HomeMy WebLinkAbout20241119.tiffCniva&It*a48Z
BOARD OF COUNTY COMMISSIONERS
PASS AROUND REVIEW
PASS -AROUND TITLE: Professional Services Agreement Amendment #2 with Various Providers
for the Case Management Agency Interim Support Level Assessment (ISLA)
DEPARTMENT: Human Services DATE: May 20, 2025
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: On March 1, 2024, the Weld County Department of Human
Services began serving as the region's Case Management Agency (CMA) as a result of an awarded
Request for Proposal (RFP) through the Colorado Department of Health Care Policy & Financing
(HCPF). To offer services to clients as the CMA, a Supports Intensity Scale (SIS) assessment is
required to be completed to develop an individualized service plan to determine the daily supports a
person with intellectual or developmental disabilities may need to live as independently as possible. As
a result, in May of 2024, the Department entered into Professional Services Agreements with vendors
to perform SIB assessments for clients.
On March 17, 2025, the Board approved Amendment #1 that implemented the Interim Support Level
Assessment (ISLA) for individuals enrolling in services. The ISLA assessment is required by the State
and went into effect on April 1, 2025.
The Department is now requesting approval of Amendment #2 to the Professional Services
Agreement for the providers listed below. This amendment extends the term(s) of the Agreement
through June 30, 2026; updates Exhibit A, Scope of Service and Rate Schedule to remove the SIS
assessment and adds Exhibit B, HIPAA Business Associate Agreement.
CMS#
Assessment Provider
Original Tyler #
9480
Alex Turner
2024-1118
9482
Stacey Larrabee
2024-1119
9483
Ayanna Griffin
2024-1120
9484
Micki Schoech
2024-1121
9485
Sulema Saenz Sanchez
2024-1123
9486
Karol Guerrero
2024-1124
What options exist for the Board?
Approval of the Professional Services Agreement Amendment #2.
Deny approval of the Professional Services Agreement Amendment #2.
Consequences: WCDHS will not have current agreements in place with providers.
Impacts: WCDHS will not be able to conduct the assessments required by the State and DHS
clients will not receive needed services.
Pass -Around Memorandum; May 20, 2025 - CMS Various
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Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
• Total cost = $185.33 per completed ISLA assessment.
• Pass-thru funding from the Colorado Department of Health Care Policy & Financing (HCPF).
Recommendation:
Approval of the Professional Services Agreement Amendment #2 for Various Providers and authorize
the Chair to sign.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
Pass -Around Memorandum; May 20, 2025 - CMS Various
AGREEMENT AMENDMENT BETWEEN
WELD COUNTY AND
STACEY L. LARRABEE
This Agreement Amendment made and entered into nd
V day of J LU&Q ,
2025 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
Stacey L. Larrabee, hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement to conduct Case Management
Agency assessments, (the "Original Agreement") identified by the Weld County Clerk to the
Board of County Commissioners as document No. 2024-1119, approved on May 6, 2024.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in
accordance with the terms of the Original Agreement and any previously adopted
amendment, which is incorporated by reference herein, as well as the terms provided
herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and
agree as follows:
• The Original Agreement was set to end on April 30, 2025.
• The Original Agreement was amended on:
• March 17, 2025 to extend the term date through June 30, 2025 and
amend Exhibit A, Scope of Services and Rate Schedule.
• The Amendments are identified by the Weld County Clerk to the Board
of County Commissioners as document number 2024-1119.
• 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 July 1, 2025:
1. Paragraph 3. Term is hereby amended as follows:
The term of this Agreement shall be from July 1, 2025, through June
30, 2026, or Contractor's completion of the responsibilities described in
Exhibit A. This Agreement may be extended annually upon written agreement
of both parties.
2. Add Paragraph 29. Health Insurance Portability & Accountability Act of 1996
("HIPAA") is hereby added as follows:
Federal law governing the privacy of certain health information requires a
"Business Associate" agreement between Contractor and the County. 45 CFR
Section 164.504(e). Attached and incorporated herein by reference as Exhibit B is
a HIPAA Business Associate Agreement for HIPAA compliance.
3. Exhibit A, Scope of Services and Rate Schedule is here by amended as attached.
4. Add Exhibit B, HIPAA Business Associate Agreement.
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: ..tteritiA) moo ',1
Clerk to the Board
BY:
Date:
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
JUN 0 2 2025
Stacey L. Larrabee
8 Woods Road, Apartment 9
Mansfield, Connecticut 06250
By: St Larrabee (May 24, 202519:29 EDT)
Stacey L. Larrabee
05/24/2025
2.02c't I l �
EXHIBIT A
SCOPE OF SERVICES AND RATE SCHEDULE
1) The Contractor will need to complete the deliverables listed below:
a. The Interim Support Level (ISLA) Assessor is obligated to maintain current
credentials with the Department of Health Care Policy & Financing (HCPF)
ISLA Team.
b. The Assessor shall provide information regarding their availability to conduct
ISLA assessments, whether in -person or virtual.
c. When an ISLA assessment needs to be scheduled or completed, the Case
Management Agency (CMA) Program Manager will email the Assessor with the
following details:
d. Name, date of birth, Medicaid number, address, phone number of the member,
and a copy of the most recently completed 100.2 assessment.
e. Names, email addresses, and phone numbers of respondents.
f. Any specific days of the week or times of day preferred or to be avoided for
scheduling the ISLA assessment.
g. The Assessor will promptly contact the member/respondents to arrange the
earliest possible date for the ISLA assessment. If the schedule date is beyond
one (1) business day, the Assessor will notify the CMA Program Manager of the
date and reason for delay.
h. After scheduling, the Assessor will share the most recent versions of the
following forms and guides with the member and respondents via email:
i. ISLA Response Option Rating Guide
ii. HCBS Waiver and ISLA Member and Family Friendly Information
Document
iii. ISLA Information and Disclosure Document
iv. ISLA Complaint Process Document
v. Support Level Review Process Document
i. On the day of the ISLA assessment, the Assessor will ensure that the ISLA
Informed Consent form was signed and returned either electronically or via U.S.
