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Home My WebLink About20221473.tiffColn- vo c* 1 $1 Q5 BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Professional Services Agreement Amendments for Core/Non-Core Contracted Services Bid # B22000040 DEPARTMENT: Human Services DATE: April 2, 2024 PERSON REQUESTING: Jamie Ulrich, Director, Human Services Brief description of the problem/issue: The Department entered into Agreements with various Child Welfare Service Providers through Request for Proposal (RFP) Bid #B2200040, identified as Tyler ID 2022-0410. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is now requesting to renew the current agreements for eight (8) of these providers with minor changes. The attached list indicates the minor changes in red for each provider. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. What options exist for the Board? • Approval of the eight (8) Child Welfare Core/Non-Core Services Agreement Amendments. • Deny approval of the eight (8) Child Welfare Core/Non-Core Services Agreement Amendments. Consequences: Child Welfare Core/Non-Core Service Agreement Amendments will not be executed. Impacts: Weld County clients will not continue to receive needed services. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): Total Cost = Various depending on services provided. Funded through Child Welfare Core/Non-Core Service funding. Pass -Around Memorandum; April 2, 2024 CMS ID rious 4/510) 5/Z Zf Ze-} J�/r/�� 2ozz-1 L473 \.00g4 Recommendation: • Approval of the Agreement Amendments and authorize the Chair to sign. Support Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: Perry L. Buck, Pro-Tem Mike Freeman Scott K. James Kevin D. Ross, Chair Lori Saine if p r4 - s5 A k - ( - - Via, JmAn,I, Pass -Around Memorandum; April 2, 2024 - CMS ID Various Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 O Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: Isaine@weldgov.com Website: www.co.weld.co.us In God We Trust Lori Saine Tuesday, April 2, 2024 2:06 PM Karla Ford RE: 9 Please Reply - PA FOR ROUTING: Core/Non-Core 2022-23 Minor Changes (CMS Various) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weld.gov> @we ld.gov> Sent: Tuesday, April 2, 2024 1:26 PM To: Lori Saine <Isaine@weld.gov> Subject: 9 - Please Reply - PA FOR ROUTING: Core/Non-Core 2022-23 Minor Changes (CMS Various) Importance: High Please advise if you support recommendation and to have department place on the agenda. Karla Ford ,k& 1 Minor Core Bid Services Changes Year 2022-23 Providers for -, :. 2024-25 Centers, Inc Griffith Program Area Service Name •Rate Unit Type Other Day Treatment Day Treatment $ 1,648.00 Month Address Change Day Treatment Mileage: Day Treatment $ 300.00 Month Address Change Home -Based Services Family Community Preservation: In -Home or $ 120.00 Hour Address Change Home -Based Services Family Preservation: In-Office/Video $ 105.00 Hour Address Change Life Skills Life Skills: Mileage $ 0.65 Mile Address Change Life Skills Life Skills: No Show Each $ 55.00 Address Change Mental Health Services Mental Professional Health Services: Staffing FTM, TDM, $ 75.00 Hour Address Change Mental Health Services Mental Health Services: No Show $ 55.00 Each Address Change Mentoring Mentoring: Mileage $ 0.65 Mile Address Change Mentoring Each Address Change Mentoring: No Show $ 55.00 Life Skills Parenting Skills: Community In -Home or $ 105.00 Hour Address Change Life Skills Parenting Skills: with Transportation $ 110.00 Hour Address Change Life Skills Parenting Skills: In-Office/Video S 90.00 Hour Address Change Life Skills Supervised Community Visitation: In -Home or $ 110.00 Hour Address Change Life Skills Supervised Transportation Visitation: with $ 115.00 Hour Address Change Program Area Service Name Rate Unit Type Other Life Skills Supervised Visitation: In-Office/Video $ 100.00 Hour Address Change Life Skills Therapeutic Community Visitation: In -Home or $ 120.00 Hour Address Change Life Skills Therapeutic Transportation Visitation: with $ 125.00 Hour Address Change Life Skills Therapeutic Office/Video Visitation: In - $ 105.00 Hour Address Change Mental Health Services Family Community Therapy: In -Home or $ 130.00 Hour Address Change Mental Health Services Family Therapy: In-Office/Video $ 125.00 Hour Address Change Mental Health Services Group In -Home Therapy: or Community In-Office/Video AND $ 45.00 Hour Address Change Mental Health Services Individual Community Therapy: In -Home or $ 130.00 Hour Address Change Mental Health Services Individual Therapy: In-Office/Video $ 125.00 Hour Address Change Home -Based Services Family Professional Preservation: Staffing FTM, TDM, $ 75.00 Hour Address Change Home -Based Services Family Preservation: Mileage 0.65 Mile Address Change Mental Health Services Mental Health Services: Mileage $ 0.65 Mile Address Change Mental Health Services Therapeutic Community Intake: In -Home or $ 100.00 Hour Address Change Mental Health Services Therapeutic Intake: In-Office/Video $ 90.00 Hour Address Change Mentoring Mentoring/Behavior Home or Community Coaching: In- $ 93.00 Hour Address Change Mentoring Mentoring/Behavior Transportation Coaching: with $ 103.00 Hour Address Change Mentoring Mentoring/Behavior Office/Video Coaching: In- fi 88.00 Hour Address Change Mentoring Mentoring: Staffing FTM, TDM, Professional $ 75.00 Hour Address Change Home -Based Services Family Preservation: No Show $ 55.00 Each Address Change Program Area Service Name Rate Unit Type Other Life Skills Life Staffing Skills: FTM, TDM, Professional $ 75.00 Hour Address Change Foster Support Care/Adoption Foster Professional Parent Staffing Education: FTM, TDM, $ 35.00 Hour Address Change Foster Support Care/Adoption Foster Community Parent Education: In -Home or 5 92.00 Hour Address Change Foster Support Care/Adoption Foster office/Video Parent Education: In - $ 64.00 Hour Address Change Foster Support Care/Adoption Foster Parent Education: No Show d. 30.00 Each Address Change Foster Support Care/Adoption Relinquishment TDM, Professional Counseling: Staffing FTM, $ 75.00 Hour Address Change Foster Support Care/Adoption Relinquishment or Community Counseling: In -Home $ 130.00 Hour Address Change Foster Support Care/Adoption Relinquishment Office/Video Counseling: In - 125.00 Hour Address Change Foster Support Care/Adoption Relinquishment Counseling: Mileage $ 0.65 Mile Address Change Foster Support Care/Adoption Relinquishment Counseling: No -Show $ 55.00 Each Address Change Lutheran Family Services Rocky Mountains Program Area Service Name _______Unit RateType Other 11 Life Skills Supervised Community Family In -Home or $ 101.00 Hour Name Change Time: Life Skills Supervised Office/Video Family Time: In - $ 90.00 Hour Name Change Life Skills Therapeutic Office/Video Family Time: In - $ 101.00 Hour Name Change Life Skills (Therapeutic Therapeutic Community) Homebasec Visitation: Services In -Home or $ 140.00 Hour Name Change Maple Star Colorado Program Area Service Name - - - • ate Unit Type Other Home -Based Services Aftercare Engagement Support Team Services (ASSET) and $ 2,300.00 Month Name Address Change Change & Program Area Service Name Rate Unit Type Other _, . Home -Based Services Stabilizing (STAY): At Risk Teens and Youth in Home $ 1,300.00 Month Name Address Change Change & Home -Based Services Stabilizing (STAY): High Teens Risk and Youth in Home $ 2,600.00 Month Name Address Change Change & Home -Based Services Stabilizing (STAY): Teens Imminent and Risk Youth in Home $ 4,000.00 Month Name Address Change & Change Life Skills Life Staffing Skills: FTM, TDM, Professional $ 93.00 Hour Name Address Change Change & Life Skills Life Skills: Mileage $ 0.65 Mile Name Address Change Change & Life Skills Life Skills: No Show $ 65.00 Each Name Address Change Change & Life Skills RAPT Training or Community - Resilient, (Parent Attuned Coaching): Parent In -Home $ 105.00 Hour Name Address Change Change & Life Skills RAPT Training Office/Video - Resilient, (Parent Attuned Coaching): Parent In- $ 89.00 Hour Name Address Change Change & Life Skills Supervised Community Family AND with Time: Transportation In -Home or $ 120.00 Hour Name Address Change Change & Life Skills Supervised Office/Video Family Time: In- $ 89.00 Hour Name Address Change Change & Life Skills Therapeutic Community AND Family with Time: Transportation In -Home or $ 168.00 Hour Name Address Change Change & Life Skills Therapeutic Office/Video Family Time: In- $ 118.00 Hour Name Address Change Change & Mental Health Services Mental Office/Video Community Health AND Services: In -Home In- or $ 130.00 Hour Name Address Change Change & Mental Health Services Mental Health Services: No Show $ 65.00 Each Name Address Change Change & Mental Health Services Mental Professional Health: Staffing FTM, TDM, $ 93.00 Hour Name Address Change Change & Mental Health Services Mental Health Services: Mileage - 0.65 Mile Name Address Change Change & Martinez, dba Assurance TM Tim Therapeutic Program .__ Area Service Name Rate Unit Type Other Sex Abuse Treatment Offense with Abel Specific Assessment Juvenile Evaluation $ 1,200.00 Episode Program Area Service Name Rate Unit Type Other Sex Abuse Treatment Offense Without Specific Abel Juvenile Assessment Evaluation $ 1,000.00 Episode Sex Abuse Treatment Therapy Offense Specific Treatment: Family $ 100.00 Hour Rate Change Sex Abuse Treatment Therapy Offense Specific Treatment: Individual $ 100.00 Hour Rate Change Sex Abuse Treatment Sex Abuse Professional Treatment: Staffing FTM, TDM, $ 75.00 Hour Sex Abuse Treatment Sex Abuse Treatment: Mileage $ 0.33 Mile Northern Colorado Youth for Christ dba Rebalance Program Area Service Name Rate Unit Type Other Mental Health Services Rebalance $ 45.00 Hour Mental Health Services Rebalance: No Show $ 20.00 Each Mentoring Mentoring $ 80.00 Hour Rate Change David Kalis, Inc. dba Parker Personal Care Homes Program Area Service Name Rate Unit Type Other Foster Support Care/Adoption Foster Masters: Staffing Care/Adoption FTM, TDM, Support Professional - $ 200.00 Hour Rate Change Foster Support Care/Adoption Foster Masters' Care/Adoption No Show Support - $ 150.00 Each Rate Change Foster Support Care/Adoption Foster Mileage Care/Adoption Support: $ 0.50 Mile Foster Support Care/Adoption Foster In-Office/Video Community Parent Consultation AND In -Home - Masters: or $ 200.00 Hour Rate Change Foster Support Care/Adoption Foster Office/Video Community Parent AND Training In -Home - Masters: or In - $ 200.00 Hour Rate Change Home -Based Services In Aftercare Masters -Home Level: or Therapy Community In-Office/Video & Consultation AND - $ 200.00 Hour Rate Change Home -Based Services In-Office/Video Home Community Based Intervention AND In -Home - Masters: or $ 200.00 Hour Rate Change Home -Based Services Home FTM, TDM, Based Professional Intervention Staffing - Masters: $ 200.00 Hour Rate Change Program Area SW Service Name Rate a a Unit Type Other Home -Based Services dome No Show Based Intervention - Masters: 150.00 Each Rate Change Home -Based Services Home -Based Services: Mileage $ 0.50 Mile Life Skills Life Professional Skills - Masters: Staffing FTM, TDM, $ 200.00 Hour Rate Change Life Skills Life Skills - Masters: No Show Si 150.00 Each Rate Change Life Skills Life Skills: Mileage $ 0.50 Mile Life Skills Parent Office/Video Community Coaching AND - Masters: In -Home In- or $ 200.00 Hour Rate Change Life Skills Supervised Office/Video Community Family AND In Time -Home - Masters: or In- $ 200.00 Hour Rate Change Life Skills Therapeutic In-Office/Video Community Family AND Time In -Home - Masters: or $ 200.00 Hour Rate Change Mental Health Services Consultation Office/Video Community - AND Masters: In -Home In- or $ 200.00 Hour Rate Change Mental Health Services Consultation AND In -Home - PhD: or Community In-Office/Video $ 250.00 Hour Rate Change Mental Health Services Counseling/Psychotherapy FTM, TDM, Professional Staffing - Masters: $ 200.00 Hour Rate Change Mental Health Services Counseling/Psychotherapy In-Office/Video Community AND In -Home -Masters: or $ 200.00 Hour Rate Change Mental Health Services Counseling/Psychotherapy Office/Video Community AND In -Home -PhD: or In- $ 250.00 Hour Rate Change Mental Health Services Evaluation & Assessment: No Show $ 500.00 Each Rate Change Mental Health Services In-Office/Video Functional Community Family AND Therapy In -Home - Masters: or $ 200.00 Hour Rate Change Mental Health Services Functional Office/Video Community Family AND Therapy In -Home - or PhD: In- $ 250.00 Hour Rate Change Mental Health Services Mental FTM, TDM, Health Professional Services - Staffing Masters: $ 200.00 Hour Rate Change Program Area Service Name Rate Unit Type Other Mental Health Services Show Mental Health Services - Masters: No $ 150.00 Each Rate Change Mental Health Services Mental TDM, Professional Health Services Staffing - PhD: FTM, $ 250.00 Hour Rate Change Mental Health Services Mental Show Health Services - PhD: No $ 250.00 Each Rate Change Mental Health Services Mental Health Services: Mileage $ 0.50 Mile Mental Health Services Multisystemic Office/Video Community AND Therapy In -Home - Masters: or In- $ 200.00 Hour Rate Change Mental Health Services Parent In-Office/Video Community -Child Interactional AND In -Home Evaluation: or $ 500.00 Hour Rate Change Mental Health Services Psychological Office/Video Community AND Evaluation: In -Home In- or $ 500.00 Hour Rate Change Mental Health Services Trauma AND In -Home Assessment: or Community In-Office/Video $ 500.00 Hour Rate Change N/A Anger Prevention AND In Management -Home - Masters: or Community Treatment/DV In-Office/Video $ 200.00 Hour Rate Change N/A Child FTM, Welfare TDM, Professional Block funded Staffing - Masters: $ 200.00 Hour Rate Change N/A Child No Show Welfare Block Funded - Masters: $ 150.00 Each Rate Change N/A Child Welfare Block Funded: Mileage $ 0.50 Mile N/A Mediation AND In -Home - Masters: or Community In-Office/Video $ 200.00 Hour Rate Change N/A In-Office/Video Relinquishment Community Counseling AND In -Home - Masters: or $ 200.00 Hour Rate Change Sex Abuse Treatment Psychosexual/Sex Evaluation - Masters: Offender In-Office/Video Specific S 400.00 Hour Rate Change Sex Abuse Treatment Psychosexual/Sex Evaluation: PhD Offender Level testing Specific $ 500.00 Hour Rate Change Sex Abuse Treatment Sexual FTM, TDM, Abuse Treatment Professional - Staffing Masters: $ 200.00 Hour Rate Change Sex Abuse Treatment Sexual No Show Abuse Treatment - Masters: $ 150.00 Each Rate Change Program Area Service Name Rate Unit Type Other Sex Abuse Treatment Sexual Consultation Office/Video Community Abuse - AND Treatment Masters: In -Home Therapy In- or and $ 200.00 Hour Rate Change Sex Abuse Treatment Sexual Abuse Treatment: Mileage $ 0.50 Mile Substance Abuse Evaluation - Substance Treatment Abuse Masters: Home In-Office/Video Community AND In - $ 400.00 Hour Rate Change Substance Abuse Substance Abuse Evaluation: PhD Treatment Level Testing $ 500.00 hour Rate Change Substance Abuse Substance Abuse Treatment - Treatment Masters: No Show $ 150.00 Each Rate Change Substance Abuse Treatment and Substance Treatment Abuse Consultation Office/Video Community - AND Masters: In -Home In - or $ 200.00 Hour Rate Change Substance Abuse Substance Abuse Treatment- Masters: Treatment FTM, TDM, Professional Staffing $ 200.00 Hour Rate Change Substance Abuse Treatment Substance Abuse Treatment: Mileage $ 0.50 Mile Therapeutic Kinship Services - Therapeutic Services Kinship Masters: Staffing FTM, TDM, Professional $ 200.00 Hour Rate Change Therapeutic Kinship Services - Therapeutic Services Kinship Masters: Home In-Office/Video or Community AND In - $ 200.00 Hour Rate Change Therapeutic Kinship Therapeutic Kinship Services - Services Masters: No Show $ 150.00 Each Rate Change Therapeutic Kinship Services Therapeutic Kinship Services: Mileage $ 0.50 Mile Shiloh Home - . Unit Program Area Service Name - Rate Type Other Day Treatment Day Treatment $ 2,125.00 Month Day Treatment Evening Reporting Center $ 98.50 Day Foster Care/Adoption Foster Care/Adoption Support: Support Mileage $ 0.59 Mile Foster Care/Adoption Foster Parent Consultation Coaching: Support FTM, TDM, Professional Staffing $ 80.00 Hour r Program Area Service Name Rate Unit Type Other Foster Support Care/Adoption Foster In -Home Parent Consultation or Community Coaching: $ 80.00 Hour Foster Support Care/Adoption Foster In-Office/Video Parent Consultation Coaching: $ 65.00 Hour Foster Support Care/Adoption Foster No Show Parent Consultation Coaching: $ 60.00 Each Foster Support Care/Adoption Foster FTM, TDM, Parent Professional Consultation Staffing Therapy: $ 95.00 Hour Foster Support Care/Adoption Foster In -Home Parent or Community Consultation Therapy: $ 120.00 Hour Foster Support Care/Adoption Foster In-Office/Video Parent Consultation Therapy: $ 95.00 Hour Foster Support Care/Adoption Foster No Show Parent Consultation Therapy: $ 75.00 Each Support Foster Care/Adoption Foster with Transportation Parent Consultation Therapy: $ 120.00 Hour Home -Based Services Aftercare FTM, TDM, Individual/Family Prof Staffing Therapy: $ 85.00 Hour Home -Based Services Aftercare In Transportation -Home Individual/Family or Community AND Therapy: with $ 115.00 Hour Home -Based Services Aftercare In-Office/Video Individual/Family Therapy: $ 85.00 Hour Home -Based Services Aftercare No Show Individual/Family Therapy: $ 75.00 Each Home -Based Services Aftercare Based TDM, Family Professional In -Home Support and Staffing Community Services: FTM, $ 85.00 Hour Home -Based Services Aftercare Based Office/Video Family In -Home Support and Community Services: In - $ 85.00 Hour Home -Based Services Aftercare Based Show In Family -Home and Support Community Services: No $ 60.00 Each Home -Based Services Home -Based Services: Mileage $ 0.59 Mile Home -Based Services Rapid Staffing Response: FTM, TDM, Prof. $ 95.00 Hour Home -Based Services Rapid Community Response: AND In -Home with Transportation or $ 140.00 Hour Home -Based Services Rapid Response: In-Office/Video $ 95.00 Hour Home -Based Services Rapid Response: No Show $ 75.00 Each Program Area Service Name, IUnit Rate Type Other Home -Based Services Youth FTM, TDM, Intervention Prof.Staffing Family Coaching: $ 65.00 Hour Home -Based Services Youth In -Home Transportation Intervention or Community Family AND Coaching: with $ 80.00 Hour Home -Based Services Youth In-Office/Video Intervention Family Coaching: $ 65.00 Hour Home -Based Services Youth No Show Intervention Family Coaching: $ 60.00 Each Home -Based Services Youth FTM, Interventions TDM, Prof.Staffing Therapy Services: $ 95.00 Hour Home -Based Services Youth In -Home Transportation Interventions or Community Therapy AND Services: with $ 125.00 Hour Home -Based Services Youth In-Office/Video Interventions Therapy Services: $ 95.00 Hour Home -Based Services Youth No Show Interventions Therapy Services: $ 75.00 Each Life Skills Beyond the Walls $ 1,115.00 Month Life Skills Comprehensive TDM, Prof.Staffing Parenting Time: FTM, $ 80.00 Hour Name Change Life Skills Comprehensive Home Transportation or Community Parenting AND Time: with In - $ 85.00 Hour Name Change Life Skills Comprehensive Office/Video Parenting Time: In - $ 80.00 Hour Name Change Life Skills Comprehensive Show Parenting Time: No $ 70.00 Each Name Change Life Skills Life Skills: FTM, TDM, Prof.Staffing $ 85.00 Hour Life Skills Life