HomeMy WebLinkAbout20231760.tiffRESOLUTION
RE: APPROVE STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR
INDIVIDUAL PROVIDER CONTRACTS FOR PURCHASE OF FOSTER CARE
SERVICES IN A FOSTER CARE HOME AND AUTHORIZE CHAIR TO SIGN
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 Standard Form of Agreement, Rates,
and Provider List for Individual Provider Contracts for Purchase of Foster Care Services in a
Foster Care Home 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 the
various providers as shown on the attached provider list, with further terms and conditions being
as stated in said standard form, and
1 Exhibit A to CWS-7A Individual Provider Contract for Purchase
of Foster Care Services in a Foster Care Home
WHEREAS, after review, the Board deems it advisable to approve said standard form,
rates, and provider list, copies of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Standard Form of Agreement, Rates, and Provider List for
Individual Provider Contracts for Purchase of Foster Care Services in a Foster Care Home
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 the various
providers as shown on the attached provider list, be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign any contracts consistent with said standard form.
cc: HST), ACT c r5(r&), C1 o n)
07/07/23
2023-1760
HR0095
STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR INDIVIDUAL
PROVIDER CONTRACTS FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER
CARE HOME
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 21st day of June, A.D., 2023.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: .,,, tj , Gje%,A
Weld County Clerk .11u
to the Board
BY:
Deputy Clerk to the Board
ountAttorney I
Date of signature:
(.e6 ZFS ) Za�� r►. tI Saine
2023-1760
HR0095
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: June 13, 2023
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: The Weld County Department of Human Services'
Child Welfare SFY 2023-24 Out -of -Home (OOH)
Foster and Kinship Care Provider Contract
Template, Provider List, and Associated Rates
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 Request Board Approval of the Weld County
Department of Human Services' Child Welfare SFY 2023-24 Out -of -Home (OOH) Foster
and Kinship Care Provider Contract Template, Provider List, and Associated Rates. The
State requires Counties to enter into agreements with providers for the purchase of OOI-I services
and has established the CWS-7A as the State prescribed agreement for County certified foster
and kinship care services. Counties are unable to alter the State CWS-7A agreement, therefore
Weld County has chosen to add County specific requirements for these providers within the
Exhibit A. This Exhibit has been reviewed by Assistant County Attorney, Byron Howell and
approved for use for the 2023-24 contract year. Upon approval by the Board, individual provider
amendments and contracts will be issued and processed through CMS.
The term of these contracts is based on the certification/recertification date of each provider and
is valid for one year. The following information is attached for your review:
1. CWS-7A Individual Provider Contract template with Exhibit A.
2. List of out -of -home providers for SFY 2023-24.
The service rate will be the State approved base anchor rate as outlined by the Colorado Office
of Children, Youth & Families Division of Child Welfare, unless the Provider and County agree
to utilize the Medically Fragile Tool and associated rates due to intensive medical/physical
needs, or limitations that interfere with daily life functioning. The Medically Fragile Tool will
be completed every six months as long as the child remains in care with the provider.
Pass -Around Memorandum; June 13, 2023 - CMS ID Not in CMS Page 1
2023-1760
0/2.1 H -P0095
PRIVILEGED AND CONFIDENTIAL
I do not recommend a Work Session. I recommend approval of the contract exhibit template, and
listed OOH County foster/kinship providers and authorize the Chair to sign approved
amendments and contracts.
Approve Schedule
Recommendation Work Session Other/Comments:
Perry L. Buck, Pro -Tern
Mike Freeman, Chair
Scott K. James
Kevin D. Ross
Lori Saine
Pass -Around Memorandum; June 13, 2023 — CMS ID Not in CMS Page 2
Karla Ford
From:
Sent:
To:
Subject:
Approve
Kevin Ross
Kevin Ross
Tuesday, June 13, 2023 11:43 AM
Karla Ford
Re: Please Reply - PA FOR ROUTING: CW Annual Foster and Kinship OOH Template,
Rate and Provider List (Not in CMS)
From: Karla Ford <kford@weld.gov>
Sent: Tuesday, June 13, 2023 12:20:32 PM
To: Kevin Ross <kross@weld.gov>
Subject: Please Reply - PA FOR ROUTING: CW Annual Foster and Kinship OOH Template, Rate and Provider List (Not in
CMS)
Please advise if you approve recommendation. Thank you.
