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Home My WebLink About20223542.tiffC4vC+aLQeq PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: January 10, 2023 TO: Board of County Commissioners — Pass -Around .y FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment #1 with Appa Therapy, PLLC 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 Appa Therapy, PLLC. The Department has an Agreement with Appa Therapy, PLLC for Home Studies and Home -Based Intervention Services. This Agreement is known to the Board as Tyler ID# 2022-3542. We are now requesting to Amend the Agreement to add Life Skills and Mental Health Services. The Term of the Agreement shall be from November I, 2022 through May 31, 2023. fees for Services Program Area: Life Skills Therapeutic Visitation Rate Unit Type Service Name $110.00 Hour In OfficeNideo $130.00 Hour In -Office with Transportation - 15 miles included in rate $130.00 Hour In -Home or Community — 15 miles included in rate $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $110.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 Parenting Classes Rate Unit Type Service Name $50.00 Hour In OfficeNideo $50.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffutg $50.00 Each No show $0 60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 Pass-Aro C.bYlS2.4'rl- #� of /Z5/23 d Memorandum; January 10, 2023 - CMS ID ¢16Z9 1M5/At Page 1 Z0LZ--35qZ PRIVILEGED AND CONFIDENTIAL Individual or Family Therapy Rate Unit Type Service Name $125.00 Hour In OfficeNideo • $140.00 Hour In -Office with Transportation - 15 miles Included in rate $140.00 Hour In -Home or Community — 15 miles included in rate $85.00 Hour Family Team Meeting (FTM), Team'Decision Making (TDM), Professional Staffing $125.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, . Greeley, Colorado 80631 Reunification Therapy Rate Unit Type Service Name $140.00 Hour In OfficeNideo $150.00 Hour In -Office with Transportation - 15 miles included in rate $150.00 Hour In -Home or Community —15 miles included in rate $90.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional • Staffing . $150.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9`h Street #5, Greeley, Colorado 80631 I do not recommend a Work Session. I recommend approval of this Agreement Amendment #1 and authorize the Chair to sign. Mike Freeman, Chair Perry L. Buck, Pro -Tern Scott K. James Kevin Ross Lori Saine Approve Schedule Recommendation Work Session Other/Comments: 1e - Pass -Around Memorandum; January 10, 2023 - CMS ID 6609 • Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND APPA THERAPY, PLLC This Agreement Amendment, made and entered into 25 day of J 2023 by and between the Board of Weld County Commissioners, on behalf of the Weld County DepartmeM of Human Services, hereinafter referred to as the "Department", and Appa Therapy, PLLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home Studies and Home -Based Intervention. (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-3542, approved on December 21, 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. 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: I. 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. ATTES BY: Deputy Cler COIINIL BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ike Freeman, Chair JAN 2 5 2323 fONTRACTOR', Appa Therapy, PLLC 2625 Redwing Road, Suite 225 Fort Collins, Colorado 80526 (520) 780-1552 ping otaGlfeez e By: emma mackentie Ilan 6,102310:28 MST, ozoaa - �T•2- Emma MacKenzie, Marriage and Family Therapist Date: Jan 6, 2023 EXHIBIT A SCOPE OF SERVICES Contractor will provide Home Studies and Home -Based Intervention, as referred by the Department. Program Area: Home Studies 1. Home Studies a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor is certified in Structured Analysis Family Evaluation (SAFE) and is on the State's approved home study vendor list. Contractor also is certified as a SAFE Supervisor. ii. Contractor will conduct the following types of Home Studies: 1. Kinship Care 2. Foster Care 3. Kinship Foster Care 4. Parent Care 5. Foster -Adoption 6. Adoption 7. Interstate Compact on the Placement of Children (ICPC) iii. Contractor will utilize the most current SAFE forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: I. SAFE Home Study template. 2. Compatibility Inventory. 3. References and documented direct follow-up with references (phone call or meeting). 4. Psychosocial Inventory for all applicants. 5. Questionnaire I and II for all applicants. 6. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. 7. All additional collateral information collected from the applicants. 8. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual Hi or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. iv. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staffas follows: 1. Following completion of individual applicant meetings. 2. Three (3) weeks after the completion of individual applicant meetings. 3. Prior to the final review with the applicant(s). b. Anticipated Frequency of Services: i. Four (4) to five (5) times per study. c. Anticipated Duration of Services: i. Contractor will complete the home study within sixty (60) days from the referral date. d. Goals of Services: 1 i. To help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement or adoption. e. Outcomes of Services: i. To determine if the character and suitability of the applicant(s) is appropriate to safely cam for the children being placed in the home. ii. A written report, using the SAFE model, submitted to the Department. iii. Approve or deny the applicant(s) based on information gathered during the Home Study. f. Target Population: i. All foster, adoption, and kinship applicants, including additional adults, and children within the house. ii. Any gender and age. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In office located at 2005 9th Street, #5, Greeley, Colorado 80631. ii. Client's home. iii. In the Community. Program Area: Life Skills I. Therapeutic Visitation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma Focused Cognitive Behavioral Therapy (TFCBT). ii. Attachment -based interventions. b. Anticipated Frequency of Services: i. Three (3) hours per week. c. Anticipated Duration of Services: i. Five (5) to six (6) months. d. Goals of Services: i. Re-establish trust and attachment within the parent/child relationship in a safe and supported space. ii. Provide psychoeducation to parents related to how they can repair the pattern of interactions that created estrangement. iii. Empower and educate parents on how they can care for their child. iv. Teach appropriate and safe parenting techniques for when children escalate in their behaviors. e. Outcomes of Services: i. Parents will be able to rebuild the trust and stability with their children. ii. Parents will be able to use appropriate and safe techniques when unwanted behavior is present. iii. Parents will feel empowered and confident int their parenting skills. 2 f. Target Population: i. Parents who have had a separation or break in their attachment to their children. ii. All genders. iii. All ages. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In office located at 2005 9th Street, 05, Greeley. Colorado 80631. ii. At the Department. iii. In client's home. iv. In the community. 