Skills: In -Home or Community $ 85.00 Hour Life Skills Life Skills: In-Office/Video $ 65.00 Hour Life Skills Life Skills: Mileage $ 0.59 Mile Life Skills Life Skills: No Show $ 60.00 Each Life Skills Parents as Teachers $ 600.00 Month Life Skills Therapeutic Prof.Staffing Family Time: FTM, TDM, $ 95.00 Hour Name Change Life Skills Therapeutic Community Family AND with Time: Transportation In -Home or 5 120.00 Hour Name Change Program Area Service Name Rate Unit Type Other Life Skills Therapeutic Office/Video Parenting Time: In - $ 95.00 Hour Name Change Life Skills Therapeutic Parenting Time: No Show $ 75.00 Each Name Change Mental Health Services Individual TDM, Prof.Staffing and Family Therapy: FTM, $ 95.00 Hour Mental Health Services Individual Home Transportation or Community and Family Therapy: AND with In - $ 120.00 Hour Mental Health Services Individual Office/Video and Family Therapy: In - $ 95.00 Hour Mental Health Services Individual Show and Family Therapy: No $ 75.00 Each Mental Health Services Mental Health Services: Mileage $ 0.59 Mile N/A FP & KP Training - 11 -hour class $ 1,760.00 Each N/A FP & KP Training - 3 -hour class $ 480.00 Each N/A FP Sexually Reactive & KP Training Abusive Youth - The and Truth Sexually about $ 480.00 Each Sex Abuse Treatment Community Youth Conduct Community with Coaching: Based Problematic AND with Treatment In -Home Transportation Sexual or for $ 130.00 Hour Sex Abuse Treatment Community Youth Conduct with Coaching: Based Problematic Treatment In-Office/Video Sexual for $ 95.00 Hour Sex Abuse Treatment Individual Home Transportation or and Community Family Treatment: AND with In - $ 130.00 Hour Sex Abuse Treatment Individual Office/Video and Family Treatment: In - $ 130.00 Hour Sex Abuse Treatment Informed Supervision $ 300.00 Each Sex Abuse Treatment Sex Professional Abuse Treatment: Staffing FTM, TDM, $ 95.00 Hour Sex Abuse Treatment Sex Abuse Treatment: Mileage $ 0.59 Mile Sex Abuse Treatment Sex Abuse Treatment: No Show $ 75.00 Each Psychology Group Transitions Program Area Service Name Rate Unit Type Other Foster Support Care/Adoption Foster Therapeutic TDM, Prof. Parent Staffing Consultation Kinship Services: and FTM, $ 140.00 Hour Foster Support Care/Adoption Foster Therapeutic or Transportation Community Parent Consultation Kinship AND Services: with and In Home $ 188.00 Hour Rate Change Foster Support Care/Adoption Foster Therapeutic Office/Video Parent Consultation Kinship Services: and In $ 125.00 Hour Rate Change Foster Support Care/Adoption Foster Therapeutic Parent Consultation Kinship Services: and Mileage $ 0.58 Mile Foster Support Care/Adoption Foster Therapeutic Show Parent Consultation Kinship Services: and No $ 90.00 Each Life Skills In -Home In Transportation Home Family or Community Prevention AND Program: with $ 188.00 Hour Rate Change Life Skills In In -Home Office/Video Family Prevention Program: $ 125.00 Hour Rate Change Life Skills LIFE Staffing SKILLS: FTM, TDM, Professional $ 140.00 Hour Life Skills LIFE SKILLS: Mileage $ 0.58 Mile Life Skills LIFE SKILLS: No Show i $ 90.00 Each Life Skills Therapeutic Community Visitation: AND with Transportation In Home or $ 188.00 Hour Rate Change Life Skills Therapeutic Office/Video Visitation: In - $ 125.00 Hour Rate Change N/A Additional Adult $ 300.00 Each N/A Child TDM, Welfare Professional Block Staffing Funded: FTM, $ 140.00 Hour N/A Full Home Study $ 1,350.00 Episode N/A Home Studies: Mileage $ 0.58 Mile N/A Partial Home Study $ 300.00 Episode N/A Relinquishment or Community Counseling: In Home $ 180.00 Hour N/A Relinquishment Office/Video Counseling: In $ 140.00 Hour N/A Updated Home Study $ 700.00 Episode AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO This Agreement Amendment made and entered into ?�Yday of 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 Maple Star Colorado, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills, Mental Health Services, and Home -Based Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1473, approved on May 25, 2022. 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 was set to end on May 31, 2023. • The Original Agreement was amended on: • May 8, 2023 to extend the term date through May 31, 2024, to amend Exhibit A, Scope of Services, and Exhibit B, Rate Schedule. • The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2022-1473. • These Amendments, 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. Term This agreement is being renewed for the third and final year, for the period June 1, 2024 through May 31, 2025. 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. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: °" )erk to the Board WELD COUNTY � ►' mac__ BY: Deputy Cl:, to t e Bs it BOARD OF COUNTY COMMISSIONERS evin D. Ross, Chair MAY 2 2 2024 TRACTOR: aple Star Colorado 2250 South Oneida Street, Suite 200 Denver, Colorado 80224 (303) 564-2595 'feather Mon -Kr Heather Morris 1May 10, 202410:03 MDT) By: Heather Morris, Executive Director May 10, 2024 Date: 2022-1973 EXHIBIT A SCOPE OF SERVICES Contractor will provide Life Skills, Mental Health Services, and Home -Based Services, as referred by the Department. Life Skills 1. Therapeutic Family Time Program a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by master's level staff under the direction of a Licensed Clinician. ii. Trauma Based Relational Intervention (TBRI) — Family First Prevention Services Act (FFPSA) clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff MI trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by National Child Traumatic Stress Network (NCTSN)), Strengthening Families, trauma informed teachings based on research of Karyn Purvis, Daniel Seigel, Bruce Perry. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. vi. Culturally- responsive and holistic interventions. b. Anticipated Frequency of Services: i. Typically, one (1) to four (4) hours per encounter. c. Anticipated Duration of Services: i. Initially, forty-five (45) to ninety (90) days, duration may change based on the case. d. Goals of Services: i. Support family connection ii. Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts. iii. Decreasing the level of service. 1 e. Outcomes of Services: i. Progress by visiting parents on goals collaboratively established with family during intake by Contractor and by Case Worker. ii. Progress by families from higher to lower level of Family Time intervention with the goal being unmonitored and reunification. iii. Fewer required supervised contact hours between a parent and child. f. Target Population: i. Children and youth ages zero (0) to eighteen (18) and their visiting parent/family member. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Family Time sessions may be provided at any of the four (4) Contractor's offices located along the front range, including: a. 2250 South Oneida, Suite. 200, Denver, Colorado 80224 b. 3225 International Circle, Bldg 323 Suite 210, Colorado Springs, Colorado 80909 c. 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 d. 1728 Topaz Drive, Loveland, Colorado 80537 ii. Weld County sites. iii. In the community. iv. In the family home. 2. Supervised Family Time Program a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by a Maple Star supervisor, under the direction of a Licensed Clinician ii. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff MI trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. 2 v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. b. Anticipated Frequency of Services: i. Typically, one (1) to four (4) hours per encounter. c. Anticipated Duration of Services: i. Initially, forty-five (45) to ninety (90) days, duration may change based on the case. d. Goals of Services: i. Support family connection ii. Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts. iii. Decreasing the level of service. e. Outcomes of Services: i. Progress by visiting parents on goals collaboratively established with family during intake by Contractor and by Case Worker ii. Progress by families from higher to lower level of Family Time intervention with the goal being unmonitored and reunification. iii. Fewer required supervised contact hours between a parent and child. f. Target Population: i. Children and youth ages zero (0) to eighteen (18) and their visiting parent/family member. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. Family Time sessions may be provided at any of the four (4) Contractor's offices located along the front range, including: a. 2250 South Oneida, Suite. 200, Denver, Colorado 80224 b. 3225 International Circle, Bldg 323 Suite 210, Colorado Springs, Colorado 80909 c. 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 d. 1728 Topaz Drive, Loveland, Colorado 80537 ii. Weld County sites. 3 iii. In the community. iv. In the family home. 3. Parent Coaching — Resilient, Attuned Parent Training (RAPT) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by team members with a High School diploma or bachelor's degree and supervised by a Maple Star supervisor. ii. Curricula used in RAPT: Strengthening Families, Hands on Parenting, Trauma Informed Parenting (by NCTSN). iii. Trauma Based Relational Intervention (TBRI)-FFPSA clearinghouse recognized Evidence Based Practice. iv. Maple Star has an on -staff MI trainer to maintain 100% staff training and model fidelity. v. Motivational Interviewing (MI)-FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff MI trainer to maintain 100% staff training and model fidelity. vi. RAPT is a stand-alone service that focuses on teaching, nurturing and facilitating mastery of the protective factors outlined in the Strengthening Families Curriculum including Parental Resilience, Social connections, knowledge of parenting and child development, concrete support in time of need and social and emotional competence of children. vii. RAPT is indicated when additional support and focus on parenting interactions are needed. RAPT is most appropriately provided outside of children's presence and includes in-depth parenting time planning/debrief, reunification planning or on -going support in the parent's home for attainment of protective factors. b. Anticipated Frequency of Services: i. One (1) to four (4) hours per encounter. c. Anticipated Duration of Services: i. Forty-five (45) to ninety (90) days, dependent on the level of service authorized d. Goals of Services: i. Provide a planned, non -crisis intervention approach that teaches, nurtures, and facilitates a parent's mastery of the protective factors outlined in the Strengthening Families curriculum. ii. Reduction in child abuse incidents through increased parenting skills. 4 iii. Provide focused, individualized goals. These goals may be determined through identified target areas from Parenting Time sessions and Caseworker input when children are placed out of home and/or Family Service Plans which outline needs for additional Parenting skills development. iv. Establish age -appropriate bonding and interactive engagement activities for parents in working with their children. v. Provide psychoeducation to parents on the impacts of trauma on the developing brain. vi. Teach parent evidence -based techniques for responding to and redirecting trauma rooted behaviors. e. Outcomes of Services: i. Increased confidence and competence of parent in the protective factors. ii. Increased understanding of the impact of trauma on children and implementation of trauma informed interventions. iii. Decrease in maladaptive parenting behaviors and patterns resulting in children being placed out of home or rupturing positive parental/child bonds. f. Target Population: i. Parents with one or more children ages zero (0) years to eighteen (18) years of age. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. Services under two (2) hours per encounter will occur in a Maple Star office or virtually, unless services can be coordinated to occur immediately before or after a scheduled Parenting Time session provided by Maple Star Colorado for the same client. ii. Services may be provided at any of the four (4) Contractor's offices located along the front range, including: a. 2250 South Oneida, Suite. 200, Denver, Colorado 80224 b. 3225 International Circle, Bldg 323 Suite 210, Colorado Springs, Colorado 80909 c. 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 d. 1728 Topaz Drive, Loveland, Colorado 80537 iii. Weld County sites. 5 iv. In the community. v. In the family home. Mental Health Services 1. Mental Health Services a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by licensed Clinicians or Colorado Department of Regulatory Agencies (DORA) registered master's level psychotherapists supervised by a Licensed Clinicians. ii. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor's employees a TBRI practitioner to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Contractor's team members are trained. iii. Motivational Interviewing (MI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor employees five (5) MI trainers to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Contractor's team members are trained. iv. Diagnosis and Treatment Planning 1. Patient Health Questionnaire -9 (PHQ-9) depression scale. 2. Columbia Suicide Severity Rating Scale. v. Trauma Informed Parenting by National Traumatic Stress Network (www.nctsn.com) vi. Culturally- responsive and holistic interventions vii. Traditional as well as non-traditional clinical expertise (mindfulness, mind -body, rhythmic movement, experiential therapy, art therapy, and dance/movement therapy). b. Anticipated Frequency of Services: i. One (1) to two (2), fifty (50) minute sessions per week. c. Anticipated Duration of Services: i. Duration is as long as clinically indicated and until treatment goals are met. ii. Treatment goals and progress will be evaluated every thirty (30) days, and treatment plans revised every ninety (90) days or as needed. Length of treatment will be driven by these indicators collaboratively. iii. On average, length of service is ninety (90) to one -hundred eighty (180) days. d. Goals of Services: 6 i. Provide stabilization, trauma informed interventions, diagnosis and treatment planning to address trauma and identified mental health issues. ii. Increase understanding of the impact of trauma on mental health and support to caregiver with regards to hands on techniques and approaches they may apply in their home. iii. Support parents and clients with communication, intervention, and teaching coping skills. iv. Support the family with potential crisis situations through 24/7 phone support. v. Serve as an advocate to families as appropriate, i.e., school, probation, or other needed services. vi. Transition cases to lower -level intervention as indicated. e. Outcomes of Services: i. Increase caregiver's understanding of mental health diagnoses, the impact of trauma and increase their ability to practice client -centered, relationship -based interactions with the child/ adolescent. ii. Increase positive parent child interactions. iii. Achievement of clients' individualized treatment goals. f. Target Population: i. Children and adolescents. g. Language: i. English. h. Medicaid Eligibility: i. Some mental health services are Medicaid eligible. i. Service Access and Transportation: i. Services to be provided primarily in the client's home. ii. Telehealth. Home -Based Services 1. Stabilizing Teens and Youth in home (STAY) — At Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor. 7 ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on staff MI trainers to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Up to ten (10) hours per month, inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. This service is a prevention support service designed to achieve: 1. Maintaining children in home to support FFPSA. 2. Secure safety in the home setting. 3. Identify and address immediate needs in the household. 4. Engage family with essential community resources. 5. Communicate with the Department in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support FFPSA goals. ii. Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. 8 f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 2. Stabilizing Teens and Youth in home (STAY) - High Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor with access to Licensed supervisors or directors as needed. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff MI trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. 9 b. Anticipated Frequency of Services: i. Up to twenty (20) hours per month, inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintaining children in home to support FFPSA. ii. Secure safety in the home setting. iii. Identify and address immediate needs in the household. iv. Engage family with essential community resources. v. Communicate with County in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support. ii. FFPSA goals Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 3. Stabilizing Teens and Youth in home (STAY) - Imminent Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. 10 iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on staff MI trainers to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs, and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Direct (in-person/virtual) service time up to thirty (30) hours per month direct. Service hours are inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintaining children in home to support FFPSA. ii. Secure safety in the home setting. iii. Identify and address immediate needs in the household. iv. Engage family with essential community resources. v. Communicate with County in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support. ii. FFPSA goals Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. 11 g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 4. Aftercare Support Services and Engagement Team (ASSET) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor under the direction of licensed clinician. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff MI trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. vi. Direct case management with clients by locating and connecting clients to community resources (Food stability, Housing stability, Child Educational needs and support with job search and preparedness. Contractor and the family directly engage in acquiring resources together to support self -efficacy and the family's ability to sustain. vii. Indirect case management by researching and locating appropriate resources for the family. Contractor's advocates and arranges resources for the family through resource location and collaborates with the client and the client's team to meet client's needs. b. Anticipated Frequency of Services: i. Direct service time five (5) hours per week up to twenty (20) hours a month. c. Anticipated Duration of Services: i. Thirty (30) to sixty (60) days. 12 d. Goals of Services: i. These services provide placement stabilization to include psycho education, needs assessment and attainment for household safety and sustainability, community resourcing and connecting, life skills development, transition, and adjustment support for reunification of family members, and positive parenting skills. ii. Specific goals are: 1. Prevention - to prevent the removal of children from their current placement and/or prevent out of home placement. 