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 0 Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kfordweldgov.com :: www.weldgov.com
**Please note my working hours are Monday -Thursday 7:00a.m.-5:00p.m.**
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed
and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of
this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Windy Luna <wluna@weld.gov>
Sent: Tuesday, June 13, 2023 11:00 AM
To: Karla Ford <kford@weld.gov>
Cc: Esther Gesick <egesick@weld.gov>; Cheryl Pattelli <cpattelli@weld.gov>; Bruce Barker <bbarker@weld.gov>; Chris
D'Ovidio <cdovidio@weld.gov>; Lennie Bottorff <bottorll@weld.gov>; HS -Contract Management <HS-
ContractManagement@co.weid.co.us>
Subject: PA FOR ROUTING: CW Annual Foster and Kinship OOH Template, Rate and Provider List (Not in CMS)
Good morning Karla,
Please see the attached PA that has been approved for routing: CW Annual Foster and Kinship OOH Template,
Rate and Provider List (Not in CMS).
Thank you,
1
a
CDHS
COLORADO
Office of Children,
Youth & Families
Division of Child Welfare
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date by and between Weld County
Department of Human or Social Services, 315 North 11th Avenue, Greeley, Colorado hereinafter called "County
Department" and hereinafter called "Provider", Provider Name at Address, City, State, Zip Code.
2. This Contract and Agreement shall be effective from Begin Date and continue in force until End Date or until the
facility certificate is revoked or surrendered. This contract and agreement may be renewed at any time during the
term of the valid facility certificate. This contract and agreement is in lieu of and supersedes all prior purchase
contracts between the parties hereto and relating to the services herein described.
3. The Provider holds a valid certificate as a: ❑ Foster Care Home or ❑ Therapeutic Foster Care Home or ❑ Kinship
Foster Care Home -(check applicable blank). Such certification standards shall be maintained during the term hereof.
The provider has read and is fully familiar with the "Rules Regulating Foster Care Homes" issued by the Colorado
Department of Human Services.
4. The County Department may, but shall not be obligated to purchase foster care home services. The County
Department or any duly authorized agent may request such services to be provided to any child or youth at any time
within the limits of the certificate and without prior notice. At such time or as soon as possible after the acceptance of
a child or youth for services, the County Department and the Provider shall verify foster care placement of each child
or youth in writing on the required form, which shall become an addendum to this contract, subject to all the terms and
conditions hereof.
5. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and Addendum 1,
which form integral parts of this Agreement. Exhibit A and Addendum 1 are specifically incorporated herein by this
reference.
The Provider agrees:
1. To the rates for child placement as set for by the State of Colorado apply to the services contemplated by this
Agreement and that such rates may be negotiated with the Provider individually in cases with exceptional
circumstances as determined by the County Department;
2. To safely provide the 24 -hour physical care and supervision of each child or youth until removed or until the
agreement is renewed;
3. To accept a child or youth, only with the approval of the certifying agency;
4. To cooperate fully with the County Department or its representatives, and participate in the development of the Family
Service Plans for a child or youth in placement, including visits with their parents, siblings, relatives, or to transition to
another foster care facility;
5. To maintain approved standards of care as set by the Colorado Department of Human Services;
6. To maintain the confidentiality of information shared about the child or youth and his/her family;
7. Not to accept money from parents or guardians;
8. Not to make any independent agreement with parents or guardians;
9. Not to release the child or youth to anyone without prior authorization from the County Department ;
10. To allow representatives of the County Department to visit the foster care home and to meet with the child or youth at
any reasonable time, including scheduled and unscheduled visits; and,
11. To give the County Department a 30 -day notice, except in an emergency, to remove a child or youth for placement
elsewhere, and to work with the County Department as requested to prepare the child or youth for another placement.
12. To provide transportation to the child or youth. Transportation to be provided will be agreed upon at placement and
may be changed upon mutual agreement of the provider and the County Department, as recorded in the Family
Service Plan. Transportation must be provided or arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For youth to participate in age or developmentally appropriate extracurricular, enrichment, cultural, and social
activities.
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
CWS-7A Revised 08/2002
d. Any significant change in the sleeping arrangement for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, school/school district staff, or other persons in
authority;
g. Any emergency;
h. Any pertinent discussion with parents or guardians about the child or youth or supervising agency; and,
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA of 1990,
concerning discrimination on the basis of race, color, sex, age, sexual orientation, expression, or gender identity,
religion, political beliefs, national origin, or handicapping condition.
Pursuant to §19-1-130, C.R.S., a service provider means the state department of human services, a county
department of human or social services, or a child placement agency. This includes a contractor or subcontractor
that provides placement -related services on a service provider's behalf.
A service provider shall provide placement -related services in a manner that is culturally responsive to the complex
social identity of the individual receiving such services. complex social identities include but are not limited to race,
ethnicity, nationality, age, religion, sex, sexual orientation, gender identity, gender expression, socioeconomic status,
physical or cognitive ability, language, beliefs, values, behavior patterns, and customs.