Postal mail.
j. Upon completion of the ISLA assessment, the Assessor will securely email the
signed ISLA Informed Consent (if not already mailed by the Member) and
completed Pilot ISLA Excel document to the CMA Program Manager within 3
days business days. The Assessor will attach their invoice to the email. If
completing multiple assessments during a calendar month, the Assessor may
submit their invoice listing all assessments at the end of the month.
k. The Assessor will provide the Member and Respondents with the ISLA
Experience Survey link. There are both English and Spanish versions of the
survey. ISLA Experience Survey - English Encuesta piloto sobre la
experiencia con ISLA
2) Fees for Services:
a. Services rendered will be reimbursed at $185.33 per completed ISLA
assessment.
3) Invoice and Payment
a. Monthly Invoicing: The Contractor shall invoice CMA within four (4) working days
of the end of the month in which the services were performed, except at the end of
the fiscal year when invoices are due two (2) working days from the end of the
fiscal year.
b. Invoices should be sent via email to kmorrison(c�weld.gov
c. Vendor must include the following detail on invoices in order to be paid for
services:
i. Name of member/respondent(s) assessed.
ii. Dates of Service.
iii. Total Amount Due.
d. In order to comply with HCPF State General Funds reporting requirements, no
invoices received from the Contractor after July 3, 2026, for Fiscal Year July 1,
2025, thru June 30, 2026, will be accepted or paid by CMA, the date of July 3,
2026 is subject to change pending Fiscal Year 25-26 holiday schedule.
e. County shall pay Contractor within thirty (30) days of County's receipt of such
invoice.
f. The County may also recover, at the County's discretion, payments made to
Contractor in error for any reason, including, but not limited to, overpayments or
improper payments, by deduction from subsequent payments under this
Contract, or by any other appropriate method for collecting debts owed to the
County.
EXHIBIT B
HIPAA BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement ("BAA") is entered into by and between the County and
the Contractor, referred to as "Business Associate", to set forth the terms and conditions
under which protected health information ("PHI"), as defined by the Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191, Regulations enacted
hereunder (HIPAA) , created or received by Business Associate on behalf of County may be
used or disclosed.
This BAA shall commence on the effective date outlined in Paragraph 3 of the Professional
Services Agreement and the obligations herein shall continue in effect so long as Business
Associate uses, discloses, creates or otherwise possesses or maintains any PHI created, or
received, maintained or transmitted on behalf of County and until all PHI created, received,
maintained or transmitted by Business Associate on behalf of County is destroyed or returned
to County pursuant to Paragraph 16 herein.
1. The following terms, if and when used in this BAA, shall have the same meaning as
those terms in the HIPAA Rules: Breach, Data Aggregation, Disclosure, Health Care
Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected
Health Information, Required by Law, Secretary, Security Incident, Subcontractor,
Unsecured Protected Health Information, and Use.
a. Business Associate. "Business Associate" shall generally have the same
meaning as the term "business associate" at 45 CFR 160.103.
b. Covered Entity. "Covered Entity" shall generally have the same meaning as the
term "covered entity" at 45 CFR 160.103.
c. HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach
Notification, and Enforcement rules at 45 CFR Part 160 and Part 164.
2. County and Business Associate hereby agree that Business Associate shall be
permitted to use and/or disclose PHI created, received, maintained or transmitted on
behalf of County in accordance with this BAA. The permitted uses and disclosures, as
may be outlined in a contract or Memorandum of Understanding, must be within the
scope of, and necessary to achieve, the obligations and responsibilities of the
Business Associate in performing on behalf of, or providing services to, County, or as
Required by Law. Business Associate may not use or disclose PHI in a manner that
would violate Subpart E of 45 CFR Part 164 if done by County except for the specific
uses and disclosures set forth herein.
3. Business Associate acknowledges Business Associate is required by law to comply
with the HIPAA Security Rule (45 CFR 164.302 through 164.318), the use and
disclosure provisions of the HIPAA Privacy Rule and the Health Information
Technology for Economic and Clinical Health Act (HITECH). To the extent Business
Associate is to carry out one or more of County's obligations under Subpart E of 45
CFR Part 164, Business Associate hereby agrees to comply with the requirements of
Subpart E that apply to County in the performance of such obligations.
4. Business Associate may use and disclose PHI created or received by Business
Associate on behalf of County if necessary for the proper management and administration
of Business Associate or to carry out Business Associate's legal responsibilities,
provided that:
a Any disclosure is required by law; or
b. Business Associate obtains reasonable assurances from the person to whom
the PHI is disclosed that (i) the PHI will be held confidentially and used or
further disclosed only as required by law or for the purpose for which it was
disclosed to the person; and (ii) the Business Associate will be notified of any
instances of which the person is aware in which the confidentiality of the
information is breached.
5. Business Associate hereby agrees to maintain the security and privacy of all PHI in a manner
consistent with state and federal laws and regulations, including HIPAA, HITECH, 42
CFR Pt. 2 if applicable, and all other applicable laws.
6. Business Associate shall ensure that any subcontractors that create, receive,
maintain, or transmit PHI on behalf of the Business Associate agree to the same
restrictions, conditions, and requirements that apply to the Business Associate with
respect to such information. Business Associate shall not disclose PHI created or
received by Business Associate on behalf of County to a person, including any agent
or subcontractor of Business Associate but not including a member of Business
Associate's own workforce, until such person agrees in writing to be bound by
provisions not less restrictive than this BAA and applicable state or federal law.
7. Business Associate shall not disclose PHI to any member of its workforce unless
Business Associate has advised such person of Business Associate's privacy and
security obligations under this Agreement, including the consequences for violation of
such obligations. Business Associate shall take appropriate disciplinary action against
any member of its workforce who uses or discloses PHI in violations of this Agreement
and applicable law, in addition to meeting its reporting obligations owed to County
hereunder.