2. Reunification - to support the successful and sustainable reunification of families/placements up to two weeks prior to return home to support transition and stabilization of the placement. 3. Positive parent child engagement - to assess and provide trauma informed psychoeducation and tools for families at a developmentally appropriate level in order to build safe and sustainable homes and family engagement. iii. Application of Evidence Based Programs included on the Federal FFPSA Clearinghouse will be utilized with the goal of maintaining children in their homes/ communities. e. Outcomes of Services: i. This service is a prevention and reunification service designed to achieve: 1. Mitigating out of home placement or removal of children from the home to support FFPSA. 2. Secure safety and stability in the home setting. 3. Identify and address immediate needs in the household, while connecting families with essential community resources and supports to obtain and sustain self -efficacy. 4. Provide FFPSA evidence -based practice model tools to families to mitigate a disruption of placement based on individualized behaviors and barriers in the home while promoting healthy and safe parent -child interactions. 5. Communicate with County in the interest of the family. f. Target Population: i. Families with children that are in stages of reunification/placement transition. ii. Families at risk of removal of the child/children from the home. g. Language: i. English and Spanish. 13 h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Service will be provided primarily in the client's home. In the 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@weldgov.com 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@weldgov.com). 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@weldgov.com). No other Department staff or 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 D, Rate Schedule, then Contractor understands that the 14 Department will not reimburse for "no-shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, 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@weldgov.com) 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@weldgov.com) 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@weldgov.com) immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Mental Health and Support Services Team. Any changes to visitation 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 15 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 Child Welfare Contract and Services Coordinator. 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@weldgov.com) of new staff who 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 16 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. 17 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. 18 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 Program Area Life S Its< Rate Unit Service Name Type 168.00 Hour Therapeutic Fain' y ° n -Ho Community $168.00 Hour Therapeutic Family Time: In -Office with Transportation Therapeutic Family Time: in-Office/Video Supervised Family Time: In -Home or Community Supervised Family Time: in-Office/Video 8.00 $120.00 Hour $89.00 Hour $120.00 Hour Supervised Family Time: In -Office with Transportation Parent Coaching (RAPT- Resilient, Attuned Parent Training): in -Home or Community $105.00 Hour Program Area Rate Life Skills $89.00 Unit Service Name Type Parent Coaching (RAPT - Resilient, Attuned Hour Parent Training): In-Office/Video 93.00 Hour Life Skills: Team Decision Making Professional Staf g., . f'f't $65.00 Each Life Skills: No Show (Max of 2 no shows or 2 hours/month/client) Mental Health Services $0.65 $130.00 Mile Hour Life Skills: Mileage's Mental Health Services: In -Home or Community Mental Health Services: In-Office/Video $130.00 Hour $93.00 Hour Mental Health Services: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing Mental Health Services: No Show (Max of 2 no shows or 2 hours/month/client) $65.00 Each $0.65 Mile Mileage* Stabilizing Teens ar d Youth in (STAY) - At Risk Home Based Services 1.,300.( Month e $2,600.00 Month Stabilizing Teens and Youth in Home (STAY) - High Risk $4,000.1 $2,300.00 onth Month Stabilizing Teens and Youth in I (STAY) -; imminent Risk Aftercare Support Services and Engagement Team (ASSET) e * For distances exceeding 30 roundtrip miles from Contractor's closest office or the employee's home, whichever is closer to the parenting time location. 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 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/Maple Star Amendment #2 Final Audit Report 2024-05-10 Created: 2024-05-02 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAhyM6RegEr7lxFTr-S2BzNYSDOB51UgoF "SIGNATURE REQUESTED: Weld/Maple Star Amendment #2" History t Document created by Windy Luna (wluna@weld.gov) 2024-05-02 - 10:17:51 PM GMT- IP address: 204.133.39.9 Ley Document emailed to Heather Morris (heather.morris@pathways.com) for signature 2024-05-02 - 10:18:28 PM GMT t Email viewed by Heather Morris (heather.morris@pathways.com) 2024-05-02 - 10:29:46 PM GMT- IP address: 104.28.48.216 t Email viewed by Heather Morris (heather.morris@pathways.com) 2024-05-06 - 2:53:09 PM GMT- IP address: 104.28.48.216 t Email viewed by Heather Morris (heather.morris@pathways.com) 2024-05-09 - 6:18:52 AM GMT- IP address: 172.225.24.50 'y New document URL requested by Heather Morris (heather.morris@pathways.com) 2024-05-10 - 3:19:56 PM GMT- IP address: 104.244.50.13 E Email viewed by Heather Morris (heather.morris@pathways.com) 2024-05-10 - 4:03:14 PM GMT- IP address: 104.244.50.13 Ll Document e -signed by Heather Morris (heather.morris@pathways.com) Signature Date: 2024-05-10 - 4:03:32 PM GMT - Time Source: server- IP address: 104.244.50.13 �ii Agreement completed. 2024-05-10 - 4:03:32 PM GMT Powered by Adobe Acrobat Sign Contract Form Entity Information Entity Name* MAPLE STAR COLORADO Entity ID* @00027042 Contract Name* MAPLE STAR COLORADO (PROFESSIONAL SERVICES AGREEMENT AMENDMENT #2 RELATED TO BID #B2200040) Contract Status CTB REVIEW Contract ID 8195 Contract Lead" WLUNA Q New Entity? Parent Contract ID 20221473 Requires Board Approval YES Contract Lead Email Department Project # wluna@weldgov.com;cob bxxlk@weldgov.com Contract Description* (CONSENT) MAPLE STAR COLORADO PROFESSIONAL SERVICES AGREEMENT AMENDMENT #2 RELATED TO BID #B2200040. TERM: 06/01/2024 THROUGH 05/31/2025. Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 04/10/24. Contract Type* AMENDMENT Amount* $0.00 Renewable* NO 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 * 05/22/2024 Due Date 05/18/2024 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 Committed Delivery Date Renewal Date Expiration Date* 05/31/2025 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 05/13/2024 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 05/13/2024 05/13/2024 05/13/2024 Final Approval BOCC Approved Tyler Ref # AG 052224 BOCC Signed Date Originator WLUNA BOCC Agenda Date 05/22/2024 Can-Fva.c+ Mit PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: May 2, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment #1 with Maple Star Colorado Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Agreement Amendment #1 with Maple Star Colorado. The Department has an Agreement with Maple Star Colorado for Life Skills, Mental Health, and Home -Base Services. This Agreement is known to the Board as Tyler ID# 2022-1473. The agreement is now being amended to renew for a second year, for the period June 1, 2023 through May 31, 2024, and to make changes to the Scope of Services and Rate Schedule as noted below. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Scope of Services Changes: • Updates to the terms as requested by the Department. Rate Schedule Changes: • Updates to the terms as requested by the Department, • Updates to the rates as requested by the Contractor. Rate changes are noted below. hp, Life Skills $168.00 Hour Therapeutic Parenting Time: In -Home or Community $168.00 Hour Therapeutic Parenting Time: In -Office with Transportation $118.00 Hour Therapeutic Parenting Time: In-Office/Video $120.00 Hour Supervised Parenting Time: In -Home or Community $85.00 Hour Supervised Parenting Time: In-OfficeNideo $120.00 Hour Supervised Parenting Time: In -Office with Transportation $105.00 Hour Parent Coaching (RAPT - Resilient, Attuned Parent Training): In -Home or Community $85.00 Hour Parent Coaching (RAPT - Resilient, Attuned Parent Training): In-OfficeNideo $93.00 Hour Life Skills: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $60.00 Each Life Skills: No Show (Max of 2 no shows or 2 hours/month/client) $0.65 Mile Life Skills: Mileage* $130.00 Hour Mental Health Services: In -Home or Community $130.00 Hour Mental Health Services: In-Office/Video Pass -Around Memorandum; May 2, 2023 — CMS ID 69 3 e,t f Cbf U'* 3V°I5 b5/o 2123 ! / Page 1 7022-I LI-13 PRIVILEGED AND CONFIDENTIAL 1)",ri1111 \rLi1 Mental Health Services RA, $93.00 1 N ils Hour SCrl lel\a1111' Mental Health Services: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each Mental Health Services: No Show (Max of 2 no shows or 2 hours/month/client) $0.65 Mile Mileage* Home Based Services $1,300.00 Month Stabilizing Teens and Youth in Home (STAY) - At Risk $2,600.00 Month Stabilizing Teens and Youth in Home (STAY) - High Risk $4,000.00 Month Stabilizing Teens and Youth in Home (STAY) - Imminent Risk $2,300.00 Month Aftercare Support Services and Engagement Team (ASSET) I do not recommend a Work Session. I recommend approval of this Agreement Amendment #1 and authorize the Chair to sign. Perry L Buck, Pro-Tem Mike Freeman, Chair Scott K. James Kevin Ross Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; May 2, 2023 — CMS ID 6923 Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO This Agreement Amendment, made and entered into u day of , 2023, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, herei er referred to as the '`Department", and Maple Star Colorado, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills, Mental Health Services, and Home -Based Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1473, approved on May 25, 2022. 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, 2023. • This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Child Protection Agreement as of June 1, 2023: 1. Term This Agreement is being renewed for the second year, for the period of June 1, 2023 through May 31, 2024. 2. Exhibit A, Scope of Services, is hereby amended as attached. 3. Exhibit B, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair MAY 0 8 2323 CONTRACTOR: Maple Star Colorado 2250 South Oneida Street, Suite 200 Denver, Colorado 80224 (909) 564-2595 /feathei- Moi-i'is By: Heather Morris (Apr 25, 2023 08:04 MDT: Heather Morris, Executive Director Apr 25, 2023 Date: EXHIBIT A SCOPE OF SERVICES Contractor wit pavide Life Skills, Mental Health Services, and Home -Based Services, as referred by the Department. Life Skills 1. Therapeutic Parenting Time Program a Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by master's level staff under the direction of a Licensed Clinician. ii. Trauma Based Relational Intervention (TBRI) — Family First Prevention Services Act (FFPSA) clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff MI trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by National Child Traumatic Stress Network (NCTSN)), Strengthening Families, trauma informed teachings based on research of Karyn Purvis, Daniel Seigel, Bruce Perry. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. vi. Culturally- responsive and holistic interventions. Is, Anticipated Frequency of Services: i. Typically, one (1) to four (4) hours per encounter. a Anticipated Duration of Services: i. Initially, forty-five (45) to ninety (90) days, duration may change based on the case. dl Goals of Services: i. Support parents in connection with their child. ii. Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts. iii. Decreasing the level of service. e Outcomes of Services: i. Progress by visiting parents on goals collaboratively established with family during intake by Contractor and by Case Worker. ii. Progress by families from higher to lower level of Parenting Time intervention with the goal being unmonitored and reunification. iii. Fewer required supervised contact hours between a parent and child. f Target Population: i. Children and youth ages zero (0) to eighteen (18) and their visiting parent/family member. g_ Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. 1 Service Access and Transportation: i. Parenting Time sessions may be provided at any of the four (4) Contractor's offices located along the front range, including: 2250 South Oneida, Suite. 200, Denver, Colorado 80224 1465 North Union Boulevard., Suite 102, Colorado Springs, Colorado 80909 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 1728 Topaz Drive, Loveland, Colorado 80537 ii. Weld County sites. iii. In the community. iv. In the family home. 2. Supervised Parenting Time Program a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by a Maple Star supervisor, under the direction of a Licensed Clinician ii. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff Ml trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. b. Anticipated Frequency of Services: i. Typically, one (1) to four (4) hours per encounter. c. Anticipated Duration of Services: i. Initially, forty-five (45) to ninety (90) days, duration may change based on the case. d. Goals of Services: i. Support parents in connection with their child. ii. Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts. iii. Decreasing the level of service. e. Outcomes of Services: i. Progress by visiting parents on goals collaboratively established with family during intake by Contractor and by Case Worker ii. Progress by families from higher to lower level of Parenting Time intervention with the goal being unmonitored and reunification. iii. Fewer required supervised contact hours between a parent and child. f. Target Population: i. Children and youth ages zero (0) to eighteen (18) and their visiting parent/family member. g. Language: i. English and Spanish. h. Medicaid Eligibility: 2 i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Parenting Time sessions may be provided at any of the four (4) Contractor's offices located along the front range, including: 2250 South Oneida, Suite. 200, Denver, Colorado 80224 1465 North Union Boulevard., Suite 102, Colorado Springs, Colorado 80909 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 1728 Topaz Drive, Loveland, Colorado 80537 ii. Weld County sites. iii. In the community. iv. In the family home. 3. Parent Coaching — Resilient, Attuned Parent Training (RAPT) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by team members with a High School diploma or bachelor's degree and supervised by a Maple Star supervisor. ii. Curricula used in RAPT: Strengthening Families, Hands on Parenting, Trauma Informed Parenting (by NCTSN). iii. Trauma Based Relational Intervention (TBRI)-FFPSA clearinghouse recognized Evidence Based Practice. iv. Maple Star has an on -staff MI trainer to maintain 100% staff training and model fidelity. v. Motivational Interviewing (MI)-FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff MI trainer to maintain 100% staff training and model fidelity. vi. RAPT is a stand-alone service that focuses on teaching, nurturing and facilitating mastery of the protective factors outlined in the Strengthening Families Curriculum including Parental Resilience, Social connections, knowledge of parenting and child development, concrete support in time of need and social and emotional competence of children. vii. RAPT is indicated when additional support and focus on parenting interactions are needed. RAPT is most appropriately provided outside of children's presence and includes in-depth parenting time planning/debrief, reunification planning or on -going support in the parent's home for attainment of protective factors. F. Anticipated Frequency of Services: i. One (1) to four (4) hours per encounter. a. Anticipated Duration of Services: i. Forty-five (45) to ninety (90) days, dependent on the level of service authorized d. Goals of Services: i. Provide a planned, non -crisis intervention approach that teaches, nurtures, and facilitates a parent's mastery of the protective factors outlined in the Strengthening Families curriculum. ii. Reduction in child abuse incidents through increased parenting skills. iii. Provide focused, individualized goals. These goals may be determined through identified target areas from Parenting Time sessions and Caseworker input when children are placed out of home and/or Family Service Plans which outline needs for additional Parenting skills development. iv. Establish age -appropriate bonding and interactive engagement activities for parents in working with their children. v. Provide psychoeducation to parents on the impacts of trauma on the developing brain. 3 vi. Teach parent evidence -based techniques for responding to and redirecting trauma rooted behaviors. e. Outcomes of Services: i. Increased confidence and competence of parent in the protective factors. ii. Increased understanding of the impact of trauma on children and implementation of trauma informed interventions. iii. Decrease in maladaptive parenting behaviors and patterns resulting in children being placed out of home or rupturing positive parental/child bonds. Target Population: i. Parents with one or more children ages zero (0) years to eighteen (18) years of age. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. Services under two (2) hours per encounter will occur in a Maple Star office or virtually, unless services can be coordinated to occur immediately before or after a scheduled Parenting Time session provided by Maple Star Colorado for the same client. ii. Services may be provided at any of the four (4) Contractor's offices located along the front range, including: 2250 South Oneida, Suite. 200, Denver, Colorado 80224 1465 North Union Boulevard., Suite 102, Colorado Springs, Colorado 80909 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 1728 Topaz Drive, Loveland, Colorado 80537 iii. Weld County sites. iv. In the community. v. In the family home. Mental Health Services 1. Mental Health Services a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by licensed Clinicians or Colorado Department of Regulatory Agencies (DORA) registered master's level psychotherapists supervised by a Licensed Clinicians. ii. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor's employees a TBRI practitioner to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Contractor's team members are trained. iii. Motivational Interviewing (MI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor employees five (5) Ml trainers to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Contractor's team members are trained. iv. Diagnosis and Treatment Planning 1. Patient Health Questionnaire -9 (PHQ-9) depression scale. 2. Columbia Suicide Severity Rating Scale. v. Trauma Informed Parenting by National Traumatic Stress Network (www.nctsn.com) vi. Culturally- responsive and holistic interventions vii. Traditional as well as non-traditional clinical expertise (mindfulness, mind -body, rhythmic movement, experiential therapy, art therapy, and dance/movement therapy). 