services with bilingual
Registered Nurse.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
4. Nursing Case Management/Education
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Evidence based research and professional experience.
ii. Family/ Caregiver education regarding medical diagnosis and treatment.
iii. Utilization of credible resources such as Children's Hospital Online and
Mayo Clinic as needed to enhance education.
iv. Setup and facilitation of home visits, medical appointments and hospital
record reviews providing required level of assistance needed specific to
referral with goal of independence.
v. Ongoing documentation and/or communication of objective observations
and interactions with the client to the caseworker via phone or email
vi. The contractor will serve as liaison between the client, caregiver,
Department and medical professionals for the purpose of setting up
and/or attending medical appointments.
vii. Health Service Plan (HSP): Contractor will work with the Department,
other professionals, the client and the caregiver to create an initial HSP
and will obtain current provider and service information pertinent to
medical and mental health needs.
b. Anticipated Frequency of Services:
i. One (1) to three (3) hours per week.
c. Anticipated Duration of Services:
i. One (1) to ninety (90) days with the option to extend upon request by
either party and with approval of the Department.
d. Goals of Services:
i. Education of family/ caregivers to gain a better understanding of medical
information and needs of identified clients.
ii. Education of caregivers to better assist caregivers in navigating the
healthcare system and understanding complex medical information
iii. Ongoing support to clients regarding facilitation/coordination of
appointments, navigation of healthcare systems and educational needs
as identified specific to all referrals.
iv. Case management support to the family / caregivers
v. Coordination and acquisition of medical supplies as identified by RN and
health care team.
e. Outcomes of Services:
i. Assessment of case -specific medical issues that may be creating child
protection concerns.
ii. Establishment of short-term and long-term goals for each individual
referral with collaboration of family.
iii. Increased understanding of medical information and healthcare system
navigation by the family supporting the caregivers and families in
mitigating or eliminating child protection concerns.
f. Target Population:
i. All ages.
ii. All genders.
g. Language:
i. English.
ii. Spanish, contingent upon ongoing subcontracted services with bilingual
Registered Nurse.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
5. Nursing Consultation
a. Contractor will utilize the following modalities, curriculum, and tools in the
delivery of services under this agreement:
i. Evidence based research and professional experience.
ii. Education regarding medical diagnosis and treatment.
iii. Utilization of credible resources such as Children's Hospital Online and
Mayo Clinic as needed to enhance education.
iv. Setup and facilitation of home visits, medical appointments, review of
medical records and discuss with/educate Department staff and clients
accordingly.
v. Meeting with Department staff and caseworkers regarding specific cases
to determine needs and goals.
vi. Ongoing documentation and/or communication of objective observations
and interactions with the client to the caseworker via phone or email
vii. The contractor will serve as liaison between the client, caregiver,
Department and medical professionals for the purpose of setting up
and/or attending medical appointments.
viii. Health Service Plan (HSP): Contractor will work with the Department,
other professionals, the client and the caregiver to create an initial HSP
and will obtain current provider and service information pertinent to
medical and mental health needs.
b. Anticipated Frequency of Services:
i. Four (4) hours per week.
c. Anticipated Duration of Services:
i. Services shall be for the term of the agreement.
d. Goals of Services:
i. Collaboration with Department staff to meet established goals specific to
each referral.
ii. Education of Department staff to gain a better understanding of medical
information and the needs of identified clients.
iii. Education of Department staff and caregivers to better assist caregivers
in navigating the healthcare system and understanding complex medical
information.
iv. Ongoing support to clients and staff regarding facilitation/coordination of
appointments, navigation of healthcare systems and educational needs
as identified specific to all referrals.
v. Case management support to the Department and clients.
e. Outcomes of Services:
i. Assessment of case -specific medical issues that may be creating child
protection concerns.
ii. Establishment of short-term and long-term goals for each individual
referral.
iii. Increased understanding of medical information and healthcare system
navigation by the Department staff, allowing the Department staff to
better assist caregivers and families in mitigating or eliminating child
protection concerns.
f. Target Population:
i. Department staff
ii. Clients as referred by Department.
iii. Adult and pediatric clients.
g. Language:
i. English.
ii. Spanish, contingent upon ongoing subcontracted services with bilingual
Registered Nurse.
h. Medicaid Eligibility:
i. This service is not Medicaid eligible.
i. Service Access and Transportation:
i. In-Office/Video.
ii. In -Home or Community.
Terms
1. Contractor understands and will comply with all aspects of the referral authorization,
billing and tracking requirements as set forth by the Department. Failure to comply with
all aspects may result in a forfeiture of payment.
2. Contractor agrees to receive referrals for services through e-mail and will provide an
identified e-mail address prior to the start of this Agreement. Contractor acknowledges
that services are not authorized until the Contractor has received an authorized referral
form from the Department. Contractor further acknowledges that services provided
prior to the authorized start date or outside the scope of services on the referral form
will not be eligible for reimbursement.
3. Contractor will respond to the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov) within three (3) business days regarding the ability to
accept the received referral.
4. Upon acceptance of a referral, Contractor will offer an initial appointment within seven
(7) days of receiving the referral. The first attempt to contact the client will occur within
24 hours of receiving the referral (excluding weekends and holidays). Contractor will
document efforts to engage client in referred services. If the client does not respond
after three (3) attempts in the first seven (7) days of the referral period, the Contractor
will notify the caseworker and the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov.
5. Contractor acknowledges that any and all modifications to an existing referral must be
approved through the Mental Health and Support Services Team HS-
CWServiceReferral@weld.gov. No other Department staffor other party to the case
may authorize services or modifications to services.
6. Contractor understands that "no shows" are defined as unexcused and
unplanned/uncommunicated absences for services. If a rate for "no shows" is not
specifically stated in Exhibit B, Rate Schedule, then Contractor understands that the
Department will not reimburse for "no-shows". Contractor understands that the
Department will only reimburse Contractor for up to two (2) "no-shows" on the part of
case participants who cancel without 24 -hour notice. After three (3) "no-shows",
Contractor will place client on a behavioral plan requiring attendance or discharge the
client from services. Contractor must inform the caseworker and the Mental Health and
Support Services Team HS-CWServiceReferral@weld.gov within three (3) days of when
the client is placed on a behavioral plan or discharged.