2. Parenting Classes a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Nurturing parenting class. ii. Beyond consequences parenting class. iii. Attachment based theories such as emotionally focused family therapy. iv. Trauma Focused Cognitive Behavioral Therapy (TFCBT). b. Anticipated Frequency of Services: i. Three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) weeks. d. Goals of Services: i. Teach parents about emotional regulation and dysregulation. ii. Teach parents about window of stress tolerance. iii. Teach parent about trauma and memory. iv. Teach parents about acting out behaviors, such as lying, stealing, and aggression. v. Teach parents about signs and stages of verbal and behavioral escalation. vi. Teach parents bow to respond to decrease escalation. vii. Teach parents about appropriate and enforceable limits. e. Outcomes of Services: i. Parents will be able to recognize emotional regulation and dysregulation. ii. Parents will be able to understand when their child is outside of their window of stress tolerance. iii. Parents will have an understanding about trauma and memory. iv. Parents will be able to have appropriate and safe skills to help their child when they are having acting out behaviors, such as lying, stealing, and aggression. v. Parents will recognize signs and stages of verbal and behavioral escalation. vi. Parents will know how to respond to their children to decrease escalation. vii. Parents will be able to have and model appropriate and enforceable limits with their children. f. Target Population: i. Parents who are struggling with appropriate, safe, and effective parenting skills. 3 g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office located at 2005 9th Street, #5, Greeley, Colorado 80631. ii. At the Department. iii. Virtual. Program Area: Mental Health Services 3. Individual or Family Therapy Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma Focused Cognitive Behavioral Therapy (TFCBT). ii. Solution Focused Family Therapy. iii. Emotionally Focused Family Therapy. iv. Systems Family Therapy. b. Anticipated Frequency of Services: i. Two (2) hours per week. c. Anticipated Duration of Services: i. Five (5) to six (6) months. d. Goals of Services: i. Help improve troubled relationships within the family. ii. Improve healthy boundaries within the family to provide stability. iii. Understand the patterns of family interactions that are present that have added to the dysfunction. iv. Provide healing and understanding of attachment wounds that are present within the family. v. Improve communication. vi. Understand how any unmet needs (emotional or physical) have contributed to felt safety in any manner. e. Outcomes of Services: i. Family will be able to communicate needs in a productive manner. ii. Family will be able to work through future problems without escalating or becoming dysregulated. iii. Family will have a better understanding of their family rules and boundaries and have appropriate problem -solving techniques if changes in the boundaries or rules are needed. f. Target Population: i. Families that are struggling with appropriate boundaries and communication. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. 4 i. Service Access and Transportation: i. In office located at 2005 9th Street, #5. Greeley, Colorado 80631. ii. In client's home. iii. In the community. 4. Reunification Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma Focused Cognitive Behavioral Therapy (TFCBT). ii. Solution Focused Family Therapy. iii. Emotionally Focused Family Therapy. iv. Systems Family Therapy. b. Anticipated Frequency of Services: i. Two (2) hours per week. c. Anticipated Duration of Services: i. Seven (7) to eight (8) months. d. Goals of Services: i. Reunite or reestablish a parent/child relationship. ii. Understand causes of estrangement as previous patterns of attachment and interactions. iii. Heal attachment wounds caused by dysfunctional patterns of interactions. iv. Promote healthy communication to help parents understand attachment needs. v. Work with parents to understand how to prevent this situation from occurring again. e. Outcomes of Services: i. Provide healing within the family system to promote healthy family relationships. ii. Parents will have a clear understanding of how their behaviors created dysfunction within the family system. iii. Allow children to regain trust within the parent/child relationship. iv. Establish new family rules and understandings within the family system to provide stability for everyone. f. Target Population: i. Parent/Child relationship that has estrangement or alienation present. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office located at 2005 9th Street, #5, Greeley, Colorado 80631. ii. In client's home. iii. In the community. Program Area: Home -Based Services 5. Parent Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Nurturing parenting class. ii. Beyond consequences parenting class. S iii. Attachment based theories such as emotionally focused family therapy. iv. Trauma Focused Cognitive Behavioral Therapy (TFCBT). b. Anticipated Frequency of Services: i. One (l) to two (2) hours per week. c. Anticipated Duration of Services: i. Three (3) to Five (5) months. d. Goals of Services: i. Teach parents about emotional regulation and dysregulation. ii. Teach parents about window of stress tolerance. iii. Teach parents about trauma and memory. iv. Teach parents about acting out behaviors, such as lying, stealing, and aggression. v. Teach parents about signs and stages of verbal and behavioral escalation. vi. Teach parents how to respond to decrease escalation. vii. Teach parents about appropriate and enforceable limits. viii. Work directly with parent and child to help coach parent in real life situations. e. Outcomes of Services: i. Parents will be able to recognize emotional regulation and dysregulation. ii. Parents will be able to understand when their child is outside of their window of stress tolerance. iii. Parents will have an understanding about trauma and memory. iv. Parents will be able to have appropriate and safe skills to help their child when they are having acting out behaviors, such as lying, stealing, and aggression. v. Parents will recognize signs and stages of verbal and behavioral escalation. vi. Parents will know how to respond to their children to decrease escalation. vii. Parents will be able to have and model appropriate and enforceable limits with their children. f. Target Population: i. Parents who are struggling with their children's behavior. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office located at 2005 9th Street, #5, Greeley, Colorado 80631. ii. In client's home. iii. In the community. Terms 1. Contractor will respond to the Mental Health and Support Team HS-CWServiceReferraIl8iweldeov.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 6 period, the Contractor will notify the caseworker and the Mental Health and Support Team HS- CW ServiceReferralCaliweldeov.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 Mental Health and Support Team HS- CWServiceReferraEtiiweldeov.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 Mental Health and Support Team HS-CWServiceReferral(a,weldeov.com immediately via email, to discuss service continuation. 5. Contractor will identify, in detail, areas of continued concem 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 concems 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 Team HS-CWServiceReferral(a,weldeov.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 Stuffings, 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 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. Stuffings 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. 