4 b. Anticipated Frequency of Services: i. One (1) to two (2), fifty (50) minute sessions per week. Anticipated Duration of Services: i. Duration is as long as clinically indicated and until treatment goals are met. ii. Treatment goats and progress will be evaluated every thirty (30) days, and treatment plans revised every ninety (90) days or as needed. Length of treatment will be driven by these indicators collaboratively. iii. On average, length of service is ninety (90) to one -hundred eighty (180) days. 1. Goals of Services: i. Provide stabilization, trauma informed interventions, diagnosis and treatment planning to address trauma and identified mental health issues. ii. Increase understanding of the impact of trauma on mental health and support to caregiver with regards to hands on techniques and approaches they may apply in their home. iii. Support parents and clients with communication, intervention, and teaching coping skills. iv. Support the family with potential crisis situations through 24/7 phone support. v. Serve as an advocate to families as appropriate, i.e., school, probation, or other needed services. vi. Transition cases to lower -level intervention as indicated. Outcomes of Services: i. Increase caregiver's understanding of mental health diagnoses, the impact of trauma and increase their ability to practice client -centered, relationship -based interactions with the child/ adolescent. ii. Increase positive parent child interactions. iii. Achievement of clients' individualized treatment goals. f. Target Population: i. Children and adolescents. g. Language: i. English. h. Medicaid Eligibility: i. Some mental health services are Medicaid eligible. i. Service Access and Transportation: i. Services to be provided primarily in the client's home. ii. Telehealth. Home -Based Services 1. Stabilizing Teens and Youth in home (STAY) — At Risk Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement i. All services provided by Bachelor level staff and supervised by Contractor's supervisor. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff Ml trainers to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. 5 V. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Up to ten (10) hours per month, inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. This service is a prevention support service designed to achieve: 1. Maintaining children in home to support FFPSA. 2. Secure safety in the home setting. 3. Identify and address immediate needs in the household. 4. Engage family with essential community resources. 5. Communicate with the Department in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support FFPSA goals. ii. Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 2. Stabilizing Teens and Youth in home (STAY) - High Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor with access to Licensed supervisors or directors as needed. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. 6 iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff Ml trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Up to twenty (20) hours per month, inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintaining children in home to support FFPSA. ii. Secure safety in the home setting. iii. Identify and address immediate needs in the household. iv. Engage family with essential community resources. v. Communicate with County in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support. ii. FFPSA goals Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. Language: i. English 1. Medicaid Eligibility: i. This service is not Medicaid eligible. . Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 3. Stab. lining Teens and Youth in home (STAY) - Imminent Risk 3. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor. 7 ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff MI trainers to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Direct (in-person/virtual) service time up to thirty (30) hours per month direct. Service hours are inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintaining children in home to support FFPSA. ii. Secure safety in the home setting. iii. Identify and address immediate needs in the household. iv. Engage family with essential community resources. v. Communicate with County in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support. ii. FFPSA goals Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 4. Aftercare Support Services and Engagement Team (ASSET) 8 Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor under the direction of licensed clinician. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff Ml trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. vi. Direct case management with clients by locating and connecting clients to community resources (Food stability, Housing stability, Child Educational needs and support with job search and preparedness. Contractor and the family directly engage in acquiring resources together to support self -efficacy and the family's ability to sustain. vii. Indirect case management by researching and locating appropriate resources for the family. Contractor's advocates and arranges resources for the family through resource location and collaborates with the client and the client's team to meet client's needs. b. Anticipated Frequency of Services: i. Direct service time five (5) hours per week up to twenty (20) hours a month. e. Anticipated Duration of Services: i. Thirty (30) to sixty (60) days. d. Goals of Services: i. These services provide placement stabilization to include psycho education, needs assessment and attainment for household safety and sustainability, community resourcing and connecting, life skills development, transition and adjustment support for reunification of family members, and positive parenting skills. ii. Specific goals are: 1. Prevention - to prevent the removal of children from their current placement and/or prevent out of home placement. 2. Reunification - to support the successful and sustainable reunification of families/placements up to two weeks prior to return home to support transition and stabilization of the placement. 3. Positive parent child engagement - to assess and provide trauma informed psychoeducation and tools for families at a developmentally appropriate level in order to build safe and sustainable homes and family engagement. iii. Application of Evidence Based Programs included on the Federal FFPSA Clearinghouse will be utilized with the goal of maintaining children in their homes/ communities. e. Outcomes of Services: i. This service is a prevention and reunification service designed to achieve: 1. Mitigating out of home placement or removal of children from the home to support FFPSA. 2. Secure safety and stability in the home setting. 3. Identify and address immediate needs in the household, while connecting families with essential community resources and supports to obtain and sustain self -efficacy. 9 4. Provide FFPSA evidence -based practice model tools to families to mitigate a disruption of placement based on individualized behaviors and barriers in the home while promoting healthy and safe parent -child interactions. 5. Communicate with County in the interest of the family. f. Target Population: i. Families with children that are in stages of reunification/placement transition. ii. Families at risk of removal of the child/children from the home. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Service will be provided primarily in the client's home. In the 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 L L CWServiceReferral/h/weldoov.com 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 - C W ServiceReferral(a)weldeov.com ). 5. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team mailto:(HS-CWServiceReferral(&,weldeov.com). No other Department staff or 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 D, 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", or up to two (2) hours, 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 10 must inbrm the caseworker and the Mental Health and Support Services Team (HS- CWSer-'iceReferral(a,weldgov.com) within three (3) days of when the client is placed on a behavioral plan or discharged 7. Contracor 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 Contracor 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 casewodcer and the Mental Health and Support Services Team (HS-CWServiceReferral(a,weldgov.com) immediately via email, to discuss service continuation. 8. Contracoor will identify, in detail, areas of continued concern and make recommendations to the casewodcer in a monthly report regarding continuation of services and/or the need for additional services. 9. Contracor 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 Cntiractor 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 casewodcer and the Mental Health and Support Services Team(HS-CWServiceReferral(ai/weldgov.com) immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Mental Health and Support Services Team. Any changes to visitatia 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 incltaie Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decisio. Making meetings. The Department will reimburse for actual participation in the meeting only so long as :here is written authorization from the Mental Health and Support Services Team, and the facilitator docusnatts 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 art the time attended on the meeting notes. Stuffings and/or meetings other than those listed above are net considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coorzlisator. 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- CWSetviceReferral(a,weldgov.com) of new staff who 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 11 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 retum 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, 12 special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purpesm of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 13 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 Program :kr. L Sills Rats $168.00 Unit Type Hour 5cr,ice Name Therapeutic l*anenting Time: In -Home` or'Caiimunity $168.00 Hour Therapeutic Parenting Time: In -Office with Transportation $118.00 iaur Therapeutics Parenting Time: In-OfficeNidea p $120.00 Hour Supervised Parenting Time: In -Home or Community $85.00 Hour Supervised Parenting Time: In-Office/Video $120.00 Hour Supervised Parenting Time: In -Office with Transportation $105 00 Maur Parent Coaching (RAPT - Resilient, Attuned Parent Training):Home or Community $85.00 Hour Parent Coaching (RAPT - Resilient, Attuned Parent Training): In-OfficeN ideo 0 $93.0 H°" Life Skills: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $60.00 Each Life Skills: No Show (Max of 2 no shows or 2 hours/month/client) $0.65 Mile Life Skills: Mileage* Mental Health Services $130.00 Hour Mental Health Services: In -Home or Community $130.00 Hour Mental Health Services: In-Office/Video $93.00 Hour Mental Health Services: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 'Each Mental I esltlz etvices: No. Show (Max of 2 no shows or 2 hours/month/client) $0.65 Mile Mileage* Program ,1rea Rate l'nit TNpe tiers ice Name Hume Based S ervicece ... Ss ° , $1,300.00 ' Month Stabilizing Teens and Your i Tluttre (STA Risk $2,600.00 Month Stabilizing Teens and Youth in Home (STAY) - High Risk $4,000.00 Month Stabilizing Teens and Youth in Home (STAY) - Imminent Risk $2,300.00 Month Aftercare Support Services and Engagement Team ASSET * For distances exceeding 40 roundtrip miles from Contractor's closest office or the employee's home, whichever is closer to the parenting time location. 3. Request for Reimbursement and Supporting Documentation Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7'h 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 7`h 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 exhaisted 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/Maple Star Amendment #1 - 2023-24 Final Audit Report 2023-04-25 Created: 2023-04-21 By: Lesley Cobb (cobbodk@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAA2yEGzH08-z8OALEZAyrcUaBN2F8suMv "SIGNATURE REQUESTED: Weld/Maple Star Amendment #1 - 2023-24" History t Document created by Lesley Cobb (cobbxxlk@co.weld.co.us) 2023-04-21 - 6:01:08 PM GMT- IP address: 204.133.39.9 El Document emailed to Heather Morris (heather.morris@pathways.com) for signature 2023-04-21 - 6:04:5£ PM GMT 5 Email viewed by Heather Morris (heather.morris@pathways.com) 2023-04-21 - 6:22:55 PM GMT- IP address: 104.28.48.215 t Email viewed by Heather Morris (heather.morris@pathways.com) 2023-04-24 - 11:40:50 PM GMT- IP address: 104.28.48.218 6® Document a -geed by Heather Morris (heather.morris@pathways.com) Signature Date: 3023-04-25 - 2:04:22 PM GMT - Time Source: server- IP address: 104.244.50.13 Q Agreement completed. 2023-04-25 - 2:06:22 PM GMT Powered b, Adobe Acrobat Sign Contract Form New Contract Request Entity Information Entity Name. MAPLE STAR COLORADO Entity ID. ,gO0027042 Contract Name. MAPLE STAR COLORADO (AGREEMENT AMENDMENT #1 PY 2023-241 Contract Status CTB REVIEW ct Description" BID# B2200040. MINOR SCOPE, FATE AND TERM CHANGES. TERM 6, 1 23-5131 124. Contract ID 6923 Contract Lead. COB BXXLK ❑ New Entity? Parent Contract ID 20221473 Requires Board Approval YES Contract Lead Email Department Project cobbxxlkOco.weld.co.us Contract Description 2 CONSENT PA ROUTING THROUGH NORMAL APPROVAL PROCESS. ETA TO C:TB 05,04, 2023. Contract Type. AMENDMENT Amount. $0.00 Renewable. NO Renewal IGA Department HUMAN SERVICES Department Email CM - H umanSe rvi ce sAweldgov. co Department Head Email CM-HurnanSeryices- DeptHeadg1weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEYgWELDG OV.C:OM If this is a renewal enter evious Contract ID If this is part of a NSA enter NSA Contract ID Requested BOCC Agenda Date. 05,`10,=2023 Due Date 05 '06,'2023 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should he left blank if those contracts are not in Ontase co Effective Date Review Date. 03i29,2024 Renewal Date Termination Notice Period Committed Delivery Date Expiration Date 05:31:'2024 Contact Information Contact Info Contact Name Contact Type Contact Email Contact Phone I Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 04'28.;202.3 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 04;2812023 04 28 2023 04 28 2023 Final Approval BOCC Approved Tyler Ref # AG 050823 BOCC Signed Date BOCC Agenda Date 05!08;2023 Originator COBBXXLK Con1vckcF ID##58(4iS CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO This Agreement, made and entered into the Z5' ay of M , 2022, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departn dit of Human Services, hereinafter referred to as the "Department" and Maple Star Colorado, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Scope of Services, Exhibit B, Rate Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to Request for Proposal. Exhibit A, B, and D are attached hereto and incorporated herein by this reference. Exhibit C is Weld County's Request for Proposal Number B220040 which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Life Skills, Mental Health Services, Crisis Intervention and Stabilization Services, Aftercare Services. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2022, upon proper execution of this Agreement and shall expire May 31, 2023, unless sooner terminated as provided herein. This agreement may be renewed for 2 additional terms by written agreement of both parties. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit A Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal. 3. Referrals, Billing and Tracking a. 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. b. 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. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team(HS-CWOualitvAssurance(aweldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the Department. Requests for Reimbursement Forms received after 45 days from the date of service may C onvin-t- Pritrtdo1/4-, a/ zs/22 cc: aubet oQ) 2022-1473 .1 a./ate i result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7th of the month, following the month of service, for each client receiving ongoing services. 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. Date and time(s) of service (i.e. two hours or 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. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. 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: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Scope of Services , Exhibit B, Rate Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to Request for Proposal., attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. 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. d. 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. 2 5. 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. 6. Payment Method Unless otherwise provided in Exhibit A, Scope of Services, Exhibit B, Rate Schedule, and Exhibit D, Contractor's Proposal: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. 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. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and 3 - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E - Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is 4 employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. 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 3(d) of this Agreement. 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect prior to execution of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage 5 listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors 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. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. 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. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire; and - $500,000 errors and omissions. iii.Automobile Liability: 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. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: - If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; - Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; - Waiver of exclusion for lawsuits by one insured against another; 6 A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. 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. 11. 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. 7 12. 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. 13. 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 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. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. 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: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - 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. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives 8 of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Heather Morris, Executive Director 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 18. Litigation For Contractor: Heather Morris, Executive Director 2250 South Oneida Street, Suite 200 Denver, Colorado 80224 (303) 564-2595 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement 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. 21. Governmental Immunity No term or condition of this contract 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 of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The 9 parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage. Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall 10 be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County 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 from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. 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. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit C, provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner 11 consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, and other similar items, generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Employee Financial Interest/Conflict of Interest. C.R.S. x$24-18-201 et seq. and $24-50-507 The signatories to this Agreement aver 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. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. 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. 34. 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. 35. Subcontractors Contractor acknowledges that the Department 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 this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 36. Attorney's Fees/Legal Costs 12 In the event of a dispute between the Department 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. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. 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 Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. 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. 39. 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 and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: "�^'' �' e1 C� • J.,to; G�- By: Deputy Cler.l o the oard Scott K. James, Chair MAY 2 5 2022 BOARD OF COUNTY COMMISSIONERS Id County Clerk to th- : oard WELD (BOUNTY, COLORADO 13 Maple Star Colorado 2250 South Oneida Street, Suite 200 Denver, CO 80224 (303) 564-2595 tfeathe`kA'mf By: Heather Morris (May 18, 2022 14:25 MDT) Heather Morris, Executive Director Date: May 18, 2022 o2 —,773 EXHIBIT A SCOPE OF SERVICES Contractor will provide Life Skills, Mental Health Services, Crisis Intervention and Stabilization Services, Aftercare Services, as referred by the Department. Life Skills 1. Therapeutic Parenting Time Program a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Masters level staff under the direction of a Licensed Clinician. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff Ml trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families, trauma informed teachings based on research of Karyn Purvis, Daniel Seigel, Bruce Perry. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. vi. Culturally- responsive and holistic interventions. b. Anticipated Frequency of Services: i. Typically, one (1) to four (4) hours per encounter. c. Anticipated Duration of Services: i. Initially, forty-five (45) to ninety (90) days, duration may change based on the case. d. Goals of Services: i. Support parents in connection with their child. ii. Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts. iii. Decreasing the level of service. e. Outcomes of Services: i. Progress by visiting parents on goals collaboratively established with family during intake by Contractor and by Case Worker. ii. Progress by families from higher to lower level of Parenting Time intervention with the goal being unmonitored and reunification. iii. Fewer required supervised contact hours between a parent and child. f. Target Population: i. Children and youth ages zero (0) to eighteen (18) and their visiting parent/family member. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. 1 i. Service Access and Transportation: i. Parenting Time sessions may be provided at any of the four (4) Contractor's offices located along the front range, including: 2250 South Oneida, Suite. 200, Denver, Colorado 80224 1465 North Union Boulevard., Suite 102, Colorado Springs, Colorado 80909 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 1728 Topaz Drive, Loveland, Colorado 80537 ii. Weld County sites. iii. In the community. iv. In the family home. 2. Supervised Parenting Time Program a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by a Maple Star supervisor, under the direction of a Licensed Clinician ii. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff Ml trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. b. Anticipated Frequency of Services: i. Typically, one (1) to four (4) hours per encounter. c. Anticipated Duration of Services: i. Initially, forty-five (45) to ninety (90) days, duration may change based on the case. d. Goals of Services: i. Support parents in connection with their child. ii. Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts. iii. Decreasing the level of service. e. Outcomes of Services: i. Progress by visiting parents on goals collaboratively established with family during intake by Contractor and by Case Worker ii. Progress by families from higher to lower level of Parenting Time intervention with the goal being unmonitored and reunification. iii. Fewer required supervised contact hours between a parent and child. f. Target Population: i. Children and youth ages zero (0) to eighteen (18) and their visiting parent/family member. g. Language: i. English and Spanish. h. Medicaid Eligibility: 2 i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Parenting Time sessions may be provided at any of the four (4) Contractor's offices located along the front range, including: 2250 South Oneida, Suite. 200, Denver, Colorado 80224 1465 North Union Boulevard., Suite 102, Colorado Springs, Colorado 80909 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81005 1728 Topaz Drive, Loveland, Colorado 80537 ii. Weld County sites. iii. In the community. iv. In the family home. 3. Mental Health Services a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by licensed Clinicians or Colorado Department of Regulatory Agencies (DORA) registered Master's level psychotherapists supervised by a Licensed Clinicians. ii. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor's employees a TBRI practitioner to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Contractor's team members are trained. iii. Motivational Interviewing (Ml)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor employees five (5) MI trainers to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Contractor's team members are trained. iv. Diagnosis and Treatment Planning 1. Patient Health Questionnaire -9 (PHQ-9) depression scale. 2. Columbia Suicide Severity Rating Scale. v. Trauma Informed Parenting by National Traumatic Stress Network (www.nctsn.com) vi. Culturally- responsive and holistic interventions vii. Traditional as well as non-traditional clinical expertise (mindfulness, mind -body, rhythmic movement, experiential therapy, art therapy, and dance/movement therapy). b. Anticipated Frequency of Services: i. One (1) to two (2), fifty (50) minute sessions per week. c. Anticipated Duration of Services: i. Duration is as long as clinically indicated and until treatment goals are met. ii. Treatment goals and progress will be evaluated every thirty (30) days, and treatment plans revised every ninety (90) days or as needed. Length of treatment will be driven by these indicators collaboratively. iii. On average, length of service is ninety (90) to one -hundred eighty (180) days. d. Goals of Services: i. Provide stabilization, trauma informed interventions, diagnosis and treatment planning to address trauma and identified mental health issues. ii. Increase understanding of the impact of trauma on mental health and support to caregiver with regards to hands on techniques and approaches they may apply in their home. iii. Support parents and clients with communication, intervention, and teaching coping skills. iv. Support the family with potential crisis situations through 24/7 phone support. v. Serve as an advocate to families as appropriate, i.e., school, probation, or other needed services. vi. Transition cases to lower -level intervention as indicated. 3 e. Outcomes of Services: i. Increase caregiver's understanding of mental health diagnoses, the impact of trauma and increase their ability to practice client -centered, relationship -based interactions with the child/ adolescent. ii. Increase positive parent child interactions. iii. Achievement of clients' individualized treatment goals. f. Target Population: i. Children and adolescents. g. Language: i. English. h. Medicaid Eligibility: i. Some mental health services are Medicaid eligible. i. Service Access and Transportation: i. Services to be provided primarily in the client's home. ii. Telehealth. Crisis Intervention and Stabilization Services 4. Stabilizing Teens and Youth in home (STAY) — At Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff Ml trainers to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Up to ten (10) hours per month, inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. This service is a prevention support service designed to achieve: 4 1. Maintaining children in home to support FFPSA. 2. Secure safety in the home setting. 3. Identify and address immediate needs in the household. 4. Engage family with essential community resources. 5. Communicate with the Department in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support FFPSA goals. ii. Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 5. Stabilizing Teens and Youth in home (STAY) - High Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor with access to Licensed supervisors or directors as needed. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff MI trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: i. Up to twenty (20) hours per month, inclusive of scheduled and on -call support hours. 5 c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintaining children in home to support FFPSA. ii. Secure safety in the home setting. iii. Identify and address immediate needs in the household. iv. Engage family with essential community resources. v. Communicate with County in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support. ii. FFPSA goals Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 6. Stabilizing Teens and Youth in home (STAY) - Imminent Risk a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (Ml) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff Ml trainers to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. vi. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. vii. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Contractor and the family directly engage in acquiring resources together. viii. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Contractor advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources. b. Anticipated Frequency of Services: 6 i. Direct (in-person/virtual) service time up to thirty (30) hours per month direct. Service hours are inclusive of scheduled and on -call support hours. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Maintaining children in home to support FFPSA. ii. Secure safety in the home setting. iii. Identify and address immediate needs in the household. iv. Engage family with essential community resources. v. Communicate with County in the interest of the family. e. Outcomes of Services: i. Maintain a safe and secure placement to prevent out of home placement and support. ii. FFPSA goals Referral reasons are mitigated. iii. Connected to sustainable Family/Community resources. f. Target Population: i. Families with children ages zero (0) to seventeen (17) with a risk of removal from home. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Primarily in the client's home. ii. In the community. iii. Telehealth. 7. Aftercare Support Services and Engagement Team (ASSET) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. All services provided by Bachelor level staff and supervised by Contractor's supervisor under the direction of licensed clinician. ii. Trauma Based Relational Intervention (TBRI) - FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. iii. Motivational Interviewing (MI)- FFPSA clearinghouse recognized Evidence Based Practice. Contractor has an on -staff Ml trainer to maintain 100% staff training and model fidelity. iv. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. v. Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. vi. Direct case management with clients by locating and connecting clients to community resources (Food stability, Housing stability, Child Educational needs and support with job search and preparedness. Contractor and the family directly engage in acquiring resources together to support self -efficacy and the family's ability to sustain. vii. Indirect case management by researching and locating appropriate resources for the family. Contractor's advocates and arranges resources for the family through resource location and collaborates with the client and the client's team to meet client's needs. 7 b. Anticipated Frequency of Services: i. Direct service time five (5) hours per week up to twenty (20) hours a month. c. Anticipated Duration of Services: i. Thirty (30) to sixty (60) days. d. Goals of Services: i. These services provide placement stabilization to include psycho education, needs assessment and attainment for household safety and sustainability, community resourcing and connecting, life skills development, transition and adjustment support for reunification of family members, and positive parenting skills. ii. Specific goals are: 1. Prevention - to prevent the removal of children from their current placement and/or prevent out of home placement. 2. Reunification - to support the successful and sustainable reunification of families/placements up to two weeks prior to return home to support transition and stabilization of the placement. 3. Positive parent child engagement - to assess and provide trauma informed psychoeducation and tools for families at a developmentally appropriate level in order to build safe and sustainable homes and family engagement. iii. Application of Evidence Based Programs included on the Federal FFPSA Clearinghouse will be utilized with the goal of maintaining children in their homes/ communities. e. Outcomes of Services: i. This service is a prevention and reunification service designed to achieve: 1. Mitigating out of home placement or removal of children from the home to support FFPSA. 2. Secure safety and stability in the home setting. 3. Identify and address immediate needs in the household, while connecting families with essential community resources and supports to obtain and sustain self -efficacy. 4. Provide FFPSA evidence -based practice model tools to families to mitigate a disruption of placement based on individualized behaviors and barriers in the home while promoting healthy and safe parent -child interactions. 5. Communicate with County in the interest of the family. f. Target Population: i. Families with children that are in stages of reunification/placement transition. ii. Families at risk of removal of the child/children from the home. g. Language: i. English and Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Service will be provided primarily in the client's home. ii. In the community. Terms 8 1. Contractor will respond to the Quality Assurance Team (HS-CWQualitvAssurance(a,weldgov.com within three (3) business days regarding the ability to accept the received referral. 2. 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 Quality Assurance Team HS- CWQualityAssurance@weldgov.com. 3. 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 D, 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", or up to two (2) hours, 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 Quality Assurance Team HS-CWQualitvAssurance(aweldgov.com within three (3) days of when the client is placed on a behavioral plan or discharged. 4. 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 Quality Assurance Team HS-CWQualitvAssurance(&weldgov.com immediately via email, to discuss service continuation. 5. 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. 6. 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 Quality Assurance Team HS-CWQualityAssurance(a,weldgov.com immediately AND on the required monthly report. 7. 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. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation 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. 9. 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 Quality Assurance Team, and the facilitator documents in the 9 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 Child Welfare Contract and Services Coordinator. Contractor may participate by phone or virtually, if approved by the Department. 10. On a monthly basis, the Contractor will notify the Quality Assurance Team HS- CWQualityAssurance(&,weldgov.com of new staff who 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. 10 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 specific in Paragraph 2, below. 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. 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 Therapeutic Parenting Time Program Rate Unit Type Service Name $112.00 Hour In-officeNideo $168.00 Hour In -Office with Transportation $168.00 Hour In -Home or Community $93.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $60.00 Each No Show $0.57 Mile For distances exceeding 30 roundtrip miles from Contractor's closest office or the employee's home, whichever is closer to the parenting time location. Supervised Parenting Time Rate Unit Type Service Name $79.00 Hour In-office/Video $120.00 Hour In -Office with Transportation $120.00 Hour In -Home or Community $93.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $60.00 Each No Show $0.57 Mile For distances exceeding 30 roundtrip miles from Contractor's closest office or the employee's home, whichever is closer to the parenting time location. Parent Coaching Rate Unit Type Service Name $95.00 Hour In-officeNideo $115.00 Hour In -Home or Community Mental Health Services Rate Unit Type Service Name $130.00 Hour In-officeNideo $130.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $65.00 Each No Show Crisis Intervention and Stabilization Services Rate I Unit Type I Service Name $1,300.00 Month Stabilizing Teens and Youth in home (STAY)- At Risk — Ten (10) hours per month. $2,600.00 Month Stabilizing Teens and Youth in home (STAY)- High Risk — Twenty (20) hours per month. $4,000.00 Month Stabilizing Teens and Youth in home (STAY)- Imminent Risk — Thirty (30) hours per month. Aftercare Services Rate Unit Type Service Name $2,300.00 Month Aftercare Support Services and Engagement Team (ASSET) — up to twenty (20) hours per month. 3. Submittal of Vouchers 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 . 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. 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. For ongoing services, proof of services rendered shall be a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. When submitting a request for payment 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. 