7. Contractor understands that the Department will not reimburse Contractor for
cancelled appointments either on the part of the client or the Contractor. If the
cancellation is generated from the Contractor, a "makeup" session/episode, to occur
within 30 days of the cancellation, will be offered to the client (excluding
session/episodes that fall on holidays). If the cancellation is generated from the client,
the Contractor must request a makeup session from the Department prior to the
makeup session occurring (excluding session/episodes that fall on holidays). After three
(3) cancellations, Contractor will inform the caseworker and the Mental Health and
Support Services Team HS-CWServiceReferral@weld.gov immediately via email, to
discuss service continuation.
8. Contractor will identify, in detail, areas of continued concern and make
recommendations to the caseworker in a monthly report regarding continuation of
services and/or the need for additional services.
9. Contractor will submit reports on a monthly basis for each active referral for ongoing
services. Reports will be submitted per the online format required by the Department,
unless otherwise directed by the Department.
10. Contractor will document in detail any and all observed or verbalized concerns
regarding any child whom the Contractor is working with under an active referral. Areas
of concern may include, but are not limited to, any physical, emotional, educational, or
behavioral issues. Areas of concern should be reported to the caseworker and the
Mental Health and Support Services Team HS-CWServiceReferral@weld.gov
immediately AND on the required monthly report.
11. Contractor agrees any change to an existing referral must be pre -approved through the
Clinical Care Coordinator or any member of the Mental Health and Support Services
Team. Any changes to Family Time referrals will be approved by a new referral signed
by the Child Welfare Supervisor. A change is defined as anything outside of the
approved documented service on the initial authorized referral form. This may include
an increase or decrease in services hours, change in frequency, change in location of
services, transportation needs, or any change to the initial referral or subsequent
authorizations.
12. Contractor agrees to attend meetings when available and as requested by the
Department. Such meetings include Court Facilitations, Bid Meetings, Professional
Staffings, Family Team Meetings and/or Team Decision Making meetings. The
Department will reimburse for actual participation in the meeting only so long as there
is written authorization from the Mental Health and Support Services Team, and the
facilitator documents in the meeting notes the timeframe that the provider attended
and when participation in the meeting is deemed appropriate and necessary by the
Department. The Facilitator will be responsible for filling out the time attended on the
meeting notes. Staffings and/or meetings other than those listed above are not
considered reimbursable unless otherwise approved by the Mental Health and Support
Services Team. Contractor may participate by phone or virtually, if approved by the
Department.
13. On a monthly basis, the Contractor will notify the Mental Health and Support Services
Team HS-CWServiceReferral@weld.gov of new staffwho will manage and/or
administer the services with the following information:
a. Staff member name and contact information
b. Education level/degree (if applicable)
c. Licensure/credentials (if applicable)
d. Department of Regulatory Authority (DORA) number (if applicable)
e. Supervisor name and contact information
The Department reserves the right to decline the new staff members managing
and/or administering services to Department clients.
14. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in
three areas: Safety, Permanency and Well Being of families. For each outcome, data
and performance indicators measure each state's performance according to national
standards and monitor progress over time. Following the review, a Program
Improvement Plan (PIP) will be implemented for the state to enhance services to
families.
Contractor agrees to continually strive for positive outcomes in the areas of Safety,
Permanency and Well Being. Contractor will ensure that any employee or subcontractor
of Contractor providing services under this Agreement will work towards positive
outcomes in the aforementioned three areas as outlined under the Child and Family
Services Review (CFSR) and will address the aforementioned three areas when
completing monthly reports as required by Paragraph 9 of this Exhibit.
15. Certification
Contractor certifies that, at the time of entering into this Agreement, it has currently in
effect all necessary licenses, approvals, insurance, etc., required to properly provide the
services and/or supplies covered by this Agreement. Copies of all necessary licenses
shall be provided to the Department by the Contractor prior to the start of any
Agreement.
16. Training
Contractor may be required to attend training at the request of the Department specific
to services provided under this Agreement. The Department will not compensate the
Contractor for said training in the form of registration fees, time spent traveling to and
from training, attending the training or any other associated costs unless otherwise
agreed to by the Department.
17. Subpoenas
Contractor will, on behalf of its employees and/or officers, accept any subpoena for
testimony from the Weld County Attorney's Office by e-mail and will return a waiver of
services within 72 business hours. For this purpose, Contractor will designate an e-mail
address prior to the start of this Agreement. If the Contractor receives a subpoena via
e-mail but will only accept personal service, the Contractor will contact the Weld County
Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be
personally served.
18. Monitoring and Evaluation
Contractor and the Department agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by the Contractor and the
Department. The results of the monitoring and evaluation shall be provided to the
Board of Weld County Commissioners, the Department, and the Contractor.
Contractor will collaborate in a timely manner with the Department to resolve issues
pertaining to service delivery, service quality, documentation, and invoicing during
referral period and after services have concluded. The Contractor will require clients to
sign releases of information. Contractor understands that the Department will not
reimburse for services rendered to Department clients until releases of information are
obtained.
Contractor shall permit the Department, and any other duly authorized agent or
governmental agency, to monitor all activities conducted by the Contractor pursuant to
the terms of this Agreement. The monitoring agency may, if in its sole discretion deems
necessary or appropriate, have access to any program data, special analyses, on -site
checking, formal audit examinations, or any other reasonable procedures for purposes
of monitoring. All such monitoring shall be performed in a manner that will not unduly
interfere with the work conducted under this Agreement.
EXHIBIT B
RATE SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse the Contractor in consideration of the work and
services performed under this Agreement at the rate(s) specified below in Paragraph 2,
Fees for Services.
Expenses incurred by the Contractor prior to the term of this Agreement are not eligible
Department expenditures and shall not be reimbursed by the Department.