Subjecting a child or youth in foster care or an individual, family, or other service provider to discrimination or
harassment on the basis of actual or perceived disability, race, creed, religion, color, sex, sexual orientation, gender
identity, gender expression, marital status, national origin, ancestry, or any communicable disease, including HIV,
when providing any placement -related service is prohibited.
15. To complete pre -service training prior to the placement of a child or youth.
16. To annually:
a. Update the Training Development Plan with the County Department;
b. Complete ongoing, quality, and relevant training that will build competencies to meet the needs of the children
and youth served in the foster care home as required by the Colorado Department of Human Services regulations
including ongoing training required to use and apply the reasonable and prudent parent standard for each child or
youth served in the foster care home.
17. To attend semi-annual Administrative Reviews for a child or youth in placement.
18. To be knowledgeable of, and comply with the "Rules Regulating Foster Care Homes" and the "General Rules for Child
Care Facilities;
19. Not to enter into any subordinate subcontract hereunder;
20. To keep required and necessary records for audit/review purposes by state and federal personnel. These records
shall document the type of care and dates that care is provided for each child or youth. In addition, medical,
educational, and progress summary records shall be maintained for each child or youth as required pursuant to the
Colorado Department of Human Services' Rules Regulating Foster Care Homes.
21. To complete or schedule a medical examination for the child or youth within 14 days of initial placement and complete
a dental examination within eight weeks of initial placement.
The County Department agrees:
1. To share all available information about the child or youth, including relevant social, medical and educational history,
behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics
of the child or youth, with the provider before placement and to share additional information when obtained while the
child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as meeting medical needs,
visitation, special psychological needs, trauma and other grief/loss issues, and the child's or youth's identification with
his/her family;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of
placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the Family Service Plan, as it pertains to their expectations for meeting the needs of the
child or youth in the foster care home, at the time of placement or when it is completed following placement;
7. To give at least a 30 -day notice of plans to remove a child or youth from the foster care home. The 30 -day notice may
be waived by mutual consent to allow and permit immediate removal of a child or youth for placement elsewhere, or
without such waiver in the event of an emergency. An emergency is defined as any situation in which a provider's
inability to provide services threatens the health, safety or welfare of a child or youth.
8. To pay the provider at the rates established by the Colorado Department of Human Services or as authorized and
negotiated between the provider and the County Department
CWS-7A Revised 08/9029 9
a. Payment shall be made by electronic banking transfers (EBT) drawn by the duly authorized county officer; and,
b. Provider shall notify the County Department of any payment or billing dispute within 60 days of the month when
service was provided. Failure to do so will result in forfeiture of the payment. The Provider understands that,
pursuant to the Colorado Department of Human Services' Rules for the General Reimbursement for Child Welfare
Services, when reimbursement is warranted the State reimburses for retroactive payments not greater than the
current and (2) preceding months.
9. To provide or arrange through statewide contracted training, a minimum of twelve hours of core pre -service training
for foster care homes and 15 hours of pre -service training directed at the needs of the child or youth to be served in
the foster care home.
10. To annually complete the following:
a. Update the Training Development Plan with the provider;
b. Provide or make available quality and relevant training for each foster parent that will build competencies to meet
the needs of the children and youth served in the foster care home;
c. Provide training that prepares each foster parent to use and apply the reasonable and prudent parent standard;
and,
d. Pursuant to the Colorado Department of Human Services' Rules Regulating Family Foster Care Homes,
document that the provider is trained in and can use and apply the reasonable and prudent parent standard for
each child or youth placed in the foster care home.
11. The County Department is responsible for providing information on county specific procedures.
12. To invite the provider to Administrative Reviews for each child or youth in placement.
13. To incorporate provider information in planning for the child or youth placed in the foster care home.
14. To assure that the service described herein has been accomplished and a record made thereof on a case by case
basis.
15. To provide notice of court hearings for each child or youth placed in the foster care home.
WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above.
COUNTY:
Jamie Ulrich
Weld County Department
of Human Services
Signature Date
ATTEST: BOARD OF COUNTY COMMISSIONERS
BY:
Clerk to the Board WELD COUNTY, COLORADO
Deputy Clerk to the Board Mike Freeman, Chair
PROVIDER:
Provider name
Provider
Provider name
Provider
Signature Date
Signature Date
CWS-7A Revised 08/2022 3
EXHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase Foster Care
Services and Foster Care Facility Agreement CWS-7A
The following additional provisions in this Exhibit A and Addendum 1 apply to the agreement entitled, "Individual Provider
Contract for Purpose of Foster Care Services and Foster Care Facility Agreement," by and between the Weld County
Department of Human Services, hereinafter referred to as, "County," and <First Name> <Last Name>, Provider ID#
<Provider Number>, hereinafter referred to as, "Provider."