7 10. On a monthly basis, the Contractor will notify the :Mental Health and Support Team HS- CWServiceReferralthweldEov.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. 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 Program Area: Home Studies Home Studies Rate Unit Type Service Name $1,200.00 Each Full Home Study with two (2) Adults $450.00 Each Partial Home Study $600.00 Each Updated Home Study $125.00 Each Additional Adult, after initial two (2) Program Area: Life Skills Therapeutic Visitation Rate Unit Type Service Name $110.00 Hour In OfficeNideo $130.00 Hour In -Office with Transportation - 15 miles included in rate $130.00 Hour In -Home or Community — 15 miles included in rate $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $110.00 Each No show S0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 Parenting Classes Rate Unit Type Service Name $50.00 Hour In OfficeNideo $50.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $50.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 Program Area: Mental Health Services Individual or Family Therapy Rate Unit Type Service Name $125.00 Hour In OfflceNideo $140.00 Hour In -Office with Transportation - 15 miles included in rate $140.00 Hour In -Home or Community —15 miles included in rate $85.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $125.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 Reunification Therapy Rate Unit Type Service Name $140.00 Hour In OffrceNideo $150.00 Hour In -Office with Transportation - 15 miles included in rate $150.00 Hour In -Home or Community —15 miles included in rate $90.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $150.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 Program Area: Home -Based Services Parent Coaching Rate Unit Type Service Name $80.00 Hour In OfficeNideo $95.00 Hour In -Office with Transportation - 15 miles included in rate $95.00 Hour In -Home or Community — 15 miles included in rate $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $80.00 Each No show S0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5, Greeley, Colorado 80631 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 7. 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. Contract Form New Contract Request Entity Information Entity Name* APPA THERAPY PLLC ❑ New Entity? Entity ID* :00046.392 Contract Name* Contract ID APPA THERAPY, PLLC (AGREEMENT AMENDMENT O1 PY 6609 2022-23) Contract Status CTB REVIEW Contract Lead* WLUNA Contract Lead Email wlunaOweldgov.com;cobbx xlkooweldgov.com Contract Description* POST -BID PROVIDER PY 2022-23. AMENDMENT #1. TERM: 11/01:2022TO05,31:2023. Contract Description 2 PA ROUTING THROUGH NORMAL PROCESS. ETA TO CTB 01 12 ' 2023. Contract Type* AMENDMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@vveldgov.co m Department Head Email CM-HumanServices- DeptHead sweldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO RN EYg'WELDG OV.COM Requested BOCC Agenda Date* 01 '182023 Parent Contract ID 20223542 Requires Board Approval YES Department Project # Due Date 01114:2023 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 ti 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 Review Date* 03=31,2023 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Expiration Date* 05,'31 2023 Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH DH Approved Date 01x'11,'2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 01=2512023 Originator WLLINA Finance Approver CHERYL PATTELLI Legal Counsel BRUCE BARKER. Finance Approved Date Legal Counsel Approved Date 01!12;2023 01,17;2023 Tyler Ref # AG 012523 RESOLUTION RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE CHAIR TO SIGN - APPA THERAPY, PLLC WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Appa Therapy, PLLC, commencing November 1, 2022, and ending May 31, 2023, 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 Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Appa Therapy, PLLC, 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 21st day of December, A.D., 2022, nunc pro tunc November 1, 2022. BOARD OF COUNTY COMMISSIONERS WE COUNTY, COUNTY, COLORADO ATTEST: +V AE.� M4i ,/ jdto;vi Weld County Clerk to the Board BY: ounty A orney Date of signature: oI/a3/23 tt K. James, Chair Mike Freeman, Pro-Tem -6PA4f,"410,,,e,t Perry L. Buck Lori Saine cc:I-15D of /pa /z3 2022-3542 HR0094 Con*aC&-U tj 551 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: December 12, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement with Appa Therapy, PLLC 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 Child Protection Agreement with Appa Therapy, PLLC. The Department is requesting to enter into an Agreement with Appa Therapy, PLLC for Home Studies and Home -Based Intervention. The Term of the Agreement shall be from November 1, 2022 through May 31, 2023. Fees for Services Program Area: Home Studies Home Studies Rate Unit Type Service Name $1,200.00 Each Full Home Study with two (2) Adults $450.00 Each Partial Home Study $600.00 Each Updated Home Study $125.00 Each Additional Adult, after initial two (2) Program Area: Home -Based Intervention Therapeutic Visitation Rate Unit Type Service Name $110.00 Each In Office/Video $130.00 Each In -Office with Transportation - 15 miles included in rate $130.00 Each In -Home or Community —15 miles included in rate $75.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $110.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 95 Street #5 Parenting Classes Rate Unit Type Service Name $50.00 Each In OfficeNideo $50.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $50.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5 Pass -Around Memorandum; December 12, 2022 - CMS ID 6557 2022-3542 PRIVILEGED AND CONFIDENTIAL Family Therapy Rate Unit Type Service Name $125.00 Each In Office/Video $140.00 Each In -Office with Transportation - 15 miles included in rate $140.00 Each In -Home or Community — 15 miles included in rate $85.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $125.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9u Street #5 Reunification Therapy Rate Unit Type Service Name $140.00 Each In OfficeNideo $150.00 Each In -Office with Transportation - 15 miles included in rate $150.00 Each In -Home or Community — 15 miles included in rate $90.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $150.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9° Street #5 Parent Coaching Rate Unit Type Service Name $80.00 Each In OfficeNideo $95.00 Each In -Office with Transportation - 15 miles included in rate $95.00 Each In -Home or Community — 15 miles included in rate $75.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $80.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9`1 Street #5 I do not recommend a Work Session. I recommend approval of this Child Protection Agreement and authorize the Chair to sign. Perry L. Buck Mike Freeman, Pro -Tern Scott K. James, Chair Steve Moreno Lori Saine Approve Schedule Recommendation Work Session ,;'91 Other/Comments: Pass -Around Memorandum; December 12, 2022 - CMS ID 6557 Page 2 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND APPA THERAPY, PLLC This Agreement, made and entered into the jj!ray of tie OM bey , Z0ZZ , 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 Appa Therapy, PLLC, 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 B2200040 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 Home Studies and Home -Based Intervention. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on November 1, 2022, upon proper execution of this Agreement and shall expire May 31, 2023, unless sooner terminated as provided herein. 