For services funded through Core Services, Contractor agrees to accept reimbursement
through ACH direct deposit one time per month. If Contractor is not currently set up
with the State of Colorado to accept direct deposit, Contractor agrees to complete and
submit a State of Colorado direct deposit enrollment form, which will be provided by
the Department, with a voided check, deposit slip or bank letter. Failure to complete
and submit this form and voided check in a timely and accurate manner may result in a
delay of payment.
For services not funded through Core Services; Contractor agrees to accept payment
through County Warrant when funding source does not allow for direct deposit.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and
contingent upon the continuing availability of said funds for the purposes hereof. In the
event that said funds, or any part thereof, become unavailable as determined by the
Department, the Department may immediately terminate the Agreement or amend it
accordingly.
2. Fees for Services
Unit
Program Area Rate Type
Service Name
Foster Parent
Training/Adoption
Support
$ 145,00
Hour
Foster Parent Training: In Office/Video AND In Home
or Community
$ 0.67
Mile
Foster Parent Training: Mileage
$ 150.0O
Each
Foster Parent Training: No. Show
Nurturing Program
$ 145.00
Hour
Family Time Support for Medically Complex
Individuals: In-Office/Video AND In -Home or
Community
$ 138.00.
Hour
Home Based Nursing Assessments & Observations: In-
Office/Video AND In -Home or Community
$ 143.00
Hour
Home Based Nursing Assessments & Observations:
Service with Transportation Provided
Program Area
Nurturing Program ,
Rate
$ : 113;00
Unit
Type
Hour
Service Name
Nursing Case Management%Education In Office/Videp'
AND In -Home or Community°
$ 113.00
Hour
Nursing Consultation: In-Office/Video AND In -Home or
Community
$ 102.00
Hour `
Nurturing Program. FTM,1"DM, Professional Staffing
$ .67
Mile
Nurturing Program: Mileage
$ 82.00'
Each
Nurturing Program: No Show
* Mileage for distances exceeding 20 roundtrip miles from 33681 County Road 13, Windsor,
Colorado 80550
3. Request for Reimbursement and Supporting Documentation
Contractor shall submit all Requests for Reimbursement and supporting documentation
to the Department by the 7. day of the month following the month of service, but no
later than 45 days from the date of service for each client receiving ongoing services.
Contractor shall prepare and submit monthly a Request for Reimbursement and
monthly report including other supporting documentation, if applicable, certifying that
services authorized were provided on the date(s) indicated and the charges were made
pursuant to the terms and conditions of Paragraph 3 of this Agreement. Monthly
reports will be submitted through the Department's online reporting system, unless
otherwise directed or agreed to by the Department. Monthly reports for ongoing
services must include the following information, entered in the "Narrative" box for each
date of service:
a. Time(s) of service (i.e. 2-4pm)
b. Location of where the service took place (i.e. clinician's office, client's home,
in the community.)
c. Clinician/therapist name
d. What interventions were used, recommendations and/or goals discussed,
progressions towards goals, and client engagement.
e. For mileage reimbursement, if applicable, the mileage accumulated minus
roundtrip mileage that is included in the rate, starting location, and ending
location.
f. Any and all safety concerns.
When submitting a Request for Reimbursement for a one-time service, the contractor
shall submit the first and last page of the evaluation/report to confirm proof of services
rendered. The full evaluation/report should be submitted by the contractor to the
caseworker.
For Monitored Sobriety services, proof of services rendered shall be the test result.
Requests for Reimbursement and/or supporting documentation received after the 7th
day of the month may delay payment. Requests for Reimbursement and/or supporting
documentation received after 45 days from the date of service may result indelay or
forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in
termination of the Agreement.
4. Payment
The Department and the Contractor agree that all benefits from private insurance
and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible
provider) or Victim's Compensation must be exhausted before Core Services or other
Department funds can be accessed for services. Exceptions to this Paragraph may
include, if approved by the Department, the following: The service being provided by
the contractor is not a Medicaid eligible service;
a. The service is not deemed medically necessary;
b. The Court with jurisdiction over the case has ordered that a non -Medicaid
provider or service be used;
c. A Medicaid provider is not available to provide the needed service;
d. Medicaid is exhausted for the needed service; or
e. Medicaid denied service.
f. The client is not eligible for Medicaid.
The Department may withhold reimbursement if Contractor has failed to comply with
any part of the Agreement, including the Financial Management requirements, program
objectives, contractual terms, or reporting requirements. In the event of forfeiture of
reimbursement, Contractor may appeal such circumstance in writing to the Director of
Human Services. The decision of the Director of Human Services shall be final.
5. Remedies
The Director of Human Services or designee may exercise the following remedial actions
should s/he find the Contractor substantially failed to satisfy the scope of work found in
this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean
incorrect or improper activities or inaction by the Contractor. These remedial actions
are as follows:
a. Withhold payment to the Contractor until the necessary services or
corrections in performance are satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables,
which have not been performed and which due to circumstances caused by
the Contractor cannot be performed or if performed would be of no value to
the Department. Denial of the amount of payment shall be reasonably
related to the amount of work or deliverables lost to the Department.
Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation
shall be recovered from Contractor by deduction from subsequent payments under this
Agreement or other agreements between the Department and Contractor, or by the
Department as a debt due to the Department or otherwise as provided by law.
6. Financial Management
At all times from the effective date of the Agreement until completion of the
Agreement, Contractor shall comply with the administrative requirements, cost
principles and other requirements set forth in the Financial Management Manual
adopted by the State of Colorado. The required annual audit of all funds expended
under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
Exhibit D
Contractor's response to the Request for Proposal
Exhibit D contains the following documents:
• Attachment B — Provider Information Form (PIF)
• Attachment C — Proposal
• Attachment D — Staff Data Sheet
• Certificate of Insurance (COI)
Exhibit C
WELD COUNTY'S REQUEST FOR PROPOSAL
(Weld County's Request for Proposal is incorporated into this agreement by reference and will
be provided upon request to the Department.)