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 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) ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: Maple Star Colorado Provider Contact Full Name: Heather Morris 303-564-2595 Primary Phone Number (10 -digit): Primary Contact Email: Trails Provider ID (if known): 90967 Title: Executive Director Ext.: Fax Number (10 -digit): heather.morris@pathways.com Web Address: www.maplestar.net 2250 5. Oneida St., suite 200 Denver CO80224 Agency Location Address (Street, city, state, zip): Agency Mailing Address (Street, city, state, zip): same Agency Type (pick one): ri Public Company ri Private Non -Profit ri Private for Profit Send Referrals for Service to: Pat Pisano Referral Contact Name: 970-413-3296 Referral Phone Number (10 -digit): Ext.: Title: No Colo Supervisor Email: patricia.pisano@pathways.com Billing Contact Billing Contact Name: Heather Childs Billing Phone Number (10 -digit): 540-710-8140 Title: Revenue Cycle Management Specialist Ext.: Email: heather.childs@pathways.com CERTIFICATION II 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 1 Department of Human Services, and comply with all requirements of the contract, if awarded. I▪ The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to 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 i Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are icompetitive in price and quality. WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. Heather Morris Executive Director ( Authorized Rep. Full Name: Title: jheather.morris@pathways.com Authorized Rep. Email: 2250 S. Oneida St., suite 200 Denver CO80224 Authorized Rep. Address (Street, cij scare, zip): ISignature of Authorized Rep.: 303-564-2595 Phone (10 -digit): Ext.: Date: 01-28-22 REV. DECEMBER 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Maple Star Colorado Program Area: Life Skills 1 Number of services offered on this Attachment C (max 5): ( 2 Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Therapeutic Parenting Time Program 2.1a Modalities, curriculum, tools used in delivery of service DO NOT list ..._,_.. �..(__. company history; DO use bullet points): • All services provided by Masters level staff under the direction of a Licensed Clinician. • Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. • Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on -staff MI trainer to maintain 100% staff training and model fidelity. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families, trauma informed teachings based on research of Karyn Purvis, Daniel Seigel, Bruce Perry. • Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. • Culturally- responsive and holistic interventions 2.1b 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: • Frequency is as authorized by Weld County dependent on the individual needs of the family - generally 1-4 hours per encounter • No maximum weekly hours per family are established by Maple Star. Services are provided according to County authorization. • Scheduling/ availability must take in to account Colorado Labor laws requiring a 30 -minute lunch/rest period after 5 hours of work. 2.1c Anticipated duration of service (i.e. 3-4 months): • Services will initially be scheduled for 45-90 days dependent on the level of service authorized. • In accordance with the Maple Star staff intake evaluation and the required referral information provided by Weld County at the time of referral, the appropriate duration of service will be determined and regularly reviewed. • Weld County will coordinate staffing required to reauthorize per this contract. All Authorizations will remain in effect and subject to billing until formal notification of service termination is received by Weld County. Maple Star will monitor service authorization periods and document these in communications with the Department. 2.1d Three (3), or more, specific goals of the service (DO use bullet points) • Support parents in connection with their child, • Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts • Decreasing the level of service 2.1e Three (3), or more, specific outcomes of service: • Progress by visiting parents on goals collaboratively established with family during intake by Maple Star and by Case Worker REV. OCT 2021 1 ATTACHMENT C - PROPOSAL • Progress by families from higher to lower level of Parenting Time intervention with the goal being unmonitored and reunification. • Fewer required supervised contact hours between a parent and child. 2.1f Target population of the service, including age and gender: Maple Star Parenting Time Program Services work with children ages 0-18 and their visiting parent/ family member. Our area of expertise is trauma informed care, but additional training/ consultation for visitation personnel may be provided by Maple Star's Domestic Violence program's DVOMB certified supervisor. 2.1g Languages service is available in (please list proficiency and if Interpreter services are available): English Spanish - Maple Star endeavors to recruit and employ individuals representative of the community within which we are providing services. 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Parenting Time services are not Medicaid billable 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) Parenting Time sessions may be provided at any of the 4 Maple Star offices located along the front range, including Loveland, Denver, Colorado Springs and Pueblo, at Weld County sites, in the community, or in the family home. Once reunification has occurred, the services may extend to the family home in the form of Parent Coaching, if contracted by Weld County. 2250 5. Oneida, Ste. 200, Denver, CO 80224 I T: (303) 433-1975 F: (303) 433-1980 1465 N. Union Blvd., Suite 102, Colorado Springs, CO 80909 I T: (719) 694-8037 F: (719) 445-0841 635 W. Corona Ave., Suite 209, Pueblo, CO 81005 1728 Topaz Drive, Loveland, CO 80537 Service #2 Name: Supervised Parenting Time Program 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): • All services provided by Bachelor level staff and supervised by a Maple Star supervisor, under the direction of a Licensed Clinician • Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. • Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has n on -staff MI trainer to maintain 100% staff training and model fidelity. • Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. • Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. 2.2b 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: • Frequency is as authorized by Weld County dependent on the individual needs of the family - generally 1- 4 hours per encounter • No maximum weekly hours per family are established by Maple Star. Services are provided according to County authorization. • Scheduling/ availability must take in to account Colorado Labor laws requiring a 30 -minute lunch/rest period after 5 hours of work. 2.2c Anticipated duration of service (i.e. 3-4 months): • Services will initially be scheduled for 45- 90 days dependent on the level of service authorized. • In accordance with the Maple Star staff intake evaluation and the required referral information provided by Weld County at the time of referral, the appropriate duration of service will be determined and regularly reviewed. • Weld County will coordinate staffing required to reauthorize per this contract. All Authorizations will remain in effect and subject to billing until formal notification of service termination is received by Weld County. Maple Star will monitor service authorization periods and document these in communications with the Department. REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.2d Three (3), or more, specific goals of the service (DO use bullet points): • Support parents in connection with their child, • Learning and implementing positive parenting skills including understanding of trauma and it developmental impacts • Decreasing the level of service 2.2e Three (3), or more, specific outcomes of service: • Progress by visiting parents on goals collaboratively established with family during intake by Maple Star and by Case Worker • Progress by families from higher to lower level of Parenting Time intervention with the goal being unmonitored and reunification. • Fewer required supervised contact hours between a parent and child. 2.2f Target population of the service: Maple Star Parenting Time Program Services work with children ages 0-18 and their visiting parent/ family member. Our area of expertise is trauma informed care, but additional training/ consultation for visitation personnel may be provided by Maple Star's Domestic Violence program's DVOMB certified supervisor. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish - Maple Star endeavors to recruit and employ individuals representative of the community within which we are providing services. 2.2h 2.2i Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Parenting Time services are not Medicaid billable w Service location — list where the service will take place (i.e. client's home, in -office, other) Parenting Time sessions may be provided at any of the 4 Maple Star offices located along the front range, including Loveland, Denver, Colorado Springs and Pueblo, at Weld County sites, in the community, or in the family home. Once reunification has occurred, the services may extend to the family home in the form of Parent Coaching, if contracted by Weld County. 2250 S. Oneida, Ste. 200, Denver, CO 80224 I T: (303) 433-1975 F: (303) 433-1980 1465 N. Union Blvd., Suite 102, Colorado Springs, CO 80909 I T: (719) 694-8037 F: (719) 445-0841 635 W. Corona Ave., Suite 209, Pueblo, CO 81005 1728 Topaz Drive, Loveland, CO 80537 Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b 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: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) REV. OCT 2021 3 ATTACHMENT C - PROPOSAL Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b 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: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b 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: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: IN YES ❑ NO 3.4 How many miles are you willing to travel round trip? List a specific number of ! 30 Miles miles. 3.5 When you calculate mileage, what is your starting point address? Maple Star's closest office or the employee's home, whichever is closer to the parenting time location. All efforts are made to assign personnel based on service location. REV. OCT 2021 4 ATTACHMENT C - PROPOSAL SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Therapeutic Parenting Time Program $ Amount Unit Type 4.1a In-Office/Video: 112.00 per Hour 4.1b In -Office with Transportation: 168.00 per Hour No. of roundtrip miles included in rate: 30 miles In -Home or Community: 168.00 per Hour No. of roundtrip miles included in rate: 30 miles 4.1c FTM, TDM, Prof. Staffing: 120.00 per Hour 4.1d No show: 60.00 per No Show 4.1e Mileage rate: 0.57 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Supervised Parenting Time Program $ Amount Unit Type 4.2a In-Office/Video: 79.00 I per Hour 4.2b In -Office with Transportation: 120.00 1 per Hour No. of roundtrip miles included in rate: 30 miles 4.2c In -Home or Community: 120.00 per Hour No. of roundtrip miles included in rate: 30 miles 4.2d FTM, TDM, Prof. Staffing: 120.00 per Hour 4.2e No show: 60.00 per No Show 4.2f Mileage rate: 0.57 per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: L Parent Coaching 1:1- 15 minute increments $ Amount Unit Type 4.3a In-Office/Video: 95.00 per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: 115.00 per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: I per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: ; per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: I per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: i per No Show REV. OCT 2021 5 ATTACHMENT C - PROPOSAL 4.5f Mileage rate: j ( per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 4.8 Home Study Providers — List your rates in the box below. Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. OCT 2021 6 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Maple Star Colorado Program Area: Mental Health Services Number of services offered on this Attachment C (max 5): ; 1 Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Mental Health Services- Office Based 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - All services provided by licensed Clinicians or DORA registered Master's level psychotherapists supervised by a Licensed CNnicians. - Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice - Maple Star Colorado employees a TBRI practitioner to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Maple Star Colorado team members are trained. Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice Maple Star Colorado employees 5 MI trainers to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Maple Star Colorado team members are trained. Diagnosis and Treatment Planning - PHQ-9 depression scale Columbia Suicide Severity Rating Scale - Trauma Informed Parenting by National Traumatic Stress Network (www.nctsn.com) - Culturally- responsive and holistic interventions - Traditional as well as non-traditional clinical expertise (mindfulness, mind -body, rhythmic movement, experiential therapy, art therapy, & dance/movement therapy). 2.1b 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: I 1-2 50 -minute sessions per week as clinically indicated using telehealth or in an office -based setting, at Maple Star Northern Colorado Hub- 1728 Topaz, Loveland, CO). This would encompass the client/family treatment. If additional service hours are indicated and approved by treatment team, they may be made available via telehealth or office visits. Frequency and duration would be as requested by Department and determined to be clinically appropriate, and medically necessary through clinical intake and treatment planning process. This would be agreed upon at the beginning of the treatment episode as well as ongoing. 2.1c Anticipated duration of service (i.e. 3-4 months): Maple Star Mental Health services will continue as long as clinically indicated and until treatment goals are met. This will also be a collaborative decision with the Department. Treatment goals and progress will be evaluated every 30 days, and treatment plans revised every 90 days or as needed. Length of treatment will be driven by these indicators collaboratively. On average length of service is 90-180 days. 2.1d Three (3), or more, specific goals of the service (DO use bullet points) • Provide stabilization, trauma informed interventions, diagnosis and treatment planning to address trauma and identified mental health issues. REV. OCT 2021 1 ATTACHMENT C - PROPOSAL • Increase understanding of the impact of trauma on mental health and support to caregiver with regards to hands on techniques and approaches they may apply in their home. • Support parents and clients with communication, intervention, and teaching coping skills. • Support the family with potential crisis situations through 24/7 phone support. • Serve as an advocate to families as appropriate, i.e., school, probation, or other needed services. • Transition cases to lower level intervention as indicated. 2.1e Three (3), or more, specific outcomes of service: Increase caregiver's understanding of mental health diagnoses, the impact of trauma and increase their ability to practice client -centered, relationship -based interactions with the child/ adolescent. Increase positive parent child interactions. Achievement of clients' individualized treatment goals 2.1f Target population of the service, including age and gender: Children and Adolescents in conjunction with family therapy 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English. Will endeavor to recruit bilingual Spanish speaking Clinician if contract awarded. 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Some Mental Health services may be eligible to be billed to Medicaid. All Medicaid billable services would be billed to Medicaid first and core services dollars only accessed as payor of last resort. Maple Star Colorado is enrolled as a Medicaid provider and is currently credentialed with CCHA and Colorado Sccess. Maple Star is pursuing credentialing and contracts with Northeast Health Partners. 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) Services to be provided primarily in the client's home but may also occur telehealth as indicated. Service #2 Name: 2.2a Modalities, curriculum, tools used In delivery of service (DO NOT list company history; DO use bullet points): 2.2b 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: 2.2c Anticipated duration of service (i.e. 3-4 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b 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: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.31 Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: _ 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b 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: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (Tease list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location list where the service will take place (i.e. client's home, in -office, other) Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b 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: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. __.... client's home, in -office, other) Section 3 — Service Access and Transportation REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ❑ YES ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? N/A El NO NO SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Mental Health Services — office based I $ Amount Unit Type 4.1a In-Office/Video: 130 per Hour 4.1b In -Office with Transportation: = N/A per Hour No. of roundtrip miles included in rate: miles In -Home or Community: N/A per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: 130 per Hour 4.1d No show: 65 per No Show 4.1e Mileage rate: N/A I per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: I I $ Amount Unit Type 4.2a In-Office/Video: I per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: per Hour per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: I per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: { per Hour 4.3e No show: j per No Show 4.3f Mileage rate: ' per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: 1 per Hour 4.4b In -Office with Transportation: i per Hour No. of roundtrip miles included in rate: miles In -Home or Community: ! per Hour No. of roundtrip miles Included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.4e Mileage rate: I i per Mile This is paid after the miles listed above. 4.5 Hourly 4.5a 4.5b 4.5c 4.5d 4.5e 4.sf Service #5 Name: t $ Amount m Unit Type per Hour per Hour No. of roundtrip miles included in rate: per Hour No. of roundtrip miles included in rate: per Hour per No Show per Mile This is paid after the miles listed above. miles miles In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: L. 4.6 Monthly Service Rates (each level must be listed): 1 Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home 4.8 Monitored Study Providers — List your rates in the box below. below. Sobriety Providers — List your rates in the box Provider special notes: REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area• Crisis Intervention and Stabilization Services n Program Areas are listed i column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Maple Star Colorado Number of services offered on this Attachment C (max 5): 3 SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Stabilizing Teens and Youth in home (STAY)- At Risk 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): All services provided by Bachelor level staff and supervised by a Maple Star supervisor. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on - staff MI trainers to maintain 100% staff training and model fidelity. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Maple Star and the family directly engage in acquiring resources together. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Maple Star advocates and arranges resources g family arranging and starting use of resources. for the family through resource location and connections with the 2.1b 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: Frequency of service is dictated by case acuity as determine by the County in the referral. The hours indicted below reflect those direct (in-person/virtual) engagement with the family. Supportive indirect service hours would accompany those direct hours of service noted in the level of service below in support of goal attainment. It is anticipated for indirect service hours to be from 50-75% of direct service hours. Indirect services include community resource development, community resource consultation, and facilitation of linkages to continue after STAY services have completed. These intensive and crucial ongoing community engagement activities will be critical to sustained family preservation to avoid out of home placement. If family engagement is limiting hours of direct service, consultation will be done with County Case Worker to improve engagement or determine case closure. If case closure occurs due to parent lack of engagement, prorated monthly billing for days from referral acceptance/first engagement attempt to case closure would be billed based on (Case rate x 12 months/365 days). If a family is experiencing higher levels of service needs than At Risk's maximum of 10 hours of direct (in-person/virtual), Maple Star would request a staffing for increasing of level to appropriate service supports. Maple Star is proposing the At Risk Level with On -Call crisis support management. On -Call Support: To maintain a 24/7 support system for families, Maple Star would manage this through our staff and supervisor teams. Note: Based on CO employment law, this does require payment of staff during On -Call coverage. At Risk Level: Maple Star will provide up to 10 hours per month at this level of service. Service hours are inclusive of scheduled and On -Call support hours utilized in the period. We will respond to referrals with initial family contact (in- person/virtual) within 48 hours of referral acceptance. Ongoing crisis intervention would primarily be responded to by phone/virtual supports on a 24 hour basis with a crisis plan developed or connection to appropriate local resources for immediate supports if phone/virtual supports are not successful. After crisis is stabilized through phone/virtual or local supports, Maple Star will make a call within 24 hours to follow up on the status of the family and determine further supports needed and potential in -person response. REV. OCT 2021 1 ATTACHMENT C - PROPOSAL 2.1c Anticipated duration of service (i.e. 3-4 months): Services are designed based on levels of intervention which drive the service hours on a per month basis. As a prevention service designed to avoid children being removed from their home, this service supports goals as outlined by FFPSA. The level of duration for a case is anticipated to be 1-3 months and may include a combination of service #1, #2, and #3 as outlined in each of those sections included in proposal. As an example of case progression, Maple Star would anticipate the following progressions (Note: these are examples and cases may move up or down dependent on individual case circumstances and in collaboration with County Case Worker). Imminent Risk Level equaling 1 month of service with movement to High Risk or At Risk for the following month. High Risk Level equaling 1 month of service with movement to At Risk for the following month. At Risk Level equaling 1-2 months of service to reach goals in the case. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): This service is a prevention support service designed to achieve: - Maintaining children in home to support FFPSA Secure safety in the home setting Identify and address immediate needs in the household Engage family with essential community resources - Communicate with County in the interest of the family 2.1e Three (3), or more, specific outcomes of service: - Maintain a safe and secure placement to prevent out of home placement and support FFPSA goals Referral reasons are mitigated Connected to sustainable Family/Community resources 2.1f Target population of the service, including age and gender: Families with children ages 0-17 with a risk of removal from home. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English 2.1h Medicaid is eligible.they the service is eligible for Medicaid in whole or in part AYs not Medicaid If Clinical services with Maple Star are added on as a separate service, we are Medicaid eligible. 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) Services are provided primarily in the home but may be provided in the community or via telehealth, as Indicated Service #2 Name: Stabilizing Teens and Youth in home (STAY)- High Risk 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - All services provided by Bachelor level staff and supervised by a Maple Star supervisor with access to Licensed supervisors or directors as needed. - Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on - staff MI trainer to maintain 100% staff training and model fidelity. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Maple Star and the family directly engage in acquiring resources together. - Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Maple Star advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources 2.2b 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: Services are designed based on levels of intervention which drive the service hours on a per month basis. As a prevention service designed to avoid children being removed from their home, this service supports goals as outlined by FFPSA. The level of duration for a case is anticipated to be 1-3 months and may include a combination of service #1, #2, and #3 as REV. OCT 2021 2 ATTACHMENT C - PROPOSAL outlined in each of those sections included in proposal. As an example of case progression, Maple Star would anticipate the following progressions (Note: these are examples and cases may move up or down dependent on individual case circumstances and in collaboration with County Case Worker). Imminent Risk Level equaling 1 month of service with movement to High Risk or At Risk for the following month. High Risk Level equaling 1 month of service with movement to At Risk for the following month. At Risk Level equaling 1-2 months of service to reach goals in the case. 2.2c Anticipated duration of service (i.e. 3-4 months): Frequency of service is dictated by case acuity as determine by the County in the referral. The hours indicted below reflect those direct (in-person/virtual) engagement with the family. Supportive indirect service hours would accompany those direct hours of service noted in the level of service below in support of goal attainment. It is anticipated for indirect service hours to be from 50-75% of direct service hours. Indirect services include community resource development, community resource consultation, and facilitation of linkages to continue after STAY services have completed. These intensive and crucial ongoing community engagement activities will be critical to sustained family preservation to avoid out of home placement. If family engagement is limiting hours of direct service, consultation will be done with County Case Worker to improve engagement or determine case closure. If case closure occurs due to parent lack of engagement, prorated monthly billing for days from referral acceptance/first engagement attempt to case closure would be billed based on (Case rate x 12 months/365 days). If a family is experiencing higher levels of service needs than High Risk's maximum of 20 hours direct (in-person/virtual), Maple Star would request a staffing for increasing of level to appropriate service supports. Maple Star is proposing the High-isk Level with On -Call crisis support management. On -Call Support: To maintain a 24/7 support system for families, Maple Star would manage this through our staff and supervisor teams. Note: Based on CO employment law, this does require payment of staff during On -Call coverage. High Risk Level: Maple Star will provide up to 20- hours per month at this level of service. Service hours are inclusive of scheduled and On -Call support hours utilized in that period. We will respond to referrals with initial family contact (in- person/virtual) within 48 hours of referral acceptance. Ongoing crisis intervention would primarily be responded to by phone/virtual supports on a 24 -hour basis with a crisis plan developed or connection to appropriate local resources for immediate supports if phone/virtual supports are not successful. After crisis is stabilized through phone/virtual or local supports, Maple Star will make a call within 24 hours to follow up on the status of the family and determine further supports needed and potential in -person response. 2.2d Three (3), or more, specific goals of the service (DO use bullet points): This service is a prevention support service designed to achieve: Maintaining children in home to support FFPSA Secure safety in the home setting Identify and address immediate needs in the household Engage family with essential community resources Communicate with County in the interest of the family 2.2e Three (3), or more, specific outcomes of service: - Maintain a safe and secure placement to prevent out of home placement and support FFPSA goals - Referral reasons are mitigated - Connected to sustainable Family/Community resources 2.2f Target population of the service: Families with children ages 0-17 with a risk of removal from home. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: STAY is not Medicaid eligible. If Clinical services with Maple Star are added on as a separate service, we are Medicaid eligible. 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Services are provided primarily in the home but may be provided in the community or via telehealth, as indicated Service #3 Name: Stabilizing Teens and Youth in home (STAY)- Imminent Risk 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): All services provided by Bachelor level staff and supervised by a Maple Star supervisor. Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has on - staff MI trainers to maintain 100% staff training and model fidelity. Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. Maple Star Parent assessment scale: Provides observational feedback and engagement with parents. Direct/virtual family service with Parent/child engagement, Parent Coaching, Parent skill building, and child resilience among activities. Direct case management with family by locating and linking family to community resources (Food stability, Housing stability, Child Educational needs and other ongoing resources after services end). Maple Star and the family directly engage in acquiring resources together. Indirect case management by facilitating through community resource involvement with the family (Parent support groups, Substance abuse groups, Domestic Violence supports, and others). Maple Star advocates and arranges resources for the family through resource location and connections with the family arranging and starting use of resources 2.3b 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: Frequency of service is dictated by case acuity as determine by the County in the referral. The hours indicted below reflect those direct (in-person/virtual) engagement with the family. Supportive indirect service hours would accompany those direct hours of service noted in the level of service below in support of goal attainment. It is anticipated for indirect service hours to be from 50-75% of direct service hours. Indirect services include community resource development, community resource consultation, and facilitation of linkages to continue after STAY services have completed. These intensive and crucial ongoing community engagement activities will be critical to sustained family preservation to avoid out of home placement. If family engagement is limiting hours of direct service, consultation will be done with County Case Worker to improve engagement or determine case closure. If case closure occurs due to parent lack of engagement, prorated monthly billing for days from referral acceptance/first engagement attempt to case closure would be billed based on (Case rate x 12 months/365 days). Maple Star is proposing the Imminent Risk Level with On -Call crisis support management. On -Call Support: To maintain a 24/7 support system for families, Maple Star would manage this through our staff and supervisor teams. Note: Based on CO employment law, this does require payment of staff during On -Call coverage. Imminent Removal Level: Maple Star will provide up to 30 hours direct (in-person/virtual) at this level of service. Service hours are inclusive of scheduled and On -Call support hours utilized in that period. We will respond to referrals with initial family contact (in-person/virtual) within 2 hours of referral acceptance when immediate safety concerns exist and the referring County Case Worker joins this contact. For cases without immediate safety concerns or County Case Worker availability for first contact, we will engage the family within 48 hours of referral. Ongoing crisis intervention would primarily be responded to by phone/virtual supports on a 24 hour basis with a crisis plan developed or connection to appropriate local resources for immediate supports if phone/virtual supports are not successful. After crisis is stabilized through phone/virtual or local supports, Maple Star will make a call within 24 hours to follow up on the status of the family and determine further supports needed and potential in -person response. 2.3c Anticipated duration of service (i.e. 3-4 months): Services are designed based on levels of intervention which drive the service hours on a per month basis. As a prevention service designed to avoid children being removed from their home, this service supports goals as outlined by FFPSA. The level of duration for a case is anticipated to be 1-3 months and may include a combination of service #1, #2, and #3 as outlined in each of those sections included in proposal. As an example of case progression, Maple Star would anticipate the following progressions (Note: these are examples and cases may move up or down dependent on individual case circumstances and in collaboration with County Case Worker). Imminent Risk Level equaling 1 month of service with movement to High Risk or At Risk for the following month. High Risk Level equaing 1 month of service with movement to At Risk for the following month. At Risk Level equaling 1-2 months of service to reach goals in the case. 2.3d Three (3), or more, specific goals of the service (DO use bullet points): This service is a prevention support service designed to achieve: Maintaining children in home to support FFPSA Secure safety in the home setting Identify and address immediate needs In the household Engage family with essential community resources Communicate with County in the interest of the family REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 2.3e Three (3), or more, specific outcomes of service: - Maintain a safe and secure placement to prevent out of home placement and support FFPSA goals - Referral reasons are mitigated - Connected to sustainable Family/Community resources 2.3f Target population of the service: Families with children ages 0-17 with a risk of removal from home. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: STAY is not Medicaid eligible. If Clinical services with Maple Star are added on as a separate service, we are Medicaid eligible. 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Services are provided primarily in the home but may be provided in the community or via telehealth, as indicated Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b 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: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b 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: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO ® YES ❑ NO ® YES ❑ NO 3.4 How many miles are you willing to travel round trip? List a specific number of ` 30 Miles miles. 3.5 When you calculate mileage, what is your starting point address? Maple Star's closest office or the employee's home, whichever is closer to the client service location. All efforts are made to assign personnel based on service location. SECTION 4 All rates need to include administrative work Rates cannot be per episode, except for - SERVICE RATES (i.e. scheduling or report writing) and overhead. home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted • For hourly rates complete • For monthly rates complete • For Home study providers • For monitored sobriety testing for services, except for those listed above. section(s) 4.1-4.5. section 4.6. complete section 4.7. providers complete section 4.8. 4.1 Hourly Service #1 Name: Ij $ Amount Unit Type per Hour per Hour per Hour per Hour p 4.2 Hourly Service #2 Name: $ Amount 4.2a In-Office/Video: r Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.2b In -Office with Transportation: f ' 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: 4.3 Hourly Service #3 Name: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.3a In-Office/Video: i _ 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: I 4.3e No show: ` 4.3f Mileage rate:: 4.4 I Hourly Service #4 Name: 1 $ Amount Unit Type REV. OCT 2021 6 ATTACHMENT C - PROPOSAL 4.4a In-Office/Video: 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Prof. Staffing: 4.4d No show: 4.4e Mileage rate: per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.5 Hourly Service #5 Name: I $ Amount 4.5a In-Office/Video: 4.5b In -Office with Transportation: 4.5c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: Unit Type per Hour per Hour per Hour i per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): 4.6e 4.6f 4.6g 4.6h 4.6i Service Name with Level Rate per Month No. of Direct Service Hours: Stabilizing Teens and Youth in home (STAY)- At Risk 1300.00 10 hours per month Stabilizing Teens and Youth in home (STAY)- High Risk 2600.00 20 hours per month Stabilizing Teens and Youth in home (STAY)- Imminent Risk 4000.00 30 hours per month 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: REV. OCT 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Maple Star Colorado Program Area: Aftercare Services Program Areas are listed in column 1 of the table located in Item Xl of the Request for Proposal starting on page .13. Number of services offered on this Attachment C (max 5): You may complete another Attachment C if you have more than 5. 