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Home My WebLink About20243268.tiffRESOLUTION RE: APPROVE AFFILIATION AGREEMENT FOR DIETETIC STUDENT INTERNSHIP OPPORTUNITIES AND AUTHORIZE CHAIR TO SIGN - KEITH AND ASSOCIATES, INC. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with an Affiliation Agreement for Dietetic Student Internship Opportunities between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Keith and Associates, Inc., commencing upon full execution of signatures, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Affiliation Agreement for Dietetic Student Internship Opportunities between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Keith and Associates, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 11th day of December, A.D., 2024. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: t/) Weld County Clerk to the Board BY:Ottat—nt •WaAdDit-1C Deputy Clerk to the Board APPROVED A ounty Attorney Date of signature: I ZI f"7 Ker!. Ross, Chair erry L. B ck, ro-Tem ott K. James 25744,4„. on Saine cc, Hsi) 0I/2V9-5 2024-3268 HR0096 Corti-vac*lMS BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Affiliation Agreement with Keith & Associates, Inc. DEPARTMENT: Human Services PERSON REQUESTING: Jamie Ulrich, Director, Human Services DATE: November 26, 2024 Brief description of the problem/issue: The Department is requesting to enter into an Affiliation Agreement with Keith & Associates, Inc., to provide dietetic student interns a learning experience by shadowing the Weld County Department of Human Services Senior Nutrition Program Registered Dietitian. This Affiliation Agreement will establish a cooperative relationship between Keith & Associates and the Department of Human Services, as well as outline the responsibilities of each party as they contribute to the learning experience of trainees who benefit from, and participate in, the Keith program in a safe and responsible manner. This Agreement has been reviewed and approved by Legal (B. Howell). What options exist for the Board? Approval of the Affiliation Agreement with Keith & Associates, Inc. Deny approval of the Affiliation Agreement with Keith & Associates, Inc. Consequences: The Department will not have an agreement with Keith and Associates, Inc. Impacts: Keith Trainees will not receive the benefit of a learning experience from shadowing the Senior Nutrition Program Registered Dietitian. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): Total cost = There is no cost associated with this agreement. Recommendation: • Approval of the Affiliation Agreement and authorize the Chair to sign. Suonort 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 mF Pass -Around Memorandum; November 26, 2024 — CMS ID TBD 2024-3268 ZA H19-009 1Oj NUTRITION Affiliation Agreement This AFFILIATION AGREEMENT ("Agreement") is made and entered into as of the I Oil day of Peornbejt , 2024 between Keith & Associates, Inc. an Oklahoma corporation, having a principal place of business 115 W. 3`d Street, Tulsa, Oklahoma 74103 ("Keith") and Weld County Department of Human Services, having a principal place of business at 315 North 11`s Avenue, Greeley, Colorado 80632 ("Affiliated Facility"). PURPOSE The purpose of this Affiliation Agreement is to form an agreement with a facility that is committed to providing desirable dietetics learning experiences and facilities for Keith Trainees enrolled with Keith & Associates Inc. This Affiliation Agreement will establish a cooperative relationship between Keith and the Affiliated Facility and outline the responsibilities of the cooperating parties as they contribute to the teaming experience of Trainees who benefit from, and participate in, the Keith program in a safe and responsible manner. TERMS THEREFORE, in consideration of the mutual promises and agreements contained in this Affiliation Agreement, Keith and the Affiliated Facility agree as follows: I. JOINT RESPONSIBILITIES The performance experiences will cover a period of time agreed on and arranged by Keith faculty supervising the Dietetic Traineeship and preceptors in the Affiliated Facility. The beginning date and length of experience shall be mutually agreed upon prior to the beginning of the affiliation. b. Both parties agree that there shall be no discrimination on the basis of marital status, race, color, ethnicity, sex, age, religion, pregnancy, sexual orientation, gender identity, genetic information, disability, national