8. Business Associate represents and warrants that it will use and disclose PHI in
accordance with the Privacy Rule's "minimum necessary" standards by taking
reasonable steps to limit uses and disclosures to the minimum amount of PHI required
in accomplishing the intended purpose and consistent with the County's minimum
necessary policies and procedures. Business Associate agrees to use appropriate
safeguards to prevent use or disclosure of PHI not permitted by this Agreement or
applicable law.
9. Business Associate agrees to maintain a record of its disclosures of PHI, including
disclosures not made for the purposes of this Agreement. Such record shall include the
date of the disclosure, the name and, if known, the address of the recipient of the PHI, the
name of the individual who is the subject of the PHI, a brief description of the PHI
disclosed, and the purpose of the disclosure consistent with enabling County to meet its
accounting of disclosure obligations under the HIPAA Rules. Business Associate shall
make such record available to County within thirty (30) days of a request and shall
include disclosures made on or after the date which is six (6) years prior to the
request.
Business Associate shall not be required to maintain a record of disclosures of PHI
made for the following purposes, unless such disclosures become mandatory for
accounting of disclosure purposes under HIPAA:
a For the purpose of treatment, payment or health care operations (as those
terms are defined under HIPAA);
b. To an individual who is the subject of the PHI; and
c. Pursuant to an Authorization which is valid under HIPAA.
10. Business Associate agrees to report to County any unauthorized use or disclosure of
PHI by Business Associate or its workforce or subcontractors within ten (10) days and
the remedial/mitigating action taken or proposed to be taken with respect to such use
or disclosure and account for such disclosure.
11. In the event of a or Security Incident involving the County's PHI, Business Associate
shall provide County a report including patient name, contact information,
nature/cause of the breach, PHI breached and the date or period of time during which
the breach occurred. Business Associate understands that such a report must be
provided to County within ten (10) days from the date of the breach or the date the
breach should have been known to have occurred, or as soon as possible upon
discovery (not to exceed 10 days from the date of the breach/breach discovery).
Business Associate is responsible for any actual and direct costs related to notification
of individuals or next of kin (if the individual is deceased) of any successful Security
Incident or Breach reported or caused by Business Associate to County.
12. Business Associates agrees to make its internal practices, books, and records relating
to the use and disclosure of PHI received from County or created or received by
Business Associate on behalf of County, available to the Secretary of the United
States Department of Health and Human Services, for purposes of determining the
County's and/or Business Associate's compliance with HIPAA.
13. Within ten (10) days of a written request by County, Business Associate shall allow a
person who is the subject of PHI, such person's legal representative, or County to
have access to and to copy such person's PHI maintained by Business Associate.
Business Associate shall provide PHI in the format requested by such person, legal
representative, or County unless it is not readily producible in such format, in which
case it shall be produced in standard hard copy format. Business Associate shall
forward any request for access to PHI by an individual to County promptly upon receipt
thereof.
14. Business Associate agrees to amend, pursuant to a request by County, PHI
maintained and created or received by Business Associate on behalf of County.
Business Associate further agrees to complete such amendment within ten (10) days
of a written request by County, and to make such amendment as directed by County.
Business Associate shall forward any request for amendment by an individual to
County promptly upon receipt thereof.
15. County shall notify Business Associate of any changes in, or revocation of, the
permission by an individual to use or disclose his or her PHI, to the extent that such
changes may affect Business Associate's use or disclosure of PHI.
16. In the event Business Associate fails to perform its obligations under this Agreement,
County may, at its option:
a. Require Business Associate to submit to a plan of compliance, including
monitoring by County and reporting by Business Associate, as County, in its
sole discretion, determines necessary to maintain compliance with this
Agreement and applicable law. Such plan shall be incorporated into this
Agreement by amendment hereto;
b. Require Business Associate to mitigate any loss occasioned by the
unauthorized disclosure or use of PHI; and
c. Immediately discontinuing providing PHI to Business Associate with or without
written notice to Business Associate.
17. County may immediately terminate this and related agreements if County determines
that Business Associate has breached a material term of this Agreement. Alternatively,
County may choose to: (i) provide Business Associate with ten (10) days written notice
of the existence of an alleged material breach and (ii) afford Business Associate an
opportunity to cure said alleged material breach to the satisfaction of County within ten
(10) days of receipt of notice. Business Associate's failure to cure shall be grounds for
immediate termination of this BAA. County's remedies under this BAA are cumulative
and the exercise of any remedy shall not preclude the exercise of any other.
18.After termination or expiration of the Underlying Agreement for any reason, Business
Associate with respect to PHI received created or maintained from or on behalf
County, shall: (i) retain only that PHI which is necessary for Business Associate to
continue its proper management and administration or to carry out its legal
responsibilities; (ii) destroy (subject to the Underlying Agreement) the remaining PHI
that the Business Associate still maintains in any form; and (iii) not use or disclose the
PHI retained by Business Associate other than for the purposes for which such PHI
was retained and subject to the same conditions set out in this BAA which applied
before termination. If the destruction of the PHI is not feasible, in Business Associate's
discretion, Business Associate shall notify County of the reasons destruction is not
feasible and Business Associate shall continue to for as long as Business Associate
retains the PHI. This section shall survive termination of this BAA.
19. Upon termination of this BAA for any reason, Business Associate, with respect to PHI
received from County, or created, maintained, transmitted, or received by Business
Associate on behalf of County, shall:
a. Retain only that PHI which is necessary for Business Associate to continue its
proper management and administration or to carry out its legal responsibilities.
b. Return to County the remaining PHI that the Business Associate still maintains
in any form or destroy said PHI.
c. Continue to use appropriate safeguards and comply with Subpart C of 45 CFR
part 164 with respect to electronic protected health information to prevent use
or disclosure of the PHI, other than as provided for in this Section, for as long
as Business Associate retains the PHI.
d. Not use or disclose the PHI retained by Business Associate other than for the
purposes for which such PHI was retained and subject to the same conditions
which applied prior to termination.
e. Return to County or destroy the PHI retained by Business Associate when it is
no longer needed by Business Associate for its proper management and
administration or to carry out its legal responsibilities. The provisions of this
section shall survive the BAA's termination.