GENERAL PROVISIONS
1. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least
thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon
the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first,
and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon
cease; however, the parties shall not be released from the duty to perform their obligations up to the date of
termination. This provision does not affect removal of a child in an emergencysituation.
2. Provider agrees that Provider is an independent contractor and that neither Provider nor Provider's agents or
employees are, or shall be deemed to be, agents or employees of the County for any purpose. Provider shall
have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The
parties agree that Provider will not become an employee of County. Provider shall be solely and entirely
responsible for its acts or of any agent, employee, servants and sub -Providers during the performance of this
Agreement. Provider is not entitled to unemployment insurance or workers' compensation benefits
through Weld County and Weld County shall not pay for or otherwise provide such coverage for Provider.
Unemployment insurance benefits will not be available to Provider for services provided under this
Agreement. Provider shall pay when due any/all applicable employment taxes and income taxes and local
head taxes (if applicable) incurred as a result of the services provided under this Agreement.
3. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the
purpose thereof.
4. This Exhibit A is intended to be applied in conjunction with the attached Agreement as the complete integration of
all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment
hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation,
renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part
of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this
Agreement in writing, if agreed to by both parties. The Agreement, this Exhibit A and the rate Addendums are
intended to be in lieu of and supersede all prior agreements between the parties hereto and relating to the care
and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is permitted to monitor
the service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are
carried out for the benefit of the aforementioned child or youth. Monitoring may occur through review of program
reports, on -site visits where applicable and other Agreements as deemed necessary. Provider understands that
the State Department and the County may provide consultation to Provider to assure satisfactory performance in
the provision of purchased services under this Agreement.
6. County shall have access to Provider's service program, financial and other records, which will sufficiently and
properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement for
purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder
and shall be retained and available for audit purposes for at least five years after final paymenthereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
8. 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.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the
Exhibit A to the CWS-7A
4 Revised 11/2022
other party at that party's address as stated in this Agreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to perform services of
the same or similar nature.
11. Provider assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily
excluded from covered transactions by a federal department or agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting
to obtain, or performing a public (federal, state, or local) transaction or contract under a 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;
c. Are not presently indicted for or otherwise criminally or civilly charged by agovernment entity (federal, state,
or local) with commission of any of the offenses enumerated in paragraph (B) above.
d. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal,
state, and local) terminated for cause ordefault.
12. In addition to terminating this Agreement in accordance with the provisions herein, County may exercise the
following remedial actions if the County finds and determines that the Provider has substantially failed to satisfy
the duties found in this Agreement and Exhibit A Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider. These remedial actions include, but are not
limited to, any one or more of the following:
a. Withhold payment to Provider until the necessary services or corrections in performance are satisfactorily
completed.
b. Deny payment or recover reimbursement for those services or deliverables which have not been performed
and which due to circumstances caused by Provider cannot be performed or if performed would be of no
value to County. Denial of the amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Provider any incorrect payment to Provider due to omission, error, fraud, and/or defalcation by
deducting from subsequent payments under thisAgreement, or other agreements between County and
Provider, or as a debt to County, or otherwise as provided by law.
13. 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 or their
assignees, and nothing contained 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 or their assignees receiving services or benefits under this Agreement
shall be an incidental beneficiary only.
14. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or
employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that
did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge
and agree that no part of this Agreement is intended to circumvent or replace such immunities.
15. Provider shall promptly notify County in the event in which it is a party defendant or respondent in a case, which
involves services provided under the agreement. The Provider, 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 County Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/orforeclosure.
16. This Agreement and the provision of services hereunder shall be subject to the laws ofColorado and be in
accordance with the policies, procedures, and practices of County. Provider shall strictly comply with all
applicable federal and State laws, rules and regulations in effect or hereafter established.
Exhibit A to the CWS-7A
5 Revised 11/2022
17. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose
being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not
create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year.
18. County agrees to purchase, and Provider agrees to provide the care and services, which are listed in this
Agreement. The State approved rate for Child Maintenance/Respite will be paid for any child placed with the
Provider unless the Medically Fragile Tool has been completed due to intensive medical/physical needs, or
limitations that interfere with daily life functioning. The Medically Fragile Tool will be completed every six months
as long as the child remains in care with the Provider. The rate will be adjusted if the Medically Fragile Tool
indicates a change in the level of care. The Medically Fragile Tool will determine the reimbursement rate as
specified in Addendum 1.
19. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's temporary absence from a
facility; however, if the absence is a result of hospitalization the maximum bed hold authorization may be up to 14
days. Bed hold requests must have prior written authorization from the Department Administrator or Designee
before payment will be release to Provider.
20. Any additional costs for specialized services, which may include but are not limited to; Co -pays, deductibles, or
services not covered by Medicaid, will need to be authorized, in writing by the Department Administrator, prior to
the service being performed. Any payment for specialized services not authorized in writing may be denied.
21. All reimbursement requests shall:
a. Be submitted in a format approved by the County. If submitted in an unapproved format or inadequate
documentation is provided, the County reserves the right to deny payment.
b. Be submitted by the 4th of each month following the month of service. If the reimbursement request is not
submitted within twenty-five (25) calendar days ofthe month following service, it may result in forfeiture of
payment.
c. Placement service reimbursement shall be paid from the date of placement up to, but not including the day of
discharge.
d. Transportation reimbursement shall be for visitation purposes or transportation to school if out of county and
with prior approval only If medical transportation is needed, Provider will arrange reimbursement through
Medicaid. Any other special requests for transportation reimbursement shall require prior approval by the
Resource Manager or the DepartmentAdministrator.
e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the clothing allowance
form provided by the Foster Care Coordinator.
22. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal
items brought to Provider by the children, Provider shall be released from responsibility for loss or damage to such
personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado
Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal
laws and regulations, as such, which may be amended from time to time, and shall be binding on Provider and
control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services provided under this
Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the express written
approval of the Director of the County Department or his/her appointed designee.
4. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $500,000 for total injuries arising from
any one accident. Provider shall provide a certificate of insurance provided by its insurer upon request by County.
Exhibit A to the CWS-7A
6 Revised 11/2022
5. Indemnify the County against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the performance of this
Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation
and the defense of any such claims or actions.
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings, if requested by the
Department. County staff shall notify the Provider of the dates and times attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations. These requests
shall be made through the child's caseworker and/or the Provider's FosterCare Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors hired by the Weld
County Department of Human Services to preserve placement in the least restrictive placement appropriate,
comply with the treatment plan of the child, and attend court hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completedwithin 8 weeks of the
child being placed with Provider. All documentation of these examinations will be placed in the foster child's
placement binder.
10. Attend all necessary school meetings and support any plan that is developed regarding the child in order to
promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or suspected child abuse or