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 Mental Health and Support Services Team (HS-CWServicereferral(a,weldeov.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 7t' 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 result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in termination of the Agreement. 1 d. Contractor agrees to submit a monthly report by the '1t'' 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. Pavment 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. 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 2 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. sec .. and its implementing regulation, 45 C.F.R. Part 80 et. m; 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. sec ., 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 Ad of 1967; and the Equal Pay Act of 1963; and the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, 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 3 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 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 4 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 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 5 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; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. 6 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. 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. 7 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 of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). 8 For Department: For Contractor: Heather Walker, Child Welfare Division Head Emma MacKenzie, Marriage and Family Therapist 17. Notice All notices required to be given by the parties hereunder shall be given by certified or regis eyed 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: Emma MacKenzie, Marriage and Family Therapist 2625 Redwing Road, Suite 225 Fort Collins, CO 80526 (520) 780-1552 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 bean 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. sea•, 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 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 9 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 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, 10 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 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 11 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. §§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 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. 12 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: Weld County Clerk to the Board ° °� t;'r L ,p WELD COUNTY, COLORADO didtkv J4L: BOARD OF COUNTY COMMISSIONERS By. Deputy Clerk to the Board 13 K. James, Chair DEC 2 12x22 CONTRACTOR: Appa Therapy, PLLC 2625 Redwing Road, Suite 225 Fort Collins, Colorado 80526 (520) 780-1552 eermra mradrreMzie By: emma mackenzie (Dec 6, 202213:25 MST) Emma MacKenzie, Marriage and Family Therapist Date: Dec 6, 2022 a0=- 35ya EXHIBIT A SCOPE OF SERVICES Contractor will provide Home Studies and Home -Based Intervention, as referred by the Department. Program Area: Home Studies 1. Home Studies a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Contractor is certified in Structured Analysis Family Evaluation (SAFE) and is on the State's approved home study vendor list. Contractor also is certified as a SAFE Supervisor. ii. Contractor will conduct the following types of Home Studies: 1. Kinship Care 2. Foster Care 3. Kinship Foster Care 4. Parent Care 5. Foster -Adoption 6. Adoption 7. Interstate Compact on the Placement of Children (ICPC) iii. Contractor will utilize the most current SAFE forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: 1. SAFE Home Study template. 2. Compatibility Inventory. 3. References and documented direct follow-up with references (phone call or meeting). 4. Psychosocial Inventory for all applicants. 5. Questionnaire I and II for all applicants. 6. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. 7. All additional collateral information collected from the applicants. 8. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual 18 or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. iv. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: 1. Following completion of individual applicant meetings. 2. Three (3) weeks after the completion of individual applicant meetings. 3. Prior to the final review with the applicant(s). b. Anticipated Frequency of Services: i. Four (4) to five (5) times per study. c. Anticipated Duration of Services: i. Contractor will complete the home study within sixty (60) days from the referral date. d. Goals of Services: 1 i. To help the Department determine if the applicants are appropriate for foster or kinship care certification, ICPC placement or adoption. e. Outcomes of Services: i. To determine if the character and suitability of the applicant(s) is appropriate to safely care for the children being placed in the home. ii. A written report, using the SAFE model, submitted to the Department. iii. Approve or deny the applicant(s) based on information gathered during the Home Study. f. Target Population: i. All foster, adoption, and kinship applicants, including additional adults, and children within the house. ii. Any gender and age. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office located at 2625 Redwing Road, Suite 225, Fort Collins, Colorado 80526. ii. Client's home. iii. In the Community. Program Area: Home -Based Intervention 1. Therapeutic Visitation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma Focused Cognitive Behavioral Therapy (TFCBT). ii. Attachment -based interventions. b. Anticipated Frequency of Services: i. Three (3) hours per week. c. Anticipated Duration of Services: i. Five (5) to six (6) months. d. Goals of Services: i. Re-establish trust and attachment within the parent/child relationship in a safe and supported space. ii. Provide psychoeducation to parents related to how they can repair the pattern of interactions that created estrangement. iii. Empower and educate parents on how they can care for their child. iv. Teach appropriate and safe parenting techniques for when children escalate in their behaviors. e. Outcomes of Services: i. Parents will be able to rebuild the trust and stability with their children. ii. Parents will be able to use appropriate and safe techniques when unwanted behavior is present. iii. Parents will feel empowered and confident int their parenting skills. 2 f. Target Population: i. Parents who have had a separation or break in their attachment to their children. ii. All genders. iii. All ages. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In office located at 2625 Redwing Road, Suite 225, Fort Collins, Colorado 80526. ii. At the Department. iii. In client's home. iv. In the community. 