This page is intentionally left blank
EXHIBIT B
WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF)
AGENCY INFORMATION
Agency Name: Creative Nursing LLC Trails Provider ID (if known):
Provider Contact Full Name: Amanda Hartshorn Title: Registered Nurse
970-980-9506
Primary Phone Number (10 -digit): Ext.: Fax Number (io-digit):
amanda.hartshorn@creativenursing.org
Primary Contact Email: Web Address:
Agency Location Address (Street, city, state, zip): 33681 County Road 13
Agency Mailing Address (street, city, state, zip): Windsor, CO 80550
Agency Type (pick one): D Public Company ® Private Non -Profit
Private for Profit
Send Referrals for Service to:
Referral Contact Name: Amanda Hartshorn Title: Registered Nurse
Referral Phone Number (lo -digit): 970-980-9506
Ext.:
Email:
amanda.hartshorn@creativenursing.org
Billing Contact
Billing Contact Name: Amanda Hartshorn
970-980-9506
Billing Phone Number (10 -digit):
Title: Registered Nurse
Ext.: Entail:
amanda.hartshorn@creativertursing.org
CERTIFICATION
• I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the
specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on
behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded.
The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to
j accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld,
State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases
where the bids are competitive in price and quality.
Authorized Rep. Full Name: Amanda Hartshorn Title: Registered Nurse
Authorized Rep. Email; amanda.hartshorn@creativenursing.org Phone (to -digit): 970-980-9506 Ext
jAuthorized Rep. Address (sweet, city, state, zip): 33681 County Road 13, Windsor, CO 80550
I Signature of Authorized Rep.: Date:
1/13/2024 I
REV. NOVEMBER 2020
ATTACHMENT C - PROPOSAL
Please type your answers in the boxes below or check the appropriate box.
Provider Information
Bidder's Legal Name:
(As reflected on W-9)
Amanda Hartshorn DBA Creative Nursing LLC
Number of services offered on this Attachment C (max 5):
You may complete another Attachment C if you have more than 5.
5
Service #1
Service Name:
N ursing Consultation
Program Area:
N urturing Program
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using buffeted (points)
1.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• Evidence based research and professional experience.
• Education regarding medical diagnosis and treatment.
• Utilization of credible resources such as Children's Hospital Online and Mayo Clinic as needed to
enhance education.
• Setup and facilitation of home visits, medical appointments, review of medical records and discuss with
/ educate department staff and clients accordingly.
• Meeting with department staff and caseworkers regarding specific cases to determine needs and goals.
• Ongoing documentation and/or communication of objective observations and interactions with the
client to the caseworker via phone or email
• The contractor will serve as liaison between the client, caregiver, department and medical professionals
for the purpose of setting up and/or attending medical appointments.
• Health Service Plan (HSP): Contractor will work with the department, other professionals, the client and
the caregiver to create an initial HSP and will obtain current provider and service information pertinent
to medical and mental health needs.
1.2 Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). if the service has levels, be specific for each level:
4 hours per week in office time, to be completed by nurses, this will be adjusted as needed.
1.3 Anticipated duration of service (i.e. 3-4 months):
Services shall be for the term of the agreement
1.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Collaboration with department staff to meet established goals specific to each referral.
• Education of department staff to gain a better understanding of medical information and the needs of
identified clients.
• Education of department staff and caregivers to better assist caregivers in navigating the healthcare
system and understanding complex medical information.
• Ongoing support to clients and staff regarding facilitation/coordination of appointments, navigation of
healthcare systems and educational needs as identified specific to all referrals.
• Case management support to the department and clients.
1.5 Three (3), or more, specific outcomes of service:
• Assessment of case -specific medical issues that may be creating child protection concerns.
• Establishment of short-term and long-term goals for each individual referral.
• Increased understanding of medical information and healthcare system navigation by the department
staff, allowing the department staff to better assist caregivers and families in mitigating or eliminating
child protection concerns.
1.6 Target population of the service, including age and gender:
REV. OCT 2023
1
ATTACHMENT C - PROPOSAL
• All department staff.
• All clients as referred by department (adult and pediatric).
1.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
Spanish, contingent upon ongoing subcontracted services with bilingual RN.
1.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
This service is not Medicaid eligible.
1.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Services will be provided in person or virtually in the clients' home, community, visitation centers, at provider
appointments (doctors or specialists offices), or withing county approved office space.
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 1.10
• For monthly Service rates please complete section 1.11
• For Home Study Providers please complete section 1.12
• For monitored Sobriety Providers please complete section 1.13
1.10 Hourly Service Rates:
Service
#1
Service
Type
$
Unit Type
Amount
1.10a
In-Office/Video
113
Per Hour
1.10b
In -Home
Community
or
113
Per Hour
1.10c
Service
Transportation
Provided
with
n/a
Per Hour
1.10d
FTM,
Staffing
TDM,
Prof.
102
per
Hour
1.10e
No
show
82
per
No
Show
1.10f
Mileage
rate
0.67
per
Mile
1.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
Mileage rate is
paid after
Rate per
Month
20
roundtrip miles.
Minimum Hours of Service:
1.12 Home Study Providers — List your rates in the box below.
1.13 Monitored Sobriety Providers — List your rates in the box below.
IAdditional Comments
I
REV. OCT 2023 2
ATTACHMENT C - PROPOSAL
1.14
Research and education necessary for ongoing support specific to referrals will be included in this nursing
consultation service.
Weld County Use OnI
REV. OCT 2023 3
ATTACHMENT C - PROPOSAL
Service #2
Service Name:
Program Area:
Home Based Nursing Assessments and Observations
Nurturing Program
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
2.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• Information gathering. Information will be collected from the department, other professionals, the client, and
the caregivers to determine medical and mental health care needs specific to each client. Contractors will
work collaboratively with all parties to gather and review all necessary information.
• Goal setting, short- and long-term goals will be established pertinent to medical and mental health needs.
• Health Service Plan (HSP): Contractor will work with the department, other professionals, the client and
caregivers to create an initial HSP, and will obtain current provider and service information pertinent to
medical and mental health needs.