neglect as set forth in Section 19-3-304, C.R.S.
12. Maintain, access and review information monthly on Binti.
13. Maintain/update information in the foster child's binder, either hard copy or in Binti. The binder will be reviewed on
a monthly basis and signed off by child's caseworker and/or the Provider's Foster Care Coordinator.
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. Comply with all County and State certification requirements as set forth in the State Department rules, Staff
Manual Volume VII and the Weld County Department of Human Services Policy and Procedure manual.
Exhibit A to the CWS-7A
7 Revised 11/2022
ADDENDUM 1
Medically Fragile Tool Rates
Child Maintenance
Daily Rate
Medically Fragile
Level 1
$57.73
Level 2
$115.82
Level 3
$174.17
Level 4
Negotiate up to $210
Addendum 1 to Exhibit A CWS-7A
8 Revised 07/2023
Weld County Foster and Kinship Provider
SFY 2024-2024
1
Provider Last
Name
Aikens
Provider
First
Name
Carly
CoProvider Last
Name
Aikens
CoProvider
First Name
George
Street Address
22250 County Road 62:
City
Greeley
State
Colorado
Zip
80631
ID
Number
1718610
Family
Type
Foster
2
Andrade
Amparo
Archuleta
Elijah
1449 24th Avenue
Greeley
Colorado
80634
1759768
Foster
3
Arce
Johanna
3038 17th Street, Apartment B
Greeley
Colorado
80631
1745668
Kinship
4
Archuleta
Christina
4995 West 5th Street
Greeley
Colorado
80634
1764452
Kinship
5
Austin
Elizabeth
775 Saddleback Drive
Milliken
Colorado
80543
1772053
Foster
6
Baldwin
Tierney
Baldwin
Danny
10377 South Crescent
Firestone
Colorado
80504
1717778
Foster
7
Barden
Pamela'
1235 1st Street
Eaton
Colorado
80615
1768873
Kinship
8
Barraza
Josefina
4126 Mesquite Lane
Evans
Colorado
80620
1760240
Kinship
9
Beckstrand
Valerie
Beckstrand
Matthew
6239 Bauer Way
Frederick
Colorado
80504
1765291
Foster
10
Berrelez
Yvette
Berrelez
Matthew
247 63rd Avenue
Greeley
Colorado
80634
1728772
Foster
11
Bieber
Dana
Conner
Wade
13611 Wrangler Way
Mead
Colorado
80542
1758807
Kinship
12
Bloomfield
Diane
1107 9th Street, Apartment 23
Greeley
Colorado
80534
1771550
Kinship
13
Bowman
Loretta
Searles
Andrew
7230 Animas Avenue
Frederick
Colorado
80530
1767668
Kinship
14
Braunagel
Karen
1775 Laurus Lane
Johnstown
Colorado
80534
1714402
Foster
15
Brinkerhoff
Samantha
Brinkerhoff
Zaquri
1968 Sweet Pea Drive-
Windsor
Colorado
8O550
1739843
Foster
16
Brown
Dorian
22690 East Ida Circle
Aurora
Colorado
80015
1770274
Foster
17
Call
Paula
Call '
Shaun
533 East 28th Street Road
Greeley
Colorado
80631
1737209
Foster
18
Carloni
Simone
Carloni
Tony
937 Mount Andrew Drive
Severance
Colorado
80550
1769514
Foster
19
Casey
Robert
Casey
Elyse
1410 10th Avenue
Greeley
Colorado
80631
1734522
Foster
20
Castaneda
Natalie
Castaneda
Freddy
2837 Avocado Avenue
Greeley
Colorado
80631
1678403
Foster
21
Clark
Kaci
Clark
David
1862 18th Avenue
Greeley
Colorado
80631
1725980
Foster
22
Clark
Arnold
Claris
Deborah
3156 Hawthorne Lane
Dacono
Colorado
80514
1697927
Foster
23
Cook
Jamie
Cook
Jeffrey
48 Coyote Trail
Greeley
Colorado
80634
1756217
Foster
24
Cox
Rebecca
Cox
Matthew
452 3rd Street
Severance
Colorado
80550
1763013
Foster
25
Cross
Hannah
Cross
Taylor
22975 County Road 40
LaSalle
Colorado
80645
1739954
Foster
26
Cunliffe
Anne
Cunliffe
Levi
2277 Pineywoods Street
Mead
Colorado
80542
1740368
Foster
27
Curley'
Brett
Ochoa-Curley
Belinda'
1117 Nantucket Street
Windsor
Colorado
80550
1745625
Foster
28
Dearborn
Kourtni
Dearborn
Brent
1664 Marbeck Drive
Windsor
Colorado
80550
1765207
Foster
29
Dennis
Esther
Grigsby
Michael
5502 West 3rd Street
Greeley
Colorado
80634
1687385
Foster
30
DeSignori
Melissa
DeSignori
Mclain
2763 Mustang Drive
Oakdale
California
95361
1766212
Kinship
31
Deutsch
Celine
Deutsch
Nicolas
2800 Crescent Cove Drive
Evans
Colorado
80620
1751838
Foster
32
Dunn
James
Dunn
Gari