2. Parenting Classes a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Nurturing parenting class. ii. Beyond consequences parenting class. iii. Attachment based theories such as emotionally focused family therapy. iv. Trauma Focused Cognitive Behavioral Therapy (TFCBT). b. Anticipated Frequency of Services: i. Three (3) hours per week. c. Anticipated Duration of Services: i. Three (3) weeks. d. Goals of Services: i. Teach parents about emotional regulation and dysregulation. ii. Teach parents about window of stress tolerance. iii. Teach parent about trauma and memory. iv. Teach parents about acting out behaviors, such as lying, stealing, and aggression. v. Teach parents about signs and stages of verbal and behavioral escalation. vi. Teach parents how to respond to decrease escalation. vii. Teach parents about appropriate and enforceable limits. e. Outcomes of Services: i. Parents will be able to recognize emotional regulation and dysregulation. ii. Parents will be able to understand when their child is outside of their window of stress tolerance. iii. Parents will have an understanding about trauma and memory. iv. Parents will be able to have appropriate and safe skills to help their child when they are having acting out behaviors, such as lying, stealing, and aggression. v. Parents will recognize signs and stages of verbal and behavioral escalation. vi. Parents will know how to respond to their children to decrease escalation. vii. Parents will be able to have and model appropriate and enforceable limits with their children. f. Target Population: 3 i. Parents who are struggling with appropriate, safe, and effective parenting skills. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. In office located at 2625 Redwing Road, Suite 225, Fort Collins, Colorado 80526. ii. At the Department. iii. Virtual. 3. Individual or Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma Focused Cognitive Behavioral Therapy (TFCBT). ii. Solution Focused Family Therapy. iii. Emotionally Focused Family Therapy. iv. Systems Family Therapy. b. Anticipated Frequency of Services: i. Two (2) hours per week. c. Anticipated Duration of Services: i. Five (5) to six (6) months. d. Goals of Services: i. Help improve troubled relationships within the family. ii. Improve healthy boundaries within the family to provide stability. iii. Understand the patterns of family interactions that are present that have added to the dysfunction. iv. Provide healing and understanding of attachment wounds that are present within the family. v. Improve communication. vi. Understand how any unmet needs (emotional or physical) have contributed to felt safety in any manner. e. Outcomes of Services: i. Family will be able to communicate needs in a productive manner. ii. Family will be able to work through future problems without escalating or becoming dysregulated. iii. Family will have a better understanding of their family rules and boundaries and have appropriate problem -solving techniques if changes in the boundaries or rules are needed. f. Target Population: i. Families that are struggling with appropriate boundaries and communication. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: 4 i. In office located at 2625 Redwing Road, Suite 225, Fort Collins, Colorado 80526. ii. In client's home. iii. In the community. 4. Reunification Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma Focused Cognitive Behavioral Therapy (TFCBT). ii. Solution Focused Family Therapy. iii. Emotionally Focused Family Therapy. iv. Systems Family Therapy. b. Anticipated Frequency of Services: i. Two (2) hours per week. c. Anticipated Duration of Services: i. Seven (7) to eight (8) months. d. Goals of Services: i. Reunite or reestablish a parent/child relationship. ii. Understand causes of estrangement as previous patterns of attachment and interactions. iii. Heal attachment wounds caused by dysfunctional patterns of interactions. iv. Promote healthy communication to help parents understand attachment needs. v. Work with parents to understand how to prevent this situation from occurring again. e. Outcomes of Services: i. Provide healing within the family system to promote healthy family relationships. ii. Parents will have a clear understanding of how their behaviors created dysfunction within the family system. iii. Allow children to regain trust within the parent/child relationship. iv. Establish new family rules and understandings within the family system to provide stability for everyone. f. Target Population: i. Parent/Child relationship that has estrangement or alienation present. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office located at 2625 Redwing Road, Suite 225, Fort Collins, Colorado 80526. ii. In client's home. iii. In the community. 5. Parent Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Nurturing parenting class. ii. Beyond consequences parenting class. iii. Attachment based theories such as emotionally focused family therapy. iv. Trauma Focused Cognitive Behavioral Therapy (TFCBT). 5 b. Anticipated Frequency of Services: i. One (1) to two (2) hours per week. c. Anticipated Duration of Services: i. Three (3) to Five (5) months. d. Goals of Services: i. Teach parents about emotional regulation and dysregulation. ii. Teach parents about window of stress tolerance. iii. Teach parents about trauma and memory. iv. Teach parents about acting out behaviors, such as lying, stealing, and aggression. v. Teach parents about signs and stages of verbal and behavioral escalation. vi. Teach parents how to respond to decrease escalation. vii. Teach parents about appropriate and enforceable limits. viii. Work directly with parent and child to help coach parent in real life situations. e. Outcomes of Services: i. Parents will be able to recognize emotional regulation and dysregulation. ii. Parents will be able to understand when their child is outside of their window of stress tolerance. iii. Parents will have an understanding about trauma and memory. iv. Parents will be able to have appropriate and safe skills to help their child when they are having acting out behaviors, such as lying, stealing, and aggression. v. Parents will recognize signs and stages of verbal and behavioral escalation. vi. Parents will know how to respond to their children to decrease escalation. vii. Parents will be able to have and model appropriate and enforceable limits with their children. f. Target Population: i. Parents who are struggling with their children's behavior. g. Language: i. English h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. In office located at 2625 Redwing Road, Suite 225, Fort Collins, Colorado 80526. ii. In client's home. iii. In the community. Terms 1. Contractor will respond to the Mental Health and Support Team HS-CWServiceReferral(a�weldeov.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 Mental Health and Support Team HS - C W ServiceReferral(a,weldgov.com. 6 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 Mental Health and Support Team HS- CWServiceReferral(rweldeov.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 Mental Health and Support Team HS-CWServiceReferral(a,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 Mental Health and Support Team HS-CWServiceReferral(&,weldeov.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 Stuffings, 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 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. Stuffings 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 Mental Health and Support Team HS- CWServiceReferral(b5weldeov.com of new staff who will manage and/or administer the services with the following information: 7 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. 8 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 Program Area: Home Studies Home Stud ies Rate Unit Type Each Service Name $1,200.00 $450.00 $600.00 $125.00 Full Home Study with two (2) Adults Partial Home Study Updated Home Study Additional Adult, after initial two (2) Each Each Each Program Area: Home -Based Intervention Therapeutic Visitation Rate Unit Type Service Name $110.00 Each In OfficeNideo $130.00 Each In -Office with Transportation - 15 miles included in rate $130.00 Each In -Home or Community — 15 miles included in rate $75.