origin, or status as a U.S. Veteran pertaining to any experiences during the Dietetic Traineeship. c. Keith faculty and the staff of the Affiliated Facility agree to establish performance objectives and experiences, devise methods for their implementation, and determine the effectiveness of these experiences by ongoing methods of evaluation. d. Keith faculty and the staff of the Affiliated Facility agree to maintain communication, cooperate in the development of educational experiences for PH: 910-574-8598 FX:918-585-3047 www.kaddi-internship.com kaddi s consultingdietitians.com 9 115 W. 3r° St. Ste. 802 Tulsa, OK 74103 KA NUTRITION the Dietetic Traineeship and review and evaluate the rules and the regulations necessary for the success of the program in the Affiliated Facility upon request. e. Keith and Affiliated Facility agree to hold harmless each party respectively as well as their officers, agents and employees for any damages including claims, demands, losses, and costs occurring during the course of a required placement in the clinical experience arising out of the negligent acts or omission of either of the parties or any of their agents, officers, or employees. f. Trainees are not employees of either Keith and Associates Inc. or the Affiliated Facility and are not entitled to any employee benefits or compensation of either party which includes not providing Worker's Compensation coverage. If the Affiliated Facility desires that the Trainee be an employee, Keith must be advised of the trainee's status as an employee and that Affiliated Facility will provide Worker's Compensation coverage and any benefits for which the employee is eligible. g. Both parties will instruct their respective faculty, staff, and participating Trainees to maintain confidentiality of student and patient information as required by law, including the Family Educational Rights and Privacy Act (FERPA), and the Health Insurance Portability Accountability Act (HIPAA) and by policies and procedures of Keith and the Affiliated Facility. h. If the Affiliated Facility is a HIPAA Covered Entity pursuant to HIPAA regulations, the Keith Dietetic Trainees are considered part of the Affiliated Facility's workforce as defined in 45 CFR 160.103 because Trainees are trainees under the direct control of the facility even though they are not compensated nor employees of the Affiliated Facility and therefore Trainees are subject to the Affiliated Facility's policy and procedure including Confidentiality of patient records and HIPAA Regulations and it is the responsibility of the Affiliated Facility to train the intern on its specific policy and procedure. If the Affiliated Facility is a HIPAA Covered Entity, it is agreed that Keith is not a "Business Associate" of the Affiliated Facility as that term is defined by HIPAA and its accompanying regulations. Neither Keith nor the Intern is engaged in performing or assisting the Affiliated Facility in performing any of the Business Associate functions that are listed in the HIPAA Regulations, 45 CFR §160.103. The Keith and Associates Distance Dietetic Traineeship program is considered part of "health care operations" under HIPAA Regulations, 45 CFR §164.501. PH: 918-574-8598 FX:918-585-3047 r� www.kaddi-internship.com kaddiconsultingdietitians.com 9 115 W. 3. St. Ste. 802 Tulsa, OK 74103 /I‘ NUTRITION j. Either party may require the immediate withdrawal of any Intern from the clinical area whose conduct has a detrimental effect on patients or personnel of the Affiliated Facility. II. RESPONSIBILITIES OF THE KEITH FACULTY Keith faculty will notify the supervisors in an Affiliated Facility of the planned schedule of Intern assignment to the facility. The Intern's name, previous academic preparation, and length and dates of the planned experience will be provided to the facility before the experience begins. b. Keith faculty will initiate a criminal background check of the Intern assigned to the Affiliated Facility. The result of the criminal background check may be obtained by the Affiliated Facility upon request. If any information is uncovered that would indicate a record of abuse or neglect or a felony conviction, Keith faculty shall notify the Affiliated Facility and decisions may be made that prevent the Intern from direct patient/client/employee access. c. Keith faculty will require the assigned Trainees to comply with the rules and regulations which are applicable to