20. The parties agree to amend this Agreement in order to maintain compliance with State
or Federal law. County shall provide ten (10) days prior written notice to Business
Associate of a need to amend the BAA and propose such amendments for Business
Associate's consideration. Upon written agreement between the parties, such
amendment shall be binding upon the parties. Either party may elect to terminate the
BAA and any underlying service agreement(s) if an amendment is not able to be
agreed upon within a reasonable timeframe from an amendment's commencement. All
duties hereunder to maintain the security and privacy of PHI shall survive such
termination. County and Business Associate may otherwise amend this Agreement by
mutual written consent.
21. To the fullest extent permitted by law, each party (the "Indemnifying Party") shall
indemnify the other party, and its officers, directors, employees and agents
(collectively the "Indemnified Parties"), against any and all claims brought by or directly
resulting from third parties, including reasonable attorneys' fees (the "Third Party
Losses"), to the extent Third Party Losses are proximately caused by a breach of this
BAA by the Indemnifying Party, each by the Indemnifying Party or its employees,
directors, officers, subcontractors, and agents. The Indemnifying Party shall have the
right to control the defense or settlement of such third -party claim, subject to the
reasonable participation of, and approval by, the Indemnified Parties of any such
settlement or defense strategy. The foregoing indemnification shall not apply to the
extent such claims arise out of (i) the Indemnified Party's negligence or willful
misconduct, or (ii) the negligence or willful misconduct of any subcontractor or agent
other than Business Associate under the Indemnified Party's control.
Stacey Larrabee Amendment #2 (f) with Exhibits
updated 5.22.25
Final Audit Report
2025-05-24
Created: 2025-05-22
By: Sara Adams (sadams@weld.gov)
Status: Signed
Transaction ID: CBJCHBCAABAABCuEpWUju-kijvDDfNBi5IgjI49AlAuT
"Stacey Larrabee Amendment #2 (f) with Exhibits updated 5.22.
25" History
t Document created by Sara Adams (sadams@weld.gov)
2025-05-22 - 7:41:46 PM GMT- IP address: 204.133.39.9
g, Document emailed to staceylarrabee15@gmail.com for signature
2025-05-22 - 7:42:02 PM GMT
n Email viewed by staceylarrabee15@gmail.com
2025-05-22 - 7:42:20 PM GMT- IP address: 66.249.83.4
4 Signer staceylarrabee15@gmail.com entered name at signing as Stacey Larrabee
2025-05-24 - 11:29:32 PM GMT- IP address: 24.177.248.245
4 Document e -signed by Stacey Larrabee (staceylarrabee15@gmail.com)
Signature Date: 2025-05-24 - 11:29:34 PM GMT - Time Source: server- IP address: 24.177.248.245
0 Agreement completed.
2025-05-24 - 11:29:34 PM GMT
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Contract Form
Entity Information
Entity Name*
LARRABEE, STACEY
Entity ID*
@00048552
Contract Name* Contract ID
LARRABEE, STACEY - CASE MANAGEMENT AGENCY 9482
(CMA) INTERIM SUPPORT LEVEL ASSESSMENT (ISLA)
AMENDMENT #2 Contract Lead
*
SADAMS
Contract Status
CTB REVIEW
❑ New Entity?
Parent Contract ID
20241119
Requires Board Approval
YES
Contract Lead Email Department Project #
sadams@weld.gov;cobbx
xlk@weld.gov
Contract Description *
(CONSENT) LARRABEE, STACEY - CASE MANAGEMENT AGENCY (CMA) INTERIM SUPPORT LEVEL ASSESSMENT
(ISLA) AMENDMENT #2 TO ADD EXTEND TERM THROUGH 6/30/2026; UPDATE EXHIBIT A, SCOPE OF SERVICES
AND RATE SCHEDULE AND ADD EXHIBIT B, HIPAA BAA.
Contract Description 2
PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB IS 5/20/2025.
Contract Type* Department Requested BOCC Agenda Due Date
AMENDMENT HUMAN SERVICES Date* 05/29/2025
06/02/2025
Amount* Department Email
$0.00 CM- Will a work session with BOCC be required?*
HumanServices@weld.gov NO
Renewable *
NO Department Head Email Does Contract require Purchasing Dept. to be
CM-HumanServices- included?
Automatic Renewal DeptHead@weld.gov
Grant County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
IGA
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
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*
04/30/2026
Committed Delivery Date
Renewal Date
Expiration Date*
06/30/2026
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
CONSENT 05/28/2025
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CONSENT CONSENT
DH Approved Date Finance Approved Date Legal Counsel Approved Date
05/28/2025 05/28/2025 05/28/2025
Final Approval
BOCC Approved Tyler Ref #
AG 060225
BOCC Signed Date Originator
SADAMS
BOCC Agenda Date
06/02/2025
Covrlvac--o# q I9°l
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Case Management Agency Supports Intensity Scale (SIS) Agreement for
Professional Services Amendment #1 with Various Providers
DEPARTMENT: Human Services DATE: March 11, 2025
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: On March 1, 2024, the Weld County Department of Human
Services began serving as the region's Case Management Agency (CMA) as a result of an awarded
Request for Proposal (RFP) through the Colorado Department of Health Care Policy & Financing
(HCPF). To offer services to clients as the CMA, a Supports Intensity Scale (SIS) assessment is
required to be completed to develop an individualized service plan to determine the daily supports a
person with intellectual or developmental disabilities may need to live as independently as possible. As
a result, in May of 2024 the Department entered into Agreements for Professional Services with vendors
to perform SIS assessments for clients.
Effective April 1, 2025, the State has implemented an Interim Support Level Assessment (ISLA) for
individuals enrolling in services, which requires the Department to amend the current Agreements for
Professional Services in order to align with this implementation.
The Department is requesting approval of Amendment #1 to the Agreement for Professional Services
for the providers listed below. This amendment updates Exhibit A, Scope of Service and Rate Schedule
and extends the term(s) of the Agreement through June 30, 2025.