111 McIntyre Street
Kersey
Colorado
80644
1714413
Foster
33
Eberle
Nicole
Eberle
Justin
4163 Limestone Avenue
Mead
Colorado
80504
1773678
Kinship
Weld County Foster and Kinship Provider
SFY 2024-2024
34
Provider Last
Name
Ervin
Provider
First
Name
Angela
CoProvider Last
Name
Ervin
CoProvider
First Name
Jason
Street Address
4609 Prairie River Court
City
Firestone
State
Colorado
Zip
80504
ID
Number
1752752
Family
Type
Foster
35
Espana
Felicia
522 30th Avenue Court
Greeley
Colorado
80631
1769785
Kinship
36
Fretwell
Crystal
Fretwell
Steven
4121 West 4th Street Road
Greeley
Colorado
80634
1749771
Foster
37
Gamble
Sharee
Gamble
Dennis
1630 Queenston Drive
Escondido
California
92027
1768453
Kinship
38
Glasmann
Tierra
Montoya
Joseph
8441 DeSoto Drive
Thornton
Colorado
80229
1769108
Kinship
39
Gloer
Julie -
Brink
Scott -
3318 West 4th Street
Greeley
Colorado
80634
90155
Kinship
40
Guildner
Courtney
Guildner
Jacob
9353 Pike Way
Arvada
Colorado
80007
1764734
Kinship
41
Hansen
Natalie
Betting
Derrick
2813 Steeple Rock Drive
Frederick
Colorado
80516
1753111
Foster
42
Haskett
Nicole
1430 12th Street, Apartment A
Greeley
Colorado
80631
1770380
Foster
43
Hays
Izzabella
Hays
Andrew
1204 Macmurry Court
Dacono
Colorado
80514
1757924
Foster
44
Hecker
Angela
Hecker
Kaci
2303 76th Avenue Court
Greeley
Colorado
80634
1743691
Foster
45
Hernandez
Shelby
Hernandez II
Matthew
8823 15thStreet
Greeley
Colorado
80634
1750326
Kinship
46
Horta
Margarito
Dos Santos
Marlene
8687 Yuba Road
Phelan
California
92371
1773575
Kinship
47
lbarra
Eric
Gomez
Maira
200 North 35th Avenue 8219
Greeley
Colorado
80634
1707673
Foster
48
Indrika
Micki
Underwood
Alensia
2122 30th Street, Apartment 1723
Greeley
Colorado
80631
1769879
Kinship
49
Irizarry
Marizol
1739 Rowan Lane
Evans
Colorado
80620
1768019
Kinship
50
Jasper
Rachel
Jasper
Brandon
4907 West 23rd Street Road
Greeley
Colorado
80634
1712735
Foster
51
Jauken
Michael
Jauken
Kristi
1730 Ruddlesway Drive #R-4
Windsor
Colorado
80550
1763790
Foster
52
Johnson
Alana
Johnson
Joshua
9981 Bountiful Street
Firestone
Colorado
80504
1625365
Foster
53
Jolly
Marcia
5222 Warrior Street
Frederick
Colorado
80504
1771925
Foster
54
Kelly
Sheila
Kelly
Richard
37125 County Road 63
Galeton
Colorado
80622
1757028
Foster
55
Klein -Troyer
Cynthia
Troyer
Rodney
2625 28th Avenue
Greeley
Colorado
80634
98370
Foster`
56
Lazuick-Marin
Justine
Marin
Gilbert
25000 County Road 69
Kersey
Colorado
80644
1661206
Foster
57
Leary
Amber
Leary
Christopher
3426 Mountainwood Street
Johnstown
Colorado
80534
1770955
Foster
58
LeRoy
Daniel
LeRoy
Susie
2692 Wrenwood Avenue
Clovis
California
93611
1774746
Kinship
59
Lopez
Sylvia
1204 29th Street Road, Apartment 210
Greeley
Colorado
80631
1764511
Kinship,
60
Major
Ruby
Major
Jim
6916 Silverleaf Avenue
Firestone
Colorado
80504
1766605
Foster
61
Markworth
Rubyann
Markworth
Johnathon
3903 West 30th Street Road
Greeley
Colorado
80634
1764307
Foster
62
Maronek
Patricia
2929 56th Avenue
Greeley
Colorado
80634
1520627
Foster
63
Martin
Sherry
Martin
Nicholas
2304 Talon Parkway
Greeley
Colorado
80634
1746250
Foster
64
Mata
Sandra
119 North 31st Avenue 8102
Greeley
Colorado
80634
1757793
Kinship
65
McCubbin
Crystal
Kennedy
Jesse.
4919 Saint Vrain Road _
Firestone
Colorado
80504
1748208
"Foster
66
McGukin
John
McGukin
Natalie
442 Pinewood Circle
Lafayette
Colorado
80026
1727904
Foster
Weld County Foster and Kinship Provider
SFY 2024-2024
Provider
Provider Last First
Name Name
CoProvider Last
Name
CoProvider
Street Address City
First Name
State
Zip
ID
Number
Family
Type
67
Mehl
Kiersten
Mehl
John
1671 Green River Drive
Windsor
Colorado
80550
1764078
Foster
68
Mendoza
Martha
1710 Glendale Avenue
Casper
Wyoming
82601
1762358
Kinship
69
Meza
Norma
Meza-Cordero
Martin
4601 Yellowstone Drive
Greeley
Colorado
80634
1768809
Kinship
70
Minteer
Kimberly
Minteer