• Hands-on demonstration: Contractor will provide skilled hands-on demonstration to caregivers regarding
performance of ordered medical tasks in a safe and competent manner. The demonstration will include skilled
nursing education around ordered interventions. Contractor will NOT provide ongoing nursing support as
Home Health Care Services.
• The contractor will provide hands on nursing skilled education by directing and educating caregivers on
ordered interventions. Contractor will NOT provide ongoing nursing support such as Home Health Care
Services.
2.2 Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level:
One (1) to ten (10) hours per week, based on needs of client, specified in referral
2.3 Anticipated duration of service (i.e. 3-4 months):
One (1) to ninety (90) days with the option to extend upon request by either party and with approval of the
department,
2.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Education of client and/or caregivers regarding client specific medical information to promote increased
understanding and knowledge of information regarding medical needs.
• Current assessments as indicated by type of referral (physical assessment, weight check, monitoring of
diabetic devices etc.). RN may also need to call information into primary or specialty providers.
• Hands-on skilled nursing demonstration of ordered medical interventions to promote understanding and
competency by client and/or caregiver.
• Hands-on education of client and/or caregiver regarding navigation of the healthcare system to promote
confidence and increase ability to navigate the system successfully and independently.
2.5 Three (3), or more, specific outcomes of service:
• Client and/or caregiver will demonstrate increased knowledge and understanding of the client's medical and
mental health information and needs, including self -care, ongoing medical needs and requirements for a safe
environment.
• Client and/or caregiver will demonstrate increased understating and competency regarding ordered medical
interventions through hands-on performance of interventions. Client will demonstrate safe, accurate and
confident performance of ordered interventions.
• Increased confidence and ability to navigate the healthcare system independently and successfully, and
confidence in accessing additional resources as needed.
• Decreased child protection issues mitigated through increased knowledge and understanding of client's
medical issues, needs and ordered interventions.
2.6 Target population of the service, including age and gender:
All ages and all genders.
2.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
Spanish, contingent upon ongoing subcontracted services with bilingual RN
REV. OCT 2023
4
ATTACHMENT C - PROPOSAL
2.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
This service is not Medicaid eligible.
2.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Services will be provided in person or virtually in the clients' home, community, visitation centers, at provider
appointments (doctors or specialists offices), or withing county approved office space.
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 2.10
• For monthly Service rates please complete section 2.11
• For Home Study Providers please complete section 2.12
• For monitored Sobriety Providers please complete section 2.13
2.10 Hourly Service Rates:
Service #2
Service
Type
$ Amount
Unit
Type
2.10a
In-Office/Video
138
Per Hour
2.10b
In
-Home or Community
138
Per
Hour
2.10c
Service
Transportation
Provided
with
143
Per Hour
2.10d
FTM,
i
TDM,
Staffing
Prof.
102
per Hour
2.10e
No
show
82
per
No
Show
2.10f
Mileage
rate
0.67
per Mile
2.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
2.11a
2.11b
2.11c
2.11d
2.11e
2.11f
2.11g
2.11h
2.11i
2.11j
Mileage rate is paid
after
20
roundtrip miles.
Rate per Month Minimum Hours of Service:
2.12 Home Study Providers — List your rates in the box below.
2.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
2.14
REV. OCT 2023
5
ATTACHMENT C - PROPOSAL
Service #3
Service Name:
Program Area:
•
N ursing Case Management/Education
N urturing Program
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
3.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• Evidence based research and professional experience.
• Family/ Caregiver education regarding medical diagnosis and treatment
• Utilization of credible resources such as Children's Hospital Online and Mayo Clinic as needed to enhance
education.
• Setup and facilitation of home visits, medical appointments and hospital record reviews providing
required level of assistance needed specific to referral with goal of independence.
• Ongoing documentation and/or communication of objective observations and interactions with the
client to the caseworker via phone or email
• The contractor will serve as liaison between the client, caregiver, department and medical professionals
for the purpose of setting up and/or attending medical appointments.
• Health Service Plan (HSP): Contractor will work with the department, other professionals, the client and
the caregiver to create an initial HSP and will obtain current provider and service information pertinent
to medical and mental health needs.
3.2 Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level:
One (1) to three (3) hours per week
3.3 Anticipated duration of service (i.e. 3-4 months):
One (1) to ninety (90) days with the option to extend upon request by either party and with approval of the
department
3.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Education of family / caregivers to gain a better understanding of medical information and needs of
identified clients.
• Education of caregivers to better assist caregivers in navigating the healthcare system and understanding
complex medical information
• Ongoing support to clients regarding facilitation/coordination of appointments, navigation of healthcare
systems and educational needs as identified specific to all referrals.
• Case management support to the family / caregivers
• Coordination and acquisition of medical supplies as identified by RN and health care team.
3.5 Three (3), or more, specific outcomes of service:
• Assessment of case -specific medical issues that may be creating child protection concerns.
• Establishment of short-term and long-term goals for each individual referral with collaboration of family.
• Increased understanding of medical information and healthcare system navigation by the family
supporting the caregivers and families in mitigating or eliminating child protection concerns.
3.6 Target population of the service, including age and gender:
All ages and genders
3.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
Spanish, contingent upon ongoing subcontracted services with bilingual RN
3.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
This service in not Medicaid eligible
3.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
Services will be provided in person or virtually in the clients' home, community, visitation centers, at provider
appointments (doctors or specialists offices), or withing county approved office space.
1
REV. OCT 2023 6
ATTACHMENT C - PROPOSAL
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 3.10
• For monthly Service rates please complete section 3.11
• For Home Study Providers please complete section 3.12
• For monitored Sobriety Providers please complete section 3.13
3.10
Hourly
Service
Rates:
Service
#3
Service
Type
$ Amount
Unit Type
3.10a
In
-Office/
Video
113
Per Hour
3.10b
In
Community
-Home
or
113
Per Hour
3.10c
Transportation
Service
Provided
with
n/a
Per Hour
3.l0d
FTM,
Staffing
TDM,
Prof.