CMS#
Assessment Provider
Alex Turner
Original Tyler #
9193
2024-1118
9200
Sulema Saenz Sanchez
2024-1123
9198
Micki Schoech
2024-1121
9197
Emilia McGinn
2024-1122
9196
Ayanna Griffin
2024-1120
4- 9199
Stacey Larrabee
2024-1119
9194
Karol Guerrero
2024-1124
What options exist for the Board?
• Approval of the Agreement for Professional Services Amendment #1
• Deny approval of the Agreement for Professional Services Amendment #1.
Consequences: WCDHS will not have current agreement in place with providers reflecting the
new assessment.
Impacts: WCDHS will not be in compliance with the State's new assessment requirement.
Pass -Around Memorandum; March 11, 2025 - CMS Various
2024- I 1 tcl
cone Nen
3/1 "1/25
3/1 -1TZS
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
• Total cost = $225.00 per completed SIS assessment
$185.33 per completed ISLA assessment
• Pass-thru funding from the Colorado Department of Health Care Policy & Financing (HCPF).
Recommendation:
Approval of the Agreement for Professional Services Amendment #1 for Various Providers and
authorize the Chair to sign.
Support Recommendation Schedule
Place on BOCC Mends Work Session Other/Comments:
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
yp4
Pass -Around Memorandum; March 11, 2025 - CMS Various
AGREEMENT AMENDMENT BETWEEN
WELD COUNTY
AND STACEY L. LARRABEE
This Agreement Amendment made and entered into hday of M(,VCY 1 ,
2025 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
Stacey L. Larrabee, hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement to conduct Case Management
Agency assessments, (the "Original Agreement") identified by the Weld County Clerk to the
Board of County Commissioners as document No. 2024-1119, approved on May 6, 2024.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in
accordance with the terms of the Original Agreement and any previously adopted
amendment, which is incorporated by reference herein, as well as the terms provided
herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and
agree as follows:
• The Original Agreement will end on April 30, 2025.
• This Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following additional changes are hereby
made to the current Agreement as of April 1, 2025:
1. Paragraph 3. Term is hereby amended as follows:
The term of this Agreement shall be from April 1, 2025, through June
30, 2025, or Contractor's completion of the responsibilities described in
Exhibit A. This Agreement may be extended annually upon written agreement
of both parties.
2. Exhibit A, Scope of Services and Rate Schedule is here by 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:
BY:
did.%) Xith;,,k.
Clerk to the Board
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
eputy Clerk to the Boa : ��,�:�; i Buck, Chair
MAR 1 7 2925
TRACTOR:
Stacey L. Larrebee
8 Woods Road, Apartment 9
Mansfield, Connecticut 06250
Stacei L. Lztabee
By: Stacey L Larra ee (Mar 8, 202518:35 EST)
Stacey L. Larrebee
Date: Mar 8, 2025
2024-11Ict
EXHIBIT A
SCOPE OF SERVICES AND RATE SCHEDULE
1) Scope of Services
a. The Contractor is obligated to maintain the required current credentials with the
Department of Health Care Policy & Financing (HCPF) to conduct Supports Intensity
Scale (SIS) assessments and Interim Support Level Assessments (ISLA).
b. Contractor will attend a total of three (3) two-hour sessions, in addition to the three
training sessions (a total of six hours) for the ISLA. The Contractor will be required to
take and pass a competency examination and provide the Certificate of Completion to
the CMA Program Manager.
c. Pre/during/post ISLA checklists will be provided to the Contractor to complete to ensure
the ISLA is implemented in a consistent manner.
d. The Contractor shall provide information regarding their availability to conduct SIS and
ISLA assessments, whether in -person or virtual.
e. When a SIS and ISLA assessment needs to be scheduled or completed, the Case
Management Agency (CMA) Program Manager will email the Contractor with the
following details:
i. Name, date of birth, Medicaid number, address, and phone number of the
member.
ii. Names, email addresses, and phone numbers of respondents.
iii. Any specific days of the week or times of day preferred or to be avoided for
scheduling the SIS and, if applicable, the ISLA assessment.
f. The Contractor will promptly contact the member/respondents to:
iv. Ask if they are willing to participate in both the SIS and ISLA assessment.
v. Arrange the earliest possible date for the SIS and, if applicable, the ISLA
assessment.
g. If the scheduled assessment date is beyond one (1) business day, the Contractor will
notify the CMA Program Manager of the date and reason for delay.
h. After scheduling, the Contractor will share the most recent versions of the following
forms and guides with the member and respondents via email:
i. SIS and/or the ISLA Complaint Process
ii. ISLA and/or Support Level Review Process
iii. ISLA and/or Supports Intensity Scale and Support Level Disclosure forms.
iv. SIS-A and/or ISLA Respondent Guide
i. On the day of the SIS and, if applicable, the ISLA assessment, the Contractor will
review each form with the individual and their guardian, if applicable, and obtain
signature(s) on the Disclosure form.
j. Upon completion of the SIS and, if applicable, the ISLA assessment, the Contractor will
enter the documentation using the prescribed method.
k. The Contractor will notify the CMA Program Manager via secure email that the SIS and,
if applicable, the ISLA assessment has been entered. The Contractor will attach the
signed Disclosure form and their invoice to the email. If completing multiple
assessments during a calendar month, the Contractor may submit their invoice listing all
assessments at the end of the month.
2) Fees for Services
a. Services rendered will be reimbursed at $225.00 per completed SIS assessment.
b. Services rendered will be reimbursed at $185.33 per completed ISLA assessment.
3) Invoice and Payment
a. Monthly Invoicing: The Contractor shall invoice CMA within four (4) working days of the
end of the month in which the services were performed, except at the end of the fiscal year
when invoices are due two (2) working days from the end of the fiscal year.
b. Invoices should be sent via email to wccmabillingweld.gov
c. The Contractor must include the following detail on invoices in order to be paid for
services:
i. Name of member/respondent(s) assessed.
ii. Type of assessment completed.
iii. Dates of Service.
iv. Total Amount Due.
d. In order to comply with HCPF State General Funds reporting requirements, no invoices
received from the Contractor after July 3, 2025, for Fiscal Year July 1, 2024 thru June 30,
2025 will be accepted or paid by CMA, the date of July 3, 2025 is subject to change
pending Fiscal Year 24-25 holiday schedule.
e. County shall pay Contractor within thirty (30) days of County's receipt of
such invoice and assessment has been approved.