Michael
13 Magnolia Drive
Perkinston
Mississippi
39573
1773203
Kinship
71
Moore
Diana
Moore
Roy
2613 West 13th Street
Greeley
Colorado
80634
1757823
Kinship
72
Muth
Rachel
Muth
Bryan
2306 Sunset Lane
Greeley
Colorado
80634
1742038
Foster
73
Neuenberger
Lidia
Neuenberger
Ryan
317149th Avenue
Greeley
Colorado
80634
1759082
Foster
74
Nix
Amanda
Nix
Randall
2124 Village Drive
Milliken
Colorado
80543
1747311
Foster
75
Norris
Emily
Norris
Jason
135 Sunflower Drive
Windsor
Colorado
80550
1758526
Foster
76
Oakleaf
Catherine
708 Moonglow Drive
Windsor
Colorado
80550
1756923
Foster
77
Patterson
Mary
Patterson
Alton
2225 Kent Road
Las Cruces
New Mexico
88001
1771530
Kinship
78
Pettie
Christine
Pettie
Ronald
4619 Kings Mills
Owings Mills
Maryland
21117
1763056
Kinship
79
Pratt
Bradley
Dennis
Maricela
19100 White Fawn Drive
Mounument
Colorado
80132
1763783
Kinship
80
Pribble
Kelly
2000 80th Avenue Court
Greeley
Colorado
80634
1659978
Foster
81
Pup -Oliver
Lynette
Oliver
Justin
1559 South Dusk Drive
Milliken
Colorado
80543
1738985
Foster
82
Purtell
Nicole
Purtell
Christopher
2391 Tate Avenue
Fort Lupton
Colorado
80620
1708813
Foster
83
Raulston
Tiffany
Raulston
Seth
25503 Highway 392
Greeley
Colorado
80631
1754590
Foster
84
Rickard
Carmen
Rickard
Jeff
5938 East Conservation Drive
Frederick
Colorado
80504
1751416
Foster
85
Rojas
Kathleen
Rojas Munoz
Jose
4367 37th Street
Evans
Colorado
80620
1553794
Foster
86
Rosales
Emilio
Martinez
Esmeralda
4315 West 20th Street Road
Greeley
Colorado
80634
1636676
Kinship
87
Sanchez
Artemisa°'
Perez Cervantes
Jose Jesus
3407 Riesling Court
Evans
Colorado
80634
1751829
Foster
88
Sanchez
Tracy
Sanchez
Isidro
423 28th Avenue
Greeley
Colorado
80634
1687293
Foster
89
Sanchez Flores
Annette
Mendez
Jayden' -
1517 10th Avenue, Apartment 8
Greeley
Colorado
80631
1771184
Kinship
90
Scudder
Mistie
Scudder
Nathan
747 Rock Road
Eaton
Colorado
80615
1521113
Foster
91
Sedlacek
Roger
Sedlacek
Allison
4428 West 14th Street Drive
Greeley
Colorado
80634
1761333,
Foster
92
Semidey
Alicia
Semidey
Carlos
4537 Kingswood Drive
Windsor
Colorado
80550
1773999
Foster
93
Serna
Kim
Serna
Peter
420 Lilac Avenue
Eaton
Colorado
80615
1772995
Foster
94
Sevestre
Maureen
Sevestre
Lewis
1717 69th Avenue
Greeley
Colorado
80634
1551169
Kinship
95
Shultzaberger
Angela
Shultzaberger
Shawn
1571 Red Tail Road
Eaton
Colorado
80615
1725981
Foster
96
Snow
Nichole
Snow
Austin
1706 Bounty Drive
Windsor
Colorado
80550
1745854
Foster
97
Soto -Feliciano
Veronica
Vega-Cubero
Francisco
6232 Bauer Drive
Frederick
Colorado
80504
1761984
Foster
98
Stump
Patrick
Sommers
Megan
5893 Maidenhead Drive
Windsor
Colorado
80550
1740805
Foster
99
Taylor
Tommie
5428 South Valdai Street
Aurora
Colorado
80015
1507199
Foster
Weld County Foster and Kinship Provider
SFY 2024-2024
Provider
CoProvider Last CoProvider
Provider Last First
Name First Name
Name Name
100 Thurman Lauren Thurman Joel
Street Address
4138 West 31st Street
Greeley
ID Family
City State Zip
Number Type
80634 1708802 n
Colorado
101
Trzcinski
Morgan
Trzcinsl<i
Brandon
705 7th Street
<i sey
Colorado
80044
1.764220
Foster
102
Tupper
Jennifer
Tupper
Donald
6877 St Vrain Ranch Boulevard
Firestone
Colorado
80504
1759758
Kinship
103
Vance -
Morgan
Kindvall
Brandon
500 Campbell Street
Kersey
Colorado
80644
1703052
Foster
104
Vandenelzen
Dawn
5819 West 16th Street Lane
Greeley
Colorado
80634
44282
Foster
105
Vega
Ignacia
3102 17th Avenue, Lot'8
Greeley
Colorado
80631
1769679
.Kinship
106
Walker
Kayla
235 West Shafer Avenue
Pierce
Colorado
80650
1693525
Foster
107
Walker
Kurt
Walker
Jennifer
7681 Carlson` Court
Fort Collins
Colorado
80524
1546248
Foster
108
Young
Stephanie
230 Platte Court
Eaton
Colorado
80615
1746103
Foster
109
Zetye
Rebecca
Zetye
Kenneth -
2350 Black' Duck Avenue
Johnstown
Colorado
80534
1750254
Foster
Hello