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $110.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5 Parenting Classes Rate Unit Type Service Name $50.00 Each In OfficeNideo $50.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $50.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5 Family The Rate rapy Unit Type Each Service Name $125.00 $140.00 $140.00 In OfficeNideo Each Each In -Office with Transportation - 15 miles included in rate In -Home or Community — 15 miles included in rate $85.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $125.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5 Reunification Therapy Rate Unit Type Service Name $140.00 Each In OfficeNideo $150.00 Each In -Office with Transportation - 15 miles included in rate $150.00 Each In -Home or Community —15 miles included in rate $90.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $150.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5 Parent Coaching Rate Unit Type Service Name $80.00 Each In OfficeNideo $95.00 Each In -Office with Transportation - 15 miles included in rate $95.00 Each In -Home or Community — 15 miles included in rate $75.00 Each Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $80.00 Each No show $0.60 Per Mile Mileage - for distances exceeding 15 roundtrip miles from 2005 9. Street #5 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 7. 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 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 Appa Therapy, PLLC Agency Name: Trails Provider ID (if known): Emma MacKenzie Marriage and Family Therapist Provider Contact Full Name: Title: 5207801552 Primary Phone Number (10 -digit): Primary Contact Email: emma@appatherapy.com Ext.: Fax Number (10 -digit): n/a Web Address: Agency Location Address (street, city, state, zip): 2625 Redwing RD suite 225, Fort Collins CO 80526 2930 W Stuart St Unit 1, Fort Collins CO 80526 Agency Mailing Address (Street, city, state, zip): Agency Type (pick one): E] Public Company Ei Private Non -Profit D Private for Profit Send Referrals for Service to: Appa Therapy, PLLC Marriage and Family Therapist Referral Contact Name: Title: 5207801552 Referral Phone Number (10 -digit): Ext.: Email- emma@appatherapy.com Billing Contact Emma MacKenzie Billing Contact Name: Billing Phone Number (10 -digit): 5207801552 Ext.: Marriage and Family Therapist Title: Email: emma@appatherapy.com I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it ihas so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County iDepartment of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept Ithe bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are I competitive in price and quality. WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBERIS I I 1 i Authorized Rep. Full Name: Emma MacKenzie Marriage and Family Therapist 1 Title: I emma@appatherapy.com Rep. Email: Phone (10 -digit): Ext.:com 5207801552 i I2930 W Stuart St Unit 1 Fort Collins CO 80526 i Authorized Rep. Address (Street, city, state, zip): i Signature of Authorized Rep.: 2 Date: 11/02/22 i 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: Appa Therapy Program Area: Home Studies Program Areas are listed in column 1 of the table located in Item XI 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: Home Studies 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - SAFE Home Study Training - Trauma -Focused Cognitive Behavioral Therapy Beyond Consequences Parenting Class - Nurturing Parenting Class - SAFE Home Study Interview Training 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: 2.1c 2.1d 2.1e Anticipated duration of service (i.e. 3-4 months): 60 days Three (3), or more, specific goals of the service (DO use bullet points): - Ensure that the child placed into the home would be in a safe and nurturing environment - Check for safety and appropriate space for children - Collect history of the family including any previous child abuse or maltreatment, family dynamics, and criminal activity - Collect social, family, and educational history - Understand support system and stability within the family - Help prepare the family for the process of caring for children Three (3), or more, specific outcomes of service: - Provide the county with a better understanding of the family system - Prepare the prospective care providers for the process of caring for children - Understand what type of environment is present in the home Ensure the family system is a suitable home 2.1f Target population of the service, including age and gender: Families wanting to be considered for prospective kinship, foster, adoptive, and/or guardianship families for the county 2.1g Languages service is available in (please list proficiency and if interpreter services are available): none 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: none 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) In office, client's home, and 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): REV. OCT 2021 1 ATTACHMENT C - PROPOSAL 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): 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: REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 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: 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 miles. 40 Miles 3.5 When you calculate mileage, what is your starting point address? 2005 9th Street #5 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: 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: $ 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 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: $ Amount Unit Type per Hour REV. OCT 2021 3 ATTACHMENT C - PROPOSAL No. of roundtrip miles included in rate: 4.2b In -Office with Transportation: per Hour miles No. of roundtrip miles included in rate: 4.2c In -Home or Community: per Hour miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: 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: 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: $ Amount Unit Type 4.4a In-Office/Video: per Hour No. of roundtrip miles included in rate: 4.4b In -Office with Transportation: per Hour miles No. included in In -Home or Community: per Hour of roundtrip miles 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 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: per No Show 4.5f Mileage rate: 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 Home Study Providers — List your rates in the box below. $1200 $450 $600 $125 — Full — Partial — Updated - Additional home home study study home fee for study with additional two adults adults 4.8 Monitored Sobriety Providers — List your rates in the box below. REV. OCT 2021 4 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: Appa Therapy Program Area: Home -Based Intervention Number of services offered on this Attachment C (max 5): 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 Visitation 2.1a 2.1b 2.1c 2.1d 2.1e Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): TF-CBT, attachment -based interventions Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 3 hours/week Anticipated duration of service (i.e. 3-4 months): 5-6 months Three (3), or more, specific goals of the service (DO use bullet points): - Re-establish trust and attachment within the parent/child relationship in a safe and supported space - Provide psycho -education to parents related to how they can repair the pattern of interactions that created estrangement