her/his performance in the Affiliated Facility. These would include: i. Following the administrative policies, standards, and practices and regulations, including dress code, of the Affiliated Facility. ii. Providing his or her own transportation and living arrangements while attending the Affiliated Facility. iii.Providing his or her own health and accident insurance and provide documentation of such coverages to the Affiliated Facility upon request. iv. Professional liability insurance coverage is maintained by Keith in the amounts of $ l million individual and $3 million aggregate using an "A" rated company. v. Providing documentation of any health screening reports, immunizations, criminal background checks, liability insurance coverage or similar documentation as requested by the Affiliated Facility. d. The Keith faculty will supply or work with the Affiliated Facility to prepare appropriate forms or arrange conferences that will be used in evaluating the performance of the assigned Intern. PH: 918-574-8598 FX: 918-585-3047 www.kaddi-internship.com kaddis consultingdietitians.com 9 115 W. 3'° St. Ste. 802 Tulsa, OK 74103 4/IDA NUTRITION e. Keith faculty will assign only Trainees to the Affiliated Facility who have satisfactorily completed the designated prerequisites as determined by the curriculum. III. RESPONSIBILITIES OF THE AFFILIATED FACILITY The Affiliated Facility shall provide the Keith with an orientation that includes: a copy of the pertinent rules and regulations with which the Intern is expected to comply, a tour of the facilities where the Intern will be learning, the philosophy of patient care at the Affiliated Facility, and other topics that will allow the Intern a quality learning experience during the Traineeship to the benefit of the Affiliated Facility, Keith and the Intern. b. The Affiliated Facility shall maintain full administrative and supervisory responsibility for the quality of care given patients and maintain administrative responsibility in so far as an Intern's presence affects the operation of the Affiliated Facility and/or direct or indirect care of patients/clients/employees. c. The Affiliated Facility shall provide observational opportunities and practical experiences to benefit the learning of Intern and agrees to adhere to the Traineeship policy that "Students in supervised practice programs shall not routinely replace employees except for planned professional staff experiences." d. The Affiliated Facility shall provide a supervised program of dietetics experience and maintain complete records pertaining to each Intern's performance. Written evaluations will be provided to the Keith faculty using the forms described in II.d. e. Preceptors in the Affiliated Facility will be provided with time to plan, implement, and evaluate the Intern experiences and, when feasible, attend relevant conferences with or about Trainees. f. In the event of an emergency, or other health care or medical needs, the Intern may be treated in the Affiliated Facility if it has an emergency department. If necessary, arrangements for transportation to another medical facility will be made. The cost of transportation and all medical treatment will be borne by the Intern. g. Upon reasonable request by Keith, the Affiliated Facility will permit the inspection of the facilities, services available for learning experiences, Intern's records, and such other items pertaining to the Keith Traineeship programs. 2 PH: 918-574-8598 FX:918-585-3047 www.kaddi-internship.com kaddi4consultingdietitians.cow 9 115 W. a' St. Ste. 802 Tulsa, OK 74103 A /1‘ NUTRITION IV. EFFECTIVE DATE, MODIFICATION, AND TERMINATION This agreement shall be effective January 1, 2025 for a term of one (l) year and will automatically renew for consecutive one-year terms unless earlier terminated by one of the parties. b. This agreement may be revised or modified by written amendment when both parties agree to such amendment. c. This Affiliation Agreement will be terminated 90 days after a written notice to the below named person by registered mail from either party. This agreement may also be terminated by either party for cause after providing the other party 30 days to cure the deficiency in performance under this Affiliation Agreement. Any Intern currently placed with an Affiliated Facility shall be permitted to complete the placement unless the Intern is personally responsible for the reason termination is