1 SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Aftercare Support Services and Engagement Team (ASSET) 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): • All services provided by Bachelor level staff and supervised by a Maple Star supervisor under the direction of licensed clinician. • Trauma Based Relational Intervention (TBRI)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has an on -staff TBRI trainer to maintain 100% staff training and model fidelity. • Motivational Interviewing (MI) — FFPSA clearinghouse recognized Evidence Based Practice. Maple Star has n on -staff MI trainer to maintain 100% staff training and model fidelity. • Curricula used in Parent engagement: Hands on Parenting, Trauma Informed Parenting (by NCTSN), Strengthening Families. • Direct and virtual family service with Parent/child engagement and problem solving, Parent Coaching, Parent skill building, psychoeducation of developmentally appropriate child engagement and intervention. • Direct case management with clients by locating and connecting clients to community resources (Food stability, Housing stability, Child Educational needs and support with job search and preparedness. Maple Star and the family directly engage in acquiring resources together to support self -efficacy and the family's ability to sustain. • Indirect case management by researching and locating appropriate resources for the family. Maple Star advocates and arranges resources for the family through resource location and collaborates with the client and the client's team to meet client's needs. 2.1b 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: Direct service time with clients to meet a minimum of S hours per week up to 20 hours a month. 2.1c Anticipated duration of service (i.e. 3-4 months): Duration of services will be held over a period of 30 days with the option of an additional referral for a second 30 days of services as agreed upon by the treatment team. Services will be provided to clients at a minimum of two contacts per week. Referral for services will start with a 30 -day authorization and a staffing scheduled prior to closure of the referral. Collaboration between ASSET staff, client and County Case Worker will determine the need for another 30 days of services. The collaborative determination of extension to a 60 -day length of service will be based on client needs and progress towards goals or permanency and sustainability. Indirect service hours will be utilized to support staffing with the County, locating additional supports and advocacy opportunities for the clients, and providing other indirect case management services to support the overall efficiency and outcome success of the placement. If the family fails to engage, Maple Star will consult with County Case Worker within the first 7 days of the referral acceptance to discuss potential closure. If a closure is determined by the County Case Worker, a prorated payment will be made based on (Month Case Rate x 12 months/365 days) from the date of referral acceptance to the date of case closure. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): REV. OCT 2021 1 ATTACHMENT C - PROPOSAL These services provide placement stabilization to include psycho education, needs assessment and attainment for household safety and sustainability, community resourcing and connecting, life skills development, transition and adjustment support for reunification of family members, and positive parenting skills. Our goals our as follows: • Prevention- to prevent the removal of children from their current placement and/or prevent out of home placement. • Reunification- to support the successful and sustainable reunification of families/placements up to two weeks prior to return home to support transition and stabilization of the placement. • Positive parent child engagement- to assess and provide trauma informed psychoeducation and tools for families at a developmentally appropriate level in order to build safe and sustainable homes and family engagement. Application of Evidence Based Programs included on the Federal FFPSA Clearinghouse will be utilized with the goal of maintaining children in their homes/ communities. 2.1e Three (3), or more, specific outcomes of service: This service is a prevention and reunification service designed to achieve: • Mitigating out of home placement or removal of children from the home to support FFPSA • Secure safety and stability in the home setting • Identify and address immediate needs in the household, while connecting families with essential community resources and supports to obtain and sustain self -efficacy. • Provide FFPSA evidence -based practice model tools to families to mitigate a disruption of placement based on individualized behaviors and barriers in the home while promoting healthy and safe parent -child interactions. • Communicate with County in the interest of the family 2.1f Target population of the service, including age and gender: These services will be provided to families with children that are in stages of reunification/placement transition. As well as families at risk of removal of the child/children from the home. Prevention services will be provided to families with children that remain with the caregivers but are at risk of removal due to safety concerns or other situations identified by the county that could disrupt placement. Reunification services will be provided to families that either have recently been reunified or will be reunified within two weeks. While these services are provided to homes at risk of prevention and in the process of reunification. They can additionally serve families that are receiving or closing with other Maple Star services as a means of providing a best practice form of continuum and continuity of care. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English/ Spanish 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No. This is a Core funded program. 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) Services to be provided primarily in the client's home but may also occur in the community. Service #2 Name: 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.2b 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: 2.2c Anticipated duration of service (i.e. 3-4 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: 2.2g Languages service is available in (please list proficiency and if interpreter services are available): • REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (he. client's home, in -office, other) v_ Service #3 Name: L 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b 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: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b 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: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b 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: 2.5c Anticipated duration of service (i.e. 3-4 months): REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e 2.5f 2.5g Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 - Service Access and Transportation Will you charge Weld County for transporting clients or mileage? Check one: • YES e NO Will you conduct services in a client's home or in the community? Check one: e YES ■ NO Will you transport clients to and/or from services? Check one: ► YES ■ NO How many miles are you willing to travel round trip? List a specific number of ! 30 Miles miles. When you calculate mileage, what is your starting point address? Maple Star's closest office or the employee's home, whichever is closer to the client service location. All efforts are made to assign personnel based on service location. SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: I _ $ Amount Unit Type 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: $ Amount 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: Unit Type per Hour per Hour per Hour per Hour I per No Show No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: miles miles REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.2f Mileage rate: I I per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included In rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: — I $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: ; per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrlp miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: 4.5f Mileage rate: I per No Show per Mie This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level I Rate per Month No. of Direct Service Hours: 4.6a ASSEST 2300.00 up to 20 service hours 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers - List your rates in the box below. 4.8 Monitored Sobriety Providers - List your rates in the box below Provider special notes: REV. OCT 2021 5 EXHIBIT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Heather Morris Maple Star Colorado PHONE NUMBER: 303-564-2595 EMAIL: heather.morris@pathways.com PROPOSED SERVICE(S): After Care, Crisis Intervention and Stabilization Services, Foster Parent Consultation TBD- other staff to be hired according to contract awards Legal Last Name Middle Initial Previous Legal Last Name (If applicable) Legal First Name Service Type Licensure/ Credentials DORA # (If applicable) Bowles Christine Program Director LPC LPC.0014372 Huddlston Maria Program Director LCSW CSW.09927349 Pisano Patricia Northern Region Supervisor BA Hapke Logan Parenting Time Supervisor LPC LPC.0015965 Tucker Sue Msw Liges Amanda BA Martinez Christia MSW Summerfield Amy BA Hardin Helen MSW After Care, Crisis Intervention Foster Parent consultation Parenting time All staff cross trained CHILD WELFARE REQUEST FOR PROPOSAL 2021-22 - VARIOUS SERVICES BID NO. B2100042 ARb® `O CERTIFICATE OF LIABILITY INSURANCE 10/19/2022 DATE (MM/DD/YYYY) 4/14/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Insurance Brokers, LLC 777 S. Figueroa Street, 52nd Fl. CA License #0F15767 Los Angeles CA 90017 (213) 689-0065 ONT NAMEACT PHONE FAX Ext): (A/C, No): E-MAIL - ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Illinois Union Insurance Company 27960 INSURED Maple Star Colorado 1454402 2250 South Oneida Street Suite 200 Denver CO 80224 INSURER B : Zurich American Insurance Company 16535 INSURER C : American Zurich Insurance Company 40142 INSURER D : INSURER E : INSURER F : COVERAGES PYRHO01 CERTIFICATE NUMBER: 18421030 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A X TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY X X CLAIMS -MADE $500,000 SIR X $1M Abusive Act OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY OTHER: $ PRO- JECT LOC ADDL INSD SUBR WVD Y POLICY NUMBER MLP G72547597 001 POLICY EFF (MM/DD/YYYY) 10/19/2021 POLICY EXP (MM/DD/YYYY) 10/19/2022 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) $ 1,000,000 $ 50,000 $ See Below PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 1,000,000 $ 3,000,000 $ 1,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY _ AUTOS ONLY X Scheduled PD Au' os N BAP 2519669-03 10/19/2021 10/19/2022 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ 2,000,000 $ XXXXXXX BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ XXXXXXX Como/Coll DED $ XXXXXXX $ 5,000 C UMBRELLA LIAB EXCESS LIAB DED I I RETENTION $ OCCUR CLAIMS -MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N N/A N NOT APPLICABLE WC 2519668-03 10/19/2021 10/19/2022 EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX X PER STATUTE OTH- ER $ XXXXXXX E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000,000 $ 1,000,000 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Auto Liability deductible is $350,000. Workers' Compensation Deductible is $250,000. Sexual Abuse and Molestation coverage is iicluded under the $1,000,000 Each Abusive Act Limit within the Professional Liability Policy. GL Med Exp.:$5,000/$25K Agg. RE: Board of County Commissioners of Weld County and its Officers/Employees are Additional Insured with respect to liability arising out of the operations of the insured and to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. 30 days notice of cancelation. CERTIFICATE HOLDER CANCELLATION See Attachments 18421030 Weld County 1150O St Greeley CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR © 1 88-201 I C D CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code: D567517 Master ID: 1454402, Certificate ID: 18421030 Weld County 1150O St Greeley, CO 80631 To whom it may concern: In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance, thus, this is your final hard -copy delivery. To ensure electronic delivery for future renewals of this certificate, we need your email address. Please contact us via one of the methods below, referencing Certificate ID 18421030. • Email: PacificeDeliveryAlockton.com • Phone: (213) 689-2300 If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. In the event your mailing address has changed, will change in the future, or you no longer require this certificate, please let us know using one of the methods above. The above inbox and phone number below are for automating electronic delivery of certificates only. Please do NOT send future certificate requests to the above inbox or call into the number below. Thank you for your cooperation and willingness in reducing our environmental footprint. Lockton Insurance Brokers, LLC - Pacific Series Lockton Insurance Brokers, LLC L.ic l.se 40;" i 213-689-0065 i FAX: 213-689-0550 lockton.com Attachment Code: D556818 Certificate ID: 18421030 CHUBB' ADDITIONAL INSURED(S) ENDORSEMENT: WRITTEN CONTRACT, QUARTERLY REPORTING Named Insured Pyramid Health Holdings, LLC Endorsement Number 3 Policy Symbol MLP Policy Number G72547597 001 Policy Period 10/19/2021 to 10/19/2022 Effective Date of Endorsement 10/19/2021 Issued By (Name of Insurance Company) Illinois Union Insurance Company THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies coverage under the following: (Select Applicable Coverage Parts) HEALTHCARE FACILITIES GENERAL LIABILITY COVERAGE PART (CLAIMS MADE) X., GENERAL LIABILITY COVERAGE PART (OCCURRENCE) X, HEALTHCARE FACILITIES PROFESSIONAL LIABILITY COVERAGE PART (CLAIMS MADE) It is agreed that: 1. The Who Is An Insured provision of the applicable Coverage Part(s) selected above shall be amended to include as "insured(s)" any natural person or organization with which the Named Insured has a written contract (i) in effect during the policy period and (ii) executed prior to the "bodily injury", "property damage", "personal or advertising injury" or "professional incident" occurring or being committed, if such written contract requires that this policy include such natural person or organization as an insured hereunder. However, coverage for such "insured" under this endorsement is limited as follows: a. If the Limits of Insurance stated in the Declarations exceed the limits of insurance required by such contract, the insurance provided by this endorsement shall be limited to the limits of insurance required by such written contract. This endorsement shall not increase the Limits of Insurance stated in the Declarations. b. If Professional Liability coverage is selected above, such natural person or organization is an "insured" only for liability arising solely out of "healthcare professional services" performed by you or on your behalf for such "insured" and within the scope of your written contract with such "insured". c. If General Liability coverage is selected above, such natural person or organization is an "insured" only for "bodily injury", "property damage" or "personal or advertising injury" caused by an "occurrence" or offense that was caused solely by: i. you or your "employees" acting on your behalf; and ii. performed on behalf of such "insured" and within the scope of your written contract with such "insured". d. Where no coverage shall apply herein for the Named Insured, no coverage or defense shall be afforded to such "insured". e. It is a condition precedent to coverage hereunder that all such organizations and written contracts be reported in writing to us on a quarterly basis during each calendar year. 2. If the General Liability Coverage Part is indicated by a check mark above, the Additional Exclusions section of the General Liability Coverage Part is amended by adding the following directly following paragraph 2b of the Contractual Liability exclusion: PF-50055 (03/i8) Primary FAC (216056) Page l of 2 Attachment Code: D556818 Certificate ID: 18421030 3. Assumed in a contract reported to us on a quarterly basis pursuant to the Additional Insured(s) Endorsement: Written Contract, Quarterly Reporting, Form No.: PF-50055. 3. If the Professional Liability Coverage Part is indicated by a check mark above, the Additional Exclusions section of the Professional Liability Coverage Part is amended by adding the following directly following paragraph 2b of the Contractual Liability exclusion: 3. Assumed in a contract reported to us on a quarterly basis pursuant to the Additional Insured(s) Endorsement: Written Contract, Quarterly Reporting, Form No.: PF-50055. All other terms and conditions of this policy remain unchanged. JOHN J. LUPICA, President Authorized Representative PF-50055 (03/i8) Primary FAC (216056) Page 2 of 2 Attachment Code: D550574 Certificate ID: 18421030 I.iOCKTON® April 14, 2022 Weld County 1150 O St Greeley, CO 80631 Re: Notice of Cancellation Clause To Whom It May Concern: As a service to our valued client, Lockton will provide at least thirty (30) days notice of cancellation to the certificate holder listed on the attached Acord 25 certificate of insurance should any of the policies described on the attached certificate be 1) cancelled by the insurer, other than for non-payment of premium (10 day notice for non-payment/non-reporting), and 2) cancelled more than 30 days prior to the expiration date of the policy (if such cancellation occurs less than 30 days prior to expiration, Lockton will provide as much prior notice as practicable). If notice is mailed, proof of mailing notice to the certificate holder to the postal mailing address as shown in the schedule will be sufficient proof of notice. Thank you and please contact our office if you have any questions. Regards, d.,,d,_..„__. David Burgos Assistant Vice President Lockton Insurance Brokers Contract Form New Contract Request Entity Information Entity Name* D* MAPLE STAR COLORADO O0027042 Contract Name* Contract ID MAPLE STAR COLORADO (NEW CHILD PROTECTION 5848 AGREEMENT) Contract Status CTB REVIEW Contract Lead* APEGG Parent Contract ID 20220410 Requires Board Approval YES Contract L •:g= Email Department Project t apeggwe ldgov. com; cobbx xlkcPweldgov.com Contract Description* CONSENT BID# 82200040 TERM: JUNE 1, 2022 THROUGH MAY 31, 2023 Contract Description 2 PROVIDER WAS USTED ON APPROVED VENDOR LIST PRESNETED TO THE BOCC ON 04,1 06,=22 AND AS A COMMUNICATION ITEM/PA SENT TO CTB ON 05110/2022. Contract Type* AGREEMENT Amount * $0.00 Renewable 2 YES Automatic Renewal Grant ICA ent HUMAN SERVICES Department Email CM - H umanServicesOweldgov. ca m Department H it CM-HumanServices- DeptHeadC wetdgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEY VJELDG OV.COM If this is a rest enter previous Contract ID If this is part of a MSA enter MSA Coil act ID Requested BOCC Age Date* 6.'08,2022 Due Date 06104!2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On8ase Contract Dates Effective Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Purchasing Approver CONSENT Approval Process Department Head JAMIE ULRICH DH Approved Date 05;`20,2022 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05,2512022 Originator APEGG Review Date* 03:31:2023 Committed Delivery Date Contact Type Contact Email Finance Approver CONSENT Renewal Date* 05'31;2022 Expiration Date Contact Phone 1 Contact Phone 2 Purchasing Approved Date 05:20'2022 Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 05:'20,2022 05:20,'2022 Tyler Ref I AG 052522 Hello