Empower and education parents on how they can care for their child Teach appropriate and safe parenting techniques for when children escalate in their behaviors Three (3), or more, specific outcomes of service: - Parents will be able to rebuild the trust and stability with their children Parents will be able to use appropriate and safe techniques when unwanted behavior is present Parent will feel empowered and confident in their parenting skills 2.1f Target population of the service, including age and gender: Parents who have had a separation or break in their attachment to their children. All genders and ages 2.1g _ Languages service is available in (please list proficiency and if interpreter services are available): No language services 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Not eligible for Medicaid 2.1i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home, in -office, at the department, and in the community Service #2 Name: Parenting Classes 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - Nurturing parenting class Beyond consequences parenting class Attachment based theories such as emotionally focused family therapy Trauma -Focused Cognitive Behavioral therapy 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: 3 hour/week 2.2c Anticipated duration of service (i.e. 3-4 months): 3 weeks 2.2d Three (3), or more, specific goals of the service (DO use bullet points): Teach parents about emotional regulation and dysregulation Teach parents about window of stress tolerance Teach parents about trauma and memory REV. OCT 2021 1 ATTACHMENT C - PROPOSAL - Teach parents about acting out behaviors i.e. lying, stealing, aggression, etc - Teach parents about signs and stages of verbal and behavioral escalation - Teach parents how to response to decrease escalation - Teach parents about appropriate and enforceable limits 2.2e Three (3), or more, specific outcomes of service: 2.2f 2.2g 2.2h 2.2i - Parents will be able to recognize emotional regulation and dysregulation - Parents will be able to understand when their child is outside of their window of stress tolerance Parents will have an understanding about trauma and memory - Parents will be able to have appropriate and safe skills to help their child when they are having acting out behaviors i.e. lying, stealing, aggression, etc - Parents will recognize signs and stages of verbal and behavioral escalation - Parents will know how to response to their children to decrease escalation - Parents will be able to have and model appropriate and enforceable limits with their children Target population of the service: Parents who are struggling with appropriate, safe, and effective parenting skills Languages service is available in (please list proficiency and if interpreter services are available): None Medicaid eligibility - list whether the service is eligible for Medicaid in whole or in part: Not eligible for Medicaid Service location - list where the service will take place (i.e. client's home, in -office, other) Virtual, in -office, or at the department Service #3 Name: Individual or Family Therapy 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - Trauma -Focused Cognitive Behavioral Therapy - Solution -Focused Family Therapy - Emotionally -Focused Family Therapy - Systems Family Therapy 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 hours/week 2.3c Anticipated duration of service (i.e. 3-4 months): 5 to 6 months 2.3d Three (3), or more, specific goals of the service (DO use bullet points): - Help improve troubled relationships within the family - Improve healthy boundaries within the family to provide stability - Understand the patterns of family interactions that are present that have added to the dysfunction Provide healing and understanding of attachment wounds that are present within the family Improve communication Understand how any unmet needs (emotional or physical) has contributed to felt safety in any manner 2.3e Three (3), or more, specific outcomes of service: 2.3f 2.3g 2.3h 2.3i - Family will be able to communicate needs in a productive manner - Family will be able to work through future problems without escalating or becoming dysregulated - Family will have a better understanding of their family rules and boundaries and have appropriate problem - solving techniques if changes in the boundaries or rules are needed - Family will be Target population of the service: Families that are struggling with appropriate boundaries and communication Languages service is available in (please list proficiency and if interpreter services are available): none Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Not eligible for Medicaid Service location - list where the service will take place (i.e. client's home, in -office, other) Client's home, in -office, and in the community Service #4 Name: Reunification Therapy 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. OCT 2021 2 ATTACHMENT C - PROPOSAL - Trauma -Focused Cognitive Behavioral Therapy - Solution -Focused Family Therapy - Emotionally -Focused Family Therapy - Systems Family Therapy 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 hours/week 2.4c Anticipated duration of service (i.e. 3-4 months): 7-8 months 2.4d Three (3), or more, specific goals of the service (DO use bullet points): Reunite or reestablish a parent/child relationship - Understand causes of estrangement as previous patterns of attachment and interactions - Heal attachment wounds caused by dysfunctional patterns of interactions - Promote healthy communication to get help parents understand attachment needs Work with parents to understand how to prevent this situations from occurring again 2.4e Three (3), or more, specific outcomes of service: - Provide healing within the family system to promote healthy family relationships - Parents will have a clear understanding of how their behaviors created dysfunction within the family system - Allow children to regain trust within the parent/child relationship Establish new family rules and understandings within the family system to provide stability for everyone 2.4f Target population _ of the service: Parent/Child relationship that has estrangement or alienation present 2.4g Languages service is available in (please list proficiency and if interpreter services are available): None i 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Not eligible for Medicaid _ 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) In -office, client's home, and in the community Service #5 Name: Parent Coaching 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): - Nurturing parenting class - Beyond consequences parenting class - Attachment based theories such as emotionally focused family therapy - Trauma -Focused Cognitive Behavioral therapy 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: 1 to 2 hours/week 2.5c Anticipated duration of service (i.e. 3-4 months): 3 to 5 months 2.5d Three (3), or more, specific goals of the service (DO use bullet points): - Teach parents about emotional regulation and dysregulation - Teach parents about window of stress tolerance - Teach parents about trauma and memory - Teach parents about acting out behaviors i.e. lying, stealing, aggression, etc Teach parents about signs and stages of verbal and behavioral escalation - Teach parents how to response to decrease escalation - Teach parents about appropriate and enforceable limits - Work directly with parent and child to help coach parent in real life situations 2.5e Three (3), or more, specific outcomes of service: - Parents will be able to recognize emotional regulation and dysregulation - Parents will be able to understand when their child is outside of their window of stress tolerance - Parents will have an understanding about trauma and memory - Parents will be able to have appropriate and safe skills to help their child when they are having acting out behaviors i.e. lying, stealing, aggression, etc - Parents will recognize signs and stages of verbal and behavioral escalation - Parents will know how to response to their children to decrease escalation REV. OCT 2021 3 ATTACHMENT C - PROPOSAL - Parents will be able to have and model appropriate and enforceable limits with their children 2.5f Target population of the service: Parents who are struggling with their children behaviors 2.5g Languages service is available in (please list proficiency and if interpreter services are available): None 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Not eligible for Medicaid 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) In office, client's home, community 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 miles. 