In order to comply with HCPF State General Funds reporting requirements, no invoices
received from the Contractor after July 3, 2025, for Fiscal Year July 1, 2024 thru June 30,
2025 will be accepted or paid by CMA, the date of July 3, 2025 is subject to change
pending Fiscal Year 24-25 holiday schedule.
County shall pay Contractor within thirty (30) days of County's receipt of such invoice.
2
SIGNATURE REQUESTED: Weld/Stacey
Larrabee Amendment #1
Final Audit Report
2025-03-08
Created: 2025-03-06
By: Sara Adams (sadams@weld.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAurfAXd4j3xl_YhuvjS9gRFpdar6wbpjc
"SIGNATURE REQUESTED: Weld/Stacey Larrabee Amendmen
t #1" History
5 Document created by Sara Adams (sadams@weld.gov)
2025-03-06 - 3:50:00 PM GMT- IP address: 204.133.39.9
tw Document emailed to staceylarrabee15@gmail.com for signature
2025-03-06 - 3:50:36 PM GMT
n Email viewed by staceylarrabee15@gmail.com
2025-03-06 - 4:31:51 PM GMT- IP address: 66.102.8.129
4 Signer staceylarrabee15@gmail.com entered name at signing as Stacey L Larrabee
2025-03-08 - 11:35:25 PM GMT- IP address: 24.177.248.245
4 Document e -signed by Stacey L Larrabee (staceylarrabee15@gmail.com)
Signature Date: 2025-03-08 - 11:35:27 PM GMT - Time Source: server- IP address: 24.177.248.245
Q Agreement completed.
2025-03-08 - 11:35:27 PM GMT
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Contr ct F
Entity Information
Entity Name*
LARRABEE, STACEY
Entity ID *
@00048552
Contract Name*
LARRABEE, STACEY - CASE MANAGEMENT AGENCY
(CMA) SUPPORT INTENSITY SCALE (SIS) AMENDMENT
#1
Contract Status
CTB REVIEW
Contract ID
9199
Contract Lead *
SADAMS
Q New Entity?
Parent Contract ID
20241119
Requires Board Approval
YES
Contract Lead Email Department Project #
sadams@weld.gov;cobbx
xlk@weld.gov
Contract Description *
(CONSENT) LARRABEE, STACEY - CASE MANAGEMENT AGENCY (CMA) SUPPORT INTENSITY SCALE (SIS)
AMENDMENT #1 TO ADD NEW ISLA ASSESSMENT AND EXTEND TERM THROUGH 6/30/2025.
Contract Description 2
PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB IS 3/11/2025.
Contract Type* Department Requested BOCC Agenda Due Date
AMENDMENT HUMAN SERVICES Date* 03/13/2025
03/17/2025
Amount* Department Email
$0.00 CM- Will a work session with BOCC be required?*
HumanServices@weld.gov NO
Renewable *
NO Department Head Email Does Contract require Purchasing Dept. to be
CM-HumanServices- included?
Automatic Renewal DeptHead@weld.gov
Grant County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
IGA
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
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
Contact Info
Review Date *
04/30/2025
Committed Delivery Date
Renewal Date
Expiration Date*
06/30/2025
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
CONSENT 03/12/2025
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
03/12/2025
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
03/17/2025
Finance Approver
CONSENT
Legal Counsel
CONSENT
Finance Approved Date Legal Counsel Approved Date
03/12/2025 03/12/2025
Tyler Ref #
AG 031725
Originator
SADAMS
Conva0 l'1) M4
WELD COUNTY AGREEMENT FOR PROFESSIONAL SERVICES
BETWEEN WELD COUNTY AND
STACEY L. LARRABEE
THIS AGREEMENT is made and entered into this Util day of M a., , 2024, by and between
the County of Weld, a body corporate and politic of the State of Colorado, by al's l through its Board of County
Commissioners, whose address is 1150 "O" Street, Greeley, Colorado 80631 hereinafter referred to as "County,"
and Stacey L. Larrabee, who whose address is 8 Woods Road, Apartment 9, Mansfield Center, Connecticut
06250, hereinafter referred to as "Contractor".
WHEREAS, County desires to retain Contractor as an Independent Contractor to perform services as
more particularly set forth below; and
WHEREAS, Contractor has the ability, qualifications, and time available to timely perform the services,
and is willing to perform the services according to the terms of this Agreement.
WHEREAS, Contractor is authorized to do business in the State of Colorado and has the time, skill,
expertise, and experience necessary to provide the services as set forth below;
NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties
hereto agree as follows:
1. Introduction. The terms of this Agreement are contained in the terms recited in this document and in Exhibit
A, Scope of Services and Rate Schedule, which forms an integral part of this Agreement. Exhibit A is specifically
incorporated herein by this reference.
2. Service or Work. Contractor agrees to provide all services, labor, personnel and materials necessary to
perform and complete the work outlined in the Scope of Work, as set forth in Exhibit A. Contractor shall further
be responsible for the timely completion and acknowledges that a failure to comply with the standards and
requirements of Work within the time limits prescribed by County may result in County's decision to withhold
payment or to terminate this Agreement.
3. Term. The term of this Agreement shall be from May 1, 2024, through April 30, 2025, or Contractor's
completion of the responsibilities described in Exhibit A. This Agreement may be extended annually upon
written agreement of both parties.