102
per Hour
3.10e
No
show
82
per
No
Show
3.l0f
Mileage
rate
0.67
per
Mile
3.11 Monthly Service Rates (each level must be listed): If applicable
3.11a
3.11b
3.11c
3.11d
3.11e
3.11f
3.11g
3.11h
3.11i
3.11j
Mileage rate is
paid after
20
roundtrip miles.
Service
Name
with
Level
Rate
Month
per
Minimum
Hours of
Service:
3.12 Home Study Providers — List your rates in the box below.
3.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
3.14
Weld County Use Only
REV. OCT 2023
7
ATTACHMENT C - PROPOSAL
Service #4
Service Name:
Program Area:
Foster Parenting Training
Non Core
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
4.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• RN will present education to foster parents in an individual or group setting.
• Content will include:
• Over the counter medications (OTC)
• Medication concepts
• Medication administration records (MAR)
• Medication administration procedure
• Medication errors
• Medication storage safety
• Seven (7) rights of medication administration
• Six (6) components of a physician order
• Common abbreviations and measurement equivalents
• RN will use developed syllabus and qualifications in alignment with the State of Colorado Regulatory Agencies
• Validation of competency will be obtained via quizzes throughout educational sessions.
• This is NOT a QMAP course.
• A certificate of completion can be provided upon request.
4.2 Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level:
3 total hours per training
4.3 Anticipated duration of service (i.e. 3-4 months):
Course will be offered up to 1 time per month with adequate notice of 2 weeks prior to desired date of course being
offered. Course duration may be extended for large group sessions
4.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Assist foster parents in gaining skills for proper medication administration.
• Educate on safety of medication storage.
• Understand over the counter medications and need for physician orders for all administered medications.
4.5 Three (3), or more, specific outcomes of service:
• Safe medication administration of physician ordered medications.
• Understanding medication orders, how to obtain orders and administer medications correctly and safely.
• Over the Counter (OTC) medications, how to use them correctly and safely with a physician order.
4.6 Target population of the service, including age and gender:
Foster Parents
4.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
4.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
This service is not Medicaid eligible
4.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
In the office/ In home, or virtually. (This service can be offered upon request, with two (2) week prior notice.
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 4.10
• For monthly Service rates please complete section 4.11
• For Home Study Providers please complete section 4.12
REV. OCT 2023
8
ATTACHMENT C - PROPOSAL
• For monitored Sobriety Providers please complete section 4.13
4.10 Hourly Service Rates:
Service #4
Service
Type
$ Amount
Unit Type
4.10a
In-Office/Video
145.00
Per
Hour
4.10b
In
-Home or Community
145.00
Per
Hour
4.10c
Service
Transportation
Provided
with
Select
Unit
Type.
4.10d
FTM,
TDM,
Staffing
Prof.
per Hour
4.10e
No
show
150.00
per
No
Show
4.10f
Mileage
rate
0.67
per
Mile
4.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
4.11a
4.11b
4.11c
4.11d
4.11e
4.11f
4.11g
4.11h
4.11i
4.11j
Mileage rate is paid
after
20
roundtrip miles.
Rate per Month Minimum Hours of Service:
4.12 Home Study Providers — List your rates in the box below.
4.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
4.14
Class participants will be limited to 10 individuals per session, each session will be billed for a minimum of 3 hours upon
class completion
Weld County Use Only
REV. OCT 2023
9
ATTACHMENT C - PROPOSAL
Service #5
Service Name:
Program Area:
Family Time Support for Medically Complex Individuals
Nurturing Program
Scope of Work
Please Note: If the service is a monthly package, different levels should be indicated.
All monthly packages must state a specific minimum number of direct service hours.
(Please address each line item below using bulleted points)
5.1 Modalities, curriculum, tools used in delivery of service (DO NOT list company history):
• RN or licensed delegated medical professional will provide family support during scheduled family time for
complex or medically fragile individuals.
• Goal setting, short- and long-term goals will be established pertinent to medical and mental health needs.
• Health Service Plan (HSP): Contractor will work with the department, other professionals, the client and
caregivers to create an initial HSP, and will obtain current provider and service information pertinent to
medical and mental health needs.
• Hands-on demonstration: Contractor will provide skilled hands-on demonstration to caregivers regarding
performance of ordered medical tasks in a safe and competent manner. The demonstration will include skilled
nursing education around ordered interventions. Contractor will NOT provide ongoing nursing support as
Home Health Care Services.
• The contractor will provide hands on nursing skilled education by directing and educating caregivers on
ordered interventions. Contractor will NOT provide ongoing nursing support such as Home Health Care
Services.
5.2 Anticipated frequency of direct service time with the client/family per week, not including professional staffing time,
administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level:
Specific to family time referred service one (1) to six (6) hours /week.
5.3 Anticipated duration of service (i.e. 3-4 months):
One (1) to ninety (90) days with the option to extend upon request by either party and with approval of the
department
5.4 Three (3), or more, specific goals of the service (DO use bullet points):
• Clinical staff (RN, or appropriately delegated individual with professional license) will provide supervision and
safety education regarding medical needs during family time.
• Family time will be a therapeutic and educational opportunity for information specific to medical diagnoses or
medical needs/ skills ordered by a provider with written orders. Any medical interventions will be monitored
for safety and correct implementation.
• Clinical staff observing these types of family time will free up visitation supervisors from needing to provide
services to the family at the same time, eliminating the need for 2 professionals during family time. RN can
request due to multiple family members, behavioral issues, etc. to have visitation supervisor present, if
necessary for safety
5.5 Three (3), or more, specific outcomes of service:
• Improved medical understanding of child with complex medical needs.
• Safe and productive family time, ensuring understanding of education regarding warnings, signs of impending
urgent or emergent medical needs, and the need to seek higher level of care.
• Increased providers, resulting in more availability for family time to begin promptly and safely with a medical
professional present during family time.
5.6 Target population of the service, including age and gender:
All ages, all genders
5.7 Languages service is available in (please list proficiency and if interpreter services are available):
English
5.8 Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part:
This service is not Medicaid eligible.