3.5 When you calculate mileage, what is your starting point address? 40 Miles 2005 9th Street #5 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 Visitation 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: $ Amount 110 130 130 75 110 60 cents U nit 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: 15 15 This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: Parenting Classes 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: 4.2f Mileage rate: $ Amount 50 50 50 60 cents U nit 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: 15 15 This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: Family Therapy 4.3a In-Office/Video: 4.3b In -Office with Transportation: $ Amount 125 140 U nit Type per Hour per Hour No. of roundtrip miles included in rate: 15 miles REV. OCT 2021 4 ■ ATTACHMENT C - PROPOSAL 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: 140 85 125 60 cents per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: 15 This is paid after the miles listed above. miles 4.4 Hourly Service #4 Name: Reunification Therapy 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: $ Amount 140 150 150 90 150 60 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 induced in rate: 15 15 This is paid after the miles listed above. miles miles 4.5 Hourly Service #5 Name: Parent Coaching 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: $ Amount 80 95 95 75 80 60 cents 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: 15 15 This is paid after the miles listed above. miles miles 4.6 Monthly Service Rates (each level must be listed): Service Name Level Rate per Month No. of Direct Service Hours: with 4.6a 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 ATTACHMENT C - PROPOSAL Provider special notes: I will complete my SAFE training on November 15th, 2022 REV. OCT 2021 5 ATTACHMENT 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: Emma MacKenzie Emma Appa MacKenzie PLLC PHONE NUMBER: 5207801552 Thearpy, EMAIL: emma@appatherapy.com PROPOSED SERVICE(S): Visitation, Family pY Parenting Classes � Parent Coaching, g� Reunification Thera Therapy, Home Studies Theraputic Therapy, Legal Last Name Middle Initial Name Previous (If Legal applicable) Last Legal First Name Service Type Licensure/ Credentials DORA # (If applicable) MacKenzie M Emma Therapy LMFT MFT.0002251 CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ACO DR DATE(MM/DD/YYY1) CERTIFICATE OF LIABILITY INSURANCE 09/28/2022 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 Trust Risk Management Services, Inc. doing business in CO as Potomac Risk Management Services, Inc. g 111 Rockville Pike Suite 700 Rockville, MD 20850 CONTACT NAME: Trust Risk Management Services, Inc. PHONE FAX (ac, No, Est): (855) 655-1801 (A/C, No): (855) 850-2230 EMAIL ADDRESS:alhedinfo@trustmis.com INSURERS) AFFORDING COVERAGE NAIL # INSURER A: ACE American Insurance Company 22667 INSURED Emma Mackenzie 2930 W Stuart St Apt 1 Fort Collins, CO 80526-6614 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUER INSR =I POLICY NUMBER POLICY EFF (MM11ITI YY) POLICY EXP (MMIDD/YYYY) LIMITS A NI - COMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR G73793725 09/30/2022 09/30/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $150,000 MED EXP (Any one person) $25,000 PERSONAL R ADV INJURY $Included GENERAL AGGREGATE $$ GEM_ ®POLICY AGGREGATE LIMIT APPLIES PER: PROJECT LOC OTHER PRODUCTS-COMP/OPAGG $$ AUTOMOBILE - _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED _ AUTOS NN -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE - EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE2741ER EXCLUDED? (Mandamry in 7,3 If yes, describe ender DESCRIPTION OF OPERATIONS below 5/O PER OTH- STATUTE ER $ E.L.EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A PROFESSIONAL LIABILITY Occurrence 673793725 09/30/2022 09/30/2023 EACH INCIDENT ANNUAL AGGREGATE $1,000,000 $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Marriage/Family Therapist/Counselor-premium paid $317 CERTIFICATE HOLDER CANCELLATION APPA THEARPY PLLC 2625 REDWING ROAD SUITE 225 FORt collins, CO 80526 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 REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SIGNATURE REQUESTED: Weld/Appa Therapy, PLLC - CPA Final Audit Report 2022-12-06 Created: By: Status: Transaction ID: 2022-12-05 Windy Luna (wluna@co.weld.co.us) Signed CBJCHBCAABAAa4Ct7L4Uw35_-RtLBHOuNPIeJgOT2z2h "SIGNATURE REQUESTED: Weld/Appa Therapy, PLLC - CPA" History ,5 Document created by Windy Luna (wluna@co.weld.co.us) 2022-12-05 - 9:44:44 PM GMT a Document emailed to emma mackenzie (emma@appatherapy.com) for signature 2022-12-05 - 9:45:53 PM GMT Email viewed by emma mackenzie (emma@appatherapy.com) 2022-12-05 - 9:46:18 PM GMT tr'S0 Document e -signed by emma mackenzie (emma@appatherapy.com) Signature Date: 2022-12-06 - 8:25:27 PM GMT - Time Source: server Agreement completed. 2022-12-06 - 8:25:27 PM GMT Powered by Adobe Acrobat Sign Contract Form New Contract Request Entity Information Entity Name* APPA THERAPY PLLC Entity ID* gO0046392 Contract Name" APPA THERAPY, PLLC (NEW CHILD PROTECTION AGREEMENT) Contract Status CTB REVIEW ❑ New Entity? Contract ID 6557 Contract Lead" WLUNA Contract Lead Email wluna@weldgov. conrcobbx xlkOweldgov.com Parent Contract ID Requires Board Approval YES Department Project # Contract Description NEW CHILD PROTECTION AGREEMENT. POST -BID PROVIDER RELATED TO BID# 62200040. TERM: 11/01/2022 TO 05/31/2023. Contract Description 2 PA ROUTING THROUGH NORMAL PROCESS. ETA TO CTB 12/15/2022. Contract Type AGREEMENT Amount° Renewable. NO Automatic Renewal Department HUMAN SERVICES Department Email CM- HurnanServices@weldgov.co ttt Department Head Email CM-HumanServices- DeptHeadti@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTORN EY@ELDG OV.COM Requested 00CC Agenda Date" 12/21/2022 Due Date 12/17/2022 2022 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 Review Date 03/31/2023 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Expiration Date'* 05/31/2023 Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date Approval Process Department Head JAMIE ULRICH OH Approved Date 12/07/2022 Final Approval 11OCC Approved BOCC Signed Date BOCC Agenda Date 12/21/2022 Originator WLL►NA Finance Approver CHERYL PATTELLI Legal Counsel MATTHEW CONROY Finance Approved Date Legal Counsel Approved Date 12/08/2022 12/09/2022 Tyler Ref # AG 122122 Hello