requested. V. MISCELLANEOUS PROVISIONS a. This Affiliation Agreement shall be governed by, and construed in accordance with, the laws of the state of Colorado, which shall be the forum for any lawsuits arising from and incident to this Affiliation Agreement. b. The Affiliated Facility agrees that Keith may use the name and location of its facility in informational materials and posted on the Keith's website in order to provide information regarding potential precepting locations to prospective applicants. c. The contact persons for any notices required by this Affiliation Agreement are as follows: For Keith: Crystal Dake 918-585-3045 For Affiliated Facility: Donnica Fagan 970-400-6132 PH: 918-574-8598 FX: 918-585-3047 www.kaddi-inlernship.com kaddisfrconsultingdietitians.com 9 115 W. 3" St. Ste. 802 Tulsa, OK 74103 KA , NUTRITION IN WITNESS WHEREOF, the authorized representatives of Keith and the Affiliated Facility have caused this Affiliation Agreement to be executed on the date listed with the representative's signature. Keith and Associates, Inc. Signature: Sandra Keith, MPH, RD/LD Sandra Keith, President Date: 12/18/2024 Affiliated Facility: Weld County Department of Human Services Signature: Printed Name: Kevin D. Ross O DEC 1 1 2D2` Title: Chair, Weld County Board of County Commissioners 2o74-3Zcolt PH: 918-574-8598 FX: 918-585-3047 i www.kaddi-internship.com kaddi"@,consultingdietitions.com 9 115 W. 3'' St. Ste. 802 Tulsa, OK 74103 Contract Form Entity Information Entity Name * KEITH & ASSOCIATES DISTANCE INTERNSHIP Entity ID* @00049314 O New Entity? Contract Name* Contract ID KEITH & ASSOCIATES DISTANCE INTERNSHIP 8923 AFFILIATION AGREEMENT Contract Status CTB REVIEW Contract Lead * SADAMS Contract Lead Email sadams@weld.gov;cobbx xlk@weld.gov Parent Contract ID Requires Board Approval YES Department Project # Contract Description* KEITH & ASSOCIATES DISTANCE INTERNSHIP AFFILIATION AGREEMENT TO PROVIDE DIETETIC STUDENT INTERNS A LEARNING EXPERIENCE BY SHADOWING A DHS SENIOR NUTRITION REGISTERED DIETITIAN. TERM: 1/1/25 THROUGH 12/31/25 AND WILL AUTO RENEW FOR 1 YEAR TERMS. Contract Description 2 PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB 11/26/24 Contract Type" AGREEMENT Amount* $0.00 Renewable * YES Automatic Renewal Grant IGA Department Requested BOCC Agenda Due Date HUMAN SERVICES Date* 12/07/2024 12/11/2024 Department Email CM- HumanServices@weld.gov Department Head Email CM-HumanServices- DeptHead@weld.gov County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL D.GOV 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* 10/31/2025 Renewal Date* 12/31/2025 Committed Delivery Date Expiration Date Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CHERYL PATTELLI BYRON HOWELL DH Approved Date Finance Approved Date Legal Counsel Approved Date 12/06/2024 12/09/2024 12/09/2024 Final Approval BOCC Approved Tyler Ref # AG 121124 BOCC Signed Date Originator SADAMS BOCC Agenda Date 12/11/2024 Houstan Aragon From: Sent: To. Subject: Onbase Wednesday, November 12, 2025 3 36 PM CM-ClerktoBoard, Sara Adams, Lesley Cobb, CM-HumanServices-DeptHead Fast Tracked Contract ID (10085) Contract # 10085 has been Fast Tracked to CM -Contract Maintenance You will be notified in the future based on the Contract information below Entity Name KEITH &ASSOCIATES DISTANCE INTERNSHIP Contract Name KEITH &ASSOCIATES DISTANCE INTERNSHIP AFFILIATION AGREEMENT Contract Amount $0 00 Contract ID 10085 Contract Lead SADAMS Department HUMAN SERVICES Review Date 10/31/2026 Renewable Contract YES Renew Date 12/31/2026 Expiration Date Tyler Ref # Thank -you �ortly� vD11 tuos5 dusk `Cvask'(Z-e\n2vs0 ZOZ4-1-3Z1o8 {WOOq t� Houstan Aragon From: Sent: To: Cc: Subject• Attchments: Good afternoon CTB, Sara Adams Wednesday, November 12, 2025 3 32 PM CTB HS -Contract Management FAST TRACK - Keith & Associates (CMS #10085) Affiliation Agreement KADDI-KACAD (e) pdf FAST TRACKITEM Attached please find the Forward Steps MOU (Tyler ID# 2024-3268) This agreement automatically renews for consecutive one-year terms It was reviewed and no changes are required This will be a Fast Track itemm,CMS for tracking purposes only (CMS# 10085) , Thank you, Sara Sara Adams Contract Administrative Coordinator Department of Human Services Desk 970-400-6603 P O Box A, 315 N 11th Ave , Greeley, CO 80632 <t .Ira OUT Team important: 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. 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