5.9 Service location — list where the service will take place (i.e. client's home, in -office, other)
FSVC, client's home, or community. (Amanda Hartshorn, RN MSN has discussed this with Taylor Ensdorff FSVC
supervisor)
REV. OCT 2023 10
ATTACHMENT C - PROPOSAL
Rates
Please Note: All rates need to include overhead and administrative work (i.e., scheduling or report writing).
All rates should be per hour unless service is for evaluations/assessments, Home Studies or Monitored Sobriety.
• For hourly Service rates please complete section 5.10
• For monthly Service rates please complete section 5.11
• For Home Study Providers please complete section 5.12
• For monitored Sobriety Providers please complete section 5.13
5.10 Hourly Service Rates:
Service #5
Service
Type
$ Amount
Unit Type
5.10a
In-Office/Video
145.00
Per Hour
5.10b
In
-Home
or Community
145.00
Per
Hour
5.10c
Service
Transportation
Provided
with
n/a
Per
Hour
5.10d
FTM,
Staffing
TDM,
Prof.
102
per Hour
5.10e
No
show
82
per
No
Show
5.10f
Mileage
rate
0.67
per
Mile
5.11 Monthly Service Rates (each level must be listed): If applicable
Service Name with Level
5.11a
5.11b
5.11c
5.11d
5.11e
5.111
5.11g
5.11h
5.11i
5.11j
Mileage rate is paid
after
(2o
roundtrip miles.
Rate per Month Minimum Hours of Service:
5.12 Home Study Providers — List your rates in the box below.
5.13 Monitored Sobriety Providers — List your rates in the box below.
Additional Comments
5.14
Weld County Use Only
REV. OCT 2023
11
EXHIBIT D - STAFF DATA SHEET
Bidder Must List All Staff Who Will Administer the Proposed Services
BIDDER'S LEGAL NAME (As it appears on the W-9):
AGENCY CONTACT: Amanda Hartshorn
Amanda Hartshorn DBA Creative Nursing LLC.
PHONE NUMBER:970-980-9506
EMAIL:Amanda.Hartshom@creativenursing.org
PROPOSED SERVICE(S): Case Management / Education
Nursing Assessment / Observation - Face to Face Home Based Services
Consultation, Foster Care Education
Legal Last Name
Middle
Initial
Previous Legal Last
Name (If applicable)
Legal First Name
Service Type
Licensure/
Credentials
DORA # (If applicable)
Hartshorn
L
_ Kohl
Amanda
All of the above
RN, MSN
RN.0189873
Wicke
N
Michelle
All of the above
RN, BSN
RN.1621492
Rosenoff
K
Amber
All of the above
RN, BSN
RN.1655764
Garcia
V
Crystal
All of the above
RN
RN.1656516
CHILD WELFARE REQUEST FOR PROPOSAL 2021-22 - VARIOUS SERVICES
BID NO. B2100042
Date: 2024-01-17
NOW
INSURANCE
CERTIFICATE OF INSURANCE
Your professional liability insurance is written on a claims made basis and provides coverage for those claims which are the result of medical incidents
occurring subsequent to the prior acts date stated and which are first made against you while this insurance is in farce. Please discuss with your program
administrator.
Prior Acts Date: 2024-01-17
Purchasing Group
Ced6llaate Number
Policy Period
Professional Services Purchasing Group
11807 Westheimer Road, Suite 550 PMB 990, Houston, TX 77077
UTA-233543-020224
from: 12:01AM Standard Time on: 202402-02
to: 12:01 AM Standard Time on: 2025-02-02
Named Insured and Address
Business Address
Program Administrator
Amanda Lee Hartshorn
33681 County Road 13 Windsor, Colorado 80550
33681 County Road 13
Windsor, Colorado 80550
NOW Insurance Services
11807 Westheimer Road, Suite 550 PMB 990
Houston, TX 77077
Medical Specialty:
Registered Nurse (RN)
Insurance Provided by:
United Indemnity Inc
COVERAGE PARTS I LIMITS OF LIABILITY
A.
PROFESSIONAL LIABILITY Deductible - $0
Professional Liability (PL)
$1,000,000 each claim
$6,000,000 aggregate
Good Samaritan Liability
included above
Personal Injury Liability
included above
Malplacement Liability
included above
B.
Coverage Extensions:
License Protection
$5,000 per proceeding
$10,000 aggregate
Deposition Representation
$5,000 per proceeding
$10,000 aggregate
First Aid
$2,500 per incident
$2,500 aggregate
Medical Payments
$2,500 per incident
$2,500 aggregate
Damage to Property of Others
$500 per incident
$2,500 aggregate
C.
GENERAL LIABILITY Deductible - $0
General Liability (GL)
$1,000,000 each occurrence
$6,000,000 aggregate
Fre & Water Legal Liability
included in the GL remit above
subject to
$10,000 sub -limit
Personal Liability
included in the GL limit
included in the GL limit
Policy norms and endorsements attached at Inception
GENERAL LIABILITY COVERAGE
SELF-EMPLOYED
Additional Insured(s):
CREATIVE NURSING LLC, WELD COUNTY AND BOARD OF COUNTY COMMISSIONERS WELD COUNTY AND IT'S OFFICERS AND EMPLOYEES
Keep this document in a safe place. It is evidence of your insurance coverage.
Master Policy eUTA-09122023-01
Authorized"Representative
Philip G. Cabaud
Please Note: All inquiries regarding this Certificate of Insurance should be addressed to the following Correspondent:
NOW Insurance
nt.gll: lnfoGnowinsurance.cont
Phone: (888) 585-2075
SIGNATURE REQUESTED: Weld/Creative
Nursing, LLC PSA
Final Audit Report
2024-05-01
Created: 2024-05-01
By: Windy Luna (wluna@weld.gov)
Status: Signed
Transactor ID: CBJCHBCAABAAvwOi9Ks0nP6KBW6QFC4wsY GRtd-I5zSi
"SIGNATURE REQUESTED: Weld/Creative Nursing, LLC PSA"
History
t Document created by Windy Luna (wluna@weld.gov)
2024-05-01 - 9:57:03 PM GMT- IP address: 204.133.39.9
P. Document emailed to nurseconsult7@gmail.com for signature
2024-05-01 - 9:57:37 PM GMT
15 Email viewed by nurseconsult7@gmail.com
2024-05-01 - 9:57:52 PM GMT- IP address: 74.125.215.66
de Signer nurseconsult7@gmail.com entered name at signing as Amanda Hartshorn RN MSN
2024-05-01 - 10:04:41 PM GMT- IP address: 216.147.123.121
4 Document e -signed by Amanda Hartshorn RN MSN (nurseconsult7@gmail.com)
Signature Date: 2024-05-01 - 10:04:43 PM GMT - Time Source: server- IP address: 216.147.123.121