4. Termination; Breach; Cure. County may terminate this Agreement for its own convenience upon thirty (30)
days written notice to Contractor. Either Party may immediately terminate this Agreement upon material breach
of the other party, however the breaching party shall have fifteen (15) days after receiving such notice to cure
such breach. If cure is timely accomplished to satisfaction of non -breaching party, then agreement will continue
under its current terms and conditions. If this Agreement is terminated by County, Contractor shall be
compensated for, and such compensation shall be limited to, (1) the sum of the amounts contained in invoices
which it has submitted and which have been approved by the County; (2) the reasonable value to County of the
services which Contractor provided prior to the date of the termination notice, but which had not yet been
approved for payment; and (3) the cost of any work which the County approves in writing which it determines
is needed to accomplish an orderly termination of the work. County shall be entitled to the use of all material
Coh5a1+1V,116-0,-,
GrA=4304e-C)
s�c�as�
2024-1119
42-009 (0
generated pursuant to this Agreement upon termination. Upon termination of this Agreement by County,
Contractor shall have no claim of any kind whatsoever against the County by reason of such termination or by
reason of any act incidental thereto, except for compensation for work satisfactorily performed and/or materials
described herein properly delivered.
5. Extension or Modification. Any amendments or modifications to this agreement shall be in writing signed
by both parties. No additional services or work performed by Contractor shall be the basis for additional
compensation unless and until Contractor has obtained written authorization and acknowledgement by County
for such additional services.
6. Compensation/Contract Amount. County agrees to pay Contractor through an invoice process during the
course of this Agreement in accordance with the Rate Schedule as described in Exhibit A. Contractor agrees to
submit invoices which detail the work completed by Contractor. The County will review each invoice and if it
agrees Contractor has completed the invoiced items to the County's satisfaction, it will remit payment to
Contractor.
Contractor agrees to work within the confines of the Scope of Services and Rate Schedule outlined in Exhibit A.
County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to
be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant
to the terms of this Agreement.
7. Independent Contractor. Contractor agrees that it is an independent Contractor and that Contractor's
officers, agents or employees will not become employees of County, nor entitled to any employee benefits 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.
8. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the
particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements
for the completion of this Project without County's prior written consent, which may be withheld in County's
sole discretion.
9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order
shall become or remain (as applicable), the property of County.
10. Confidentiality. Contractor agrees to keep confidential all of County's confidential information. Contractor
agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity
without seeking written permission from the County. Contractor agrees to advise its employees, agents, and
consultants, of the confidential and proprietary nature of this confidential information and of the restrictions
imposed by this agreement.
2
11. Warranty. Contractor warrants that the services performed under this Agreement will be performed in a
manner consistent with the standards governing such services and the provisions of this Agreement. Contractor
further represents and warrants that all services shall be performed by qualified personnel in a professional and
workmanlike manner, consistent with industry standards, and that all services will conform to applicable
specifications, including all Healthcare Policy and Finance requirements related to SIS Assessment Certification.
12. Acceptance of Services Not a Waiver. In no event shall any action by County hereunder constitute or be
construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part
of Contractor. Acceptance by the County of, or payment for, the services completed under this Agreement shall
not be construed as a waiver of any of the County's rights under this Agreement or under the law generally.
13. Insurance and Indemnification. Contractor shall procure at least the minimum amount of automobile
liability insurance required by the State of Colorado for the use of any personal vehicle. Proof of said automobile
liability insurance shall be provided to County prior to the performance of any services under this Agreement.
14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and
employees, from and against injury, loss damage, liability, suits, actions, or claims of any type or character arising
out of the work done in fulfillment of the terms of this Contract or on account of any act, claim or amount arising
or recovered under workers' compensation law or arising out of the failure of the Contractor to conform to any
statutes, ordinances, regulation, law or court decree.
15. Non -Assignment. Contractor may not assign or transfer this Agreement or any interest therein or claim
thereunder, without the prior written approval of County.
16. 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.
17. Compliance with Law. Contractor shall strictly comply with all applicable federal and State laws, rules and
regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and
unfair employment practices.
18. Non -Exclusive Agreement. This Agreement is nonexclusive, and County may engage or use other
Contractors or persons to perform services of the same or similar nature.
19. Entire Agreement/Modifications. This Agreement including the Exhibits attached hereto and incorporated
herein, contains the entire agreement between the parties with respect to the subject matter contained in this
Agreement. This instrument supersedes all prior negotiations, representations, and understandings or
agreements with respect to the subject matter contained in this Agreement. This Agreement may be changed
or supplemented only by a written instrument signed by both parties.
20. Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent
upon funds for that purpose being appropriated, budgeted and otherwise made available. Execution of this
Agreement by County does not create an obligation on the part of County to expend funds not otherwise
appropriated in each succeeding year.
3
21. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-50-507. The
signatories to this Agreement state that to their knowledge, no employee of Weld County has any personal or
beneficial interest whatsoever in the service or property which is the subject matter of this Agreement.
22. 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.
23. 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 §§24-10-101 et seq., as applicable now or hereafter amended.
24. Force Majeure. Neither the Contractor nor the County shall be liable for any delay in, or failure of
performance of, any covenant or promise contained in this Agreement, nor shall any delay or failure
constitute default or give rise to any liability for damages if, and only to extent that, such delay or failure is
caused by "force majeure." As used in this Agreement, "force majeure" means acts of God, acts of the public
enemy, unusually severe weather, fires, floods, epidemics, quarantines, strikes, labor disputes and freight
embargoes, to the extent such events were not the result of, or were not aggravated by, the acts or omissions
of the non -performing or delayed party.
25. No Third -Party Beneficiary. It is expressly understood and agreed that the enforcement of the terms and
conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to
the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever
by any other person not included in this Agreement. It is the express intention of the undersigned parties that
any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
26. Board of County Commissioners of Weld County Approval. This Agreement shall not be valid until it has
been approved by the Board of County Commissioners of Weld County, Colorado or its designee.
27. 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.
28. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it
and agrees to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibit
A , is the complete and exclusive statement of agreement between the parties and supersedes all proposals or
prior agreements, oral or written, and any other communications between the parties relating to the subject
matter of this Agreement.