0 Agreement completed.
2024-05-01 - 10:04:43 PM GMT
Powered by
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Acrobat Sign
Contract Form
Entity Information
Entity Name*
CREATIVE NURSING LLC
Entity ID*
@00045193
Contract Name*
CREATIVE NURSING, LLC (PROFESSIONAL SERVICES
AGREEMENT RELATED TO BID #B2400040(
Contract Status
CTB REVIEW
Contract ID
8151
Contract Lead *
WLUNA
O New Entity?
Parent Contract ID
Requires Board Approval
YES
Contract Lead Email Department Project #
wluna@weldgov.com;cob
bxxlk@weldgov.com
Contract Description*
(CONSENT) CREATIVE NURSING, LLC (PROFESSIONAL SERVICES AGREEMENT RELATED TO BID #B2400040). TERM
6/1/24 THROUGH 5/31/27.
Contract Description 2
PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 04/10/24.
Contract Type*
AGREEMENT
Amount*
$0.00
Renewable*
YES
Automatic Renewal
Grant
IGA
Department Requested BOCC Agenda Due Date
HUMAN SERVICES Date* 05/11/2024
05/15/2024
Department Email
CM-
HumanServices@weldgov.
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
03/31/2025
Renewal Date*
06/01/2025
Committed Delivery Date Expiration Date
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
CONSENT 05/09/2024
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CONSENT CONSENT
DH Approved Date Finance Approved Date Legal Counsel Approved Date
05/09/2024 05/09/2024 05/09/2024
Final Approval
BOCC Approved Tyler Ref #
AG 051524
BOCC Signed Date Originator
WLUNA
BOCC Agenda Date
05/15/2024
Houstan Aragon
From:
Sent:
To:
Subject:
noreply@weldgov.com
Friday, April 4, 2025 1:31 PM
CM-ClerktoBoard; Windy Luna; Lesley Cobb; CM-HumanServices-DeptHead
Fast Tracked Contract ID (9297)
Contract # 9297 has been Fast Tracked to CM -Contract Maintenance.
You will be notified in the future based on the Contract information below:
Entity Name: CREATIVE NURSING LLC
Contract Name: CREATIVE NURSING, LLC (PROFESSIONAL SERVICES AGREEMENT AMENDMENT#1) Contract
Amount: $0.00 Contract ID: 9297 Contract Lead: WLUNA
Department: HUMAN SERVICES
Review Date: 3/31/2027
Renewable Contract: NO
Renew Date:
Expiration Date:5/31/2027
Tyler Ref #:
Thank -you
ConkvacV azq
�evA-e),)3ed
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Houstan Aragon
From:
Sent:
To:
Cc:
Subject:
Sara Adams
Friday, April 4, 2025 1:15 PM
CTB
HS -Contract Management
FAST TRACK - Various Core Agreements (Tyler# Various)
Good afternoon CTB,
FAST TRACK ITEM:
The below list will be Fast Track items in CMS for tracking purposes only to correct the expiration date.
Contractor
CMS # Tyler# New CMS#
APPA THERAPY,PLLC
8150
2023-1434
9290
ASPEN COUNSELING, LLC
BARTGES, ANGELA
CASA OF LARIMER COUNTY
COLORADO STATE UNIVERSITY
CREATIVE NURSING, LLC
CROSSROADSX COUNSELING
CRUX COUNSELING, LLC
DEEP WATERS PARENTING
8141
2023-1393
9291
8165 2023-1460 9292
8176
8286
8151
8171
8132
2024-1270
9293
2024-1518 9294
2024-1221 9297
2024-1268 9298
2023-1396 9300
8734 2024-1264 9301
KEEP SWIMMING,LLC
KRAFT, DARLA
MAISHA BORA LLC
NEUROPSYCHOLOGICALSOLUTIONS, LLC
NOCO SPEECH & DIAGNOSTICS
NORTHERN HORIZON BEHAVIORAL HEALTH
8750 2023-1438
8167 20231568
8163
2024-1265
8383 ; 2024=1266
8156 2023-1439
8187 2024-1319
2023-1401
POLARIS PARTNERS LLC
RABILLARD, APRIL r ,
REACHING HOPE
REECE, ALISON
RHEGNUMI CONSULTING, LLC
RIGHT ON LEARNING,
SENSITIVE SOLUTIONS BEHAVIORAL HEALTH, LLC
SEVIER, STACY G.
SIMPLE ASSENT, LLC
SOVEREIGNTY COUNSELING SERVICES PLLC
SPECIALTY COUNSELING & CONSULTING LLC
THE HOPE INITIATIVE
UNIVERSITY OF NORTHERN COLORADO
WHICH WAY? LLP
8148
7 , 2023-1569
8190
8170 2024.1473
8168
8204
8182
2024-1321
2024-1267
4-1325
2024-1271
28 2023-1432
8215
393
8263
8188
8219
8162 2023-1436 9320
9302
9303
9304
9305
9306
07
9308
309
9310
2024-1416
2024-1324
2024-1474
2024-1320
2024-1327
9311
9312
9313
9314
9315
9323
9316
9317
9318
9319
WILLOW COLLECTIVE PLLC
MI YUNGS PRAYER
8192 2024-1323 9321
9015 2023-1397 9322
Thank you,
Sara
couNr co
Sara Adams
Contract Administrative Coordinator
Department of Human Services
Desk: 970-400-6603
P.O. Box A, 315 N. 11th Ave., Greeley, CO 80632
013000
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