4
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
COUNTY:
ATTEST: '€ BOARD OF COUNTY COMMISSIONERS
Clerk to the Board
Deputy Clerk to the Board
WELD COUNTY, COLORADO
C
Kevin D. Ross, Chair
V 9
acey L. Larrabee
Woods Road, Apartment 9
Mansfield Center, Connecticut 06250
Seace) Larrabee
By: Stacey Larrab a (Apr 24, 2024 18:41 EDT)
Stacey L. Larrabee
Date: Apr 24, 2024
5
EXHIBIT A
SCOPE OF SERVICES AND RATE SCHEDULE
1) The Contractor will need to complete the deliverables listed below:
a. The Support Intensity Scale (SIS) Assessor is obligated to maintain current credentials with the
Department of Health Care Policy & Financing (HCPF) SIS Team.
b. The Assessor shall provide information regarding their availability to conduct SIS assessments,
whether in -person or virtual.
c. When a SIS assessment needs to be scheduled or completed, the Case Management Agency
(CMA) Program Manager will email the Assessor with the following details:
d. Name, date of birth, Medicaid number, address, and phone number of the member.
e. Names, email addresses, and phone numbers of respondents.
f. Any specific days of the week or times of day preferred or to be avoided for scheduling the SIS
assessment.
g. The SIS Assessor will promptly contact the member/respondents to arrange the earliest
possible date for the SIS assessment. If the schedule date is beyond one (1) business day, the
SIS assessor will notify the CMA Program Manager of the date and reason for delay.
h. After scheduling, the Assessor will share the most recent versions of the following forms and
guides with the member and respondents via email:
i. SIS Complaint Process
j. Support Level Review Process
k. Supports Intensity Scale and Support Level Disclosure forms.
I. SIS-A Respondent Guide
m. On the day of the SIS assessment, the Assessor will review each form with the individual and
their guardian, if applicable, and obtain signature(s) on the Disclosure form.
n. Upon completion of the SIS assessment, the Assessor will enter the documentation into SIS
Online within 3 days business days.
o. The Assessor will notify the CMA Program Manager via secure email that the SIS assessment
has been entered. The Assessor will attach the signed Disclosure form and their invoice to the
email. If completing multiple assessments during a calendar month, the Assessor may submit
their invoice listing all assessments at the end of the month.
2) Fees for Services:
a. Services rendered will be reimbursed at $225.00 per completed assessment.
3) Invoice and Payment
a. Monthly Invoicing: The Contractor shall invoice CMA within four (4) working days of the end of the
month in which the services were performed, except at the end of the fiscal year when invoices
are due two (2) working days from the end of the fiscal year.
b. Invoices should be sent via email to wccmabilling@weld.gov
c. Vendor must include the following detail on invoices in order to be paid for services:
i. Name of member/respondent(s) assessed.
ii. Dates of Service.
iii. Total Amount Due.
6
d. In order to comply with HCPF State General Funds reporting requirements, no
invoices received from the Contractor after July 3, 2024, for Fiscal Year July 1, 2023
thru June 30, 2024 will be accepted or paid by CMA, the date of July 3, 2024 is subject
to change pending Fiscal Year 24-25 holiday schedule.
e. County shall pay Contractor within thirty (30) days of County's receipt of such
invoice.
7
SIGNATURE REQUESTED: Weld/Stacey
Larrabee SIS PSA 2024
Final Audit Report
2024-04-24
Created: 2024-04-24
By: Sara Adams (sadams@weld.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAcYbPrNBPskA2PuiWb9tDAiZfHzTW6ieM
"SIGNATURE REQUESTED: Weld/Stacey Larrabee SIS PSA 2
024" History
t Document created by Sara Adams (sadams@weld.gov)
2024-04-24 - 10:08:10 PM GMT
E-7,. Document emailed to staceylarrabee15@gmail.com for signature
2024-04-24 - 10:09:00 PM GMT
5 Email viewed by staceylarrabee15@gmail.com
2024-04-24 - 10:36:02 PM GMT
4 Signer staceylarrabee15@gmail.com entered name at signing as Stacey Larrabee
2024-04-24 - 10:41:55 PM GMT
4 Document e -signed by Stacey Larrabee (staceylarrabee15@gmail.com)
Signature Date: 2024-04-24 - 10:41:57 PM GMT - Time Source: server
0 Agreement completed.
2024-04-24 - 10:41:57 PM GMT
Powered by
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Contract Form
Entity Information
Entity Name*
LARRABEE, STACEY
Entity ID*
@00048552
Contract Name* Contract ID
LARRABEE, STACEY CASE MANAGEMENT AGENCY 8084
(CMA) SUPPORT INTENSITY SCALE (SIS) PROFESSIONAL
SERVICES AGREEMENT Contract Lead*
SADAMS
Contract Status
CTB REVIEW
O New Entity?
Contract Lead Email
sadams@weld.gov;cobbx
xlk@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description*
(CONSENT) LARRABEE, STACEY CASE MANAGEMENT AGENCY (CMA) SUPPORT INTENSITY SCALE (SIS)
PROFESSIONAL SERVICES AGREEMENT. TERM 05/01 /25 THROUGH 04/30/25.
Contract Description 2
PA ROUTED THROUGH BOCC ON 4/24/2024 AND WAS APPROVED ON 5/1/2024, KNOWN TO CTB AS TYLER#
2024-1053
Contract Type"
AGREEMENT
Amount*
$0.00
Renewable"
NO
Automatic Renewal
Grant
IGA
Department Requested BOCC Agenda Due Date
HUMAN SERVICES Date* 05/02/2024
05/06/2024
Department Email
CM-
HumanServices@weldgov.
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
02/28/2025
Committed Delivery Date
Renewal Date
Expiration Date*
04/30/2025
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
CONSENT 05/01/2024
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CONSENT CONSENT
DH Approved Date Finance Approved Date Legal Counsel Approved Date
05/01/2024 05/01/2024 05/01/2024
Final Approval
BOCC Approved Tyler Ref #
AG 050624
BOCC Signed Date Originator
SADAMS
BOCC Agenda Date
05/06/2024
Hello