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Home My WebLink About20221664.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. GG: 1-ISD,cA(Kn), A c r(cP/co), c-TB(cw) 7 /27 /22 2022-1664 H R0094 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 15th day of June, A.D., 2022. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: d‘t444) Cd j,:,/ :4 Weld County Clerk to the Board Deputy Clerk to the Board Scbtt K. James, Chair APP:: County Attorney Date of signature: ��' Lori Saine 2022-1664 HR0094 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: June 6, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: The Weld County Department of Human Services' Child Welfare SFY 2022-23 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 Weld County Department of Human Services' Child Welfare SFY 2022-23 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 OOH 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, Caitlin Perry, and approved for use for the 2022-23 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 2022-23. 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 7, 2022 — CMS (Not in CMS) Page 1 2022-1664 ao/t5 dig_00c1c-I 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. Perry L. Buck Mike Freeman, Pro-Tem Scott K. James, Chair Steve Moreno Lori Saine Approve Recommendation of atmaiD Schedule Work Session Other/Comments: Pass -Around Memorandum; June 7, 2022 - CMS (Not in CMS) Page 2 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 O Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: IsainclOweldgov.com Website: www.co.weld.co.us In God We Trust Lori Saine Tuesday, June 7, 2O22 1:24 PM Karla Ford RE: Please Reply - DHS 10 PA FOR ROUTING: CW Annual Foster and Kinship OOH Template, Rate, and Provider List (Not in CMS) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weldgov.com> Sent: Tuesday, June 7, 2O22 9:06 AM To: Lori Saine <Isaine@weldgov.com> Subject: Please Reply - DHS 10 PA FOR ROUTING: CW Annual Foster and Kinship OOH Template, Ra-e, and Provider List (Not in CMS) Importance: High Please advise if you approve recommendation. Thanks. Karla Ford Executive Assistant & Office Manager, Board of Weld County Commissioners 1150 0 Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford@weldgov.com :: www.weldgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-5:00p.m.** 1 COLORADO Office of Children, Youth & Families Department of Human Services 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 the Weld County Department of Human Services, P. O. Box A, Greeley, CO 80632, hereinafter called "County Department" and <First Name> <Last Name(s)>, <Address>, <City>, <ST> <Zip>, hereinafter called "Provider". 2. This Contract and Agreement shall be effective from < > and continue in force until < > 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 certificateas a <Foster or Kinship> Care home. 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 furnish foster care services to eligible children and youth at the established rate based on the individual child or youth rates negotiated between the county department and the provider; 2. To safely provide the 24 -hour physical care and supervision of each child or youth until removed or until the agreement isrenewed; 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; 1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs Jared Polls, Governor I Michelle Barnes, Executive Director 1 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. The amount of 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 children or 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; 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 identity, religion, political beliefs, national origin, or handicapping condition. 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; and, c. Obtain certification 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 Family Foster Care Homes. 21. To complete or schedule a medical examination for the child or youth within 14 days after initial placement and a dental examination within eight weeks of initial placement; 1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs Jared Polis, Governor Michelle Barnes, Executive Director 2 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/herfamily; 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: 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 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. 1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs Jared Polis, Governor I Michelle Barnes, Executive Director 3 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. Jamie Ulrich Weld County Department of Human Services Signature Date WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: BOARD OF COUNTY COMMISSIONERS Clerk to the Board WELD COUNTY, COLORADO BY: Deputy Clerk to the Board Scott K. James, Chair PROVIDER: <Provider Name> Name <Co -Provider Name> Signature Date Name Signature Date 1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs Jared Polls, Governor I Michelle Barnes, Executive Director 4 MI-11BIT A to the CWS-7q 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 5 Revised 6/2022 other party at that party's address as stated in thisAgreement. 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 certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Provider 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). Provider shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Provider 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 Provider obtains actual knowledge that a sub -contractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Provider shall notify the sub- contractor and County within three (3) days that Provider has actual knowledge that a sub -contractor is employing or contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Provider shall not terminate the contract if within three days the sub -contractor provides information to establish that the sub -contractor has not knowingly employed or contracted with an illegal alien. Provider shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Provider participates in the State of Colorado program, Contract Professional shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Provider 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. Provider shall deliver to County, 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 Provider fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Provider shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5 103(3), if Provider receives federal or state funds under the contract, Provider 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 Provider 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. 12. 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. 13. 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: Exhibit A to the CWS-7A 6 Revised 6/2022 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, fraudand/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Provider, or as a debt to County, or otherwise as provided by law. 14. 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. 15. 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 deemedto 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. 16. 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/or foreclosure. 17. 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. 18. 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. 19. 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. 20. 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. 21. 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. 22. 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 Exhibit A to the CWS-7A 7 Revised 6/2022 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 Department Administrator. e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the clothing allowance form provided by the Foster Care Coordinator. 23. 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. 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 Foster Care 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 attendcourt hearings as requested. 9. Have physical examinations completed within 14 days and dental examinations completed within 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. Exhibit A to the CWS-7A 8 Revised 6/2022 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 9 Revised 6/2022 ADDENDUM Medically Fragile Tool Rates Child Maintenance Daily Rate Medically Fragile Level 1 $54.73 Level 2 $110.30 Level 3 $165.88 Level 4 Negotiate up to $200 Exhibit A to the CWS-7A 10 Revised 6/2022 Weld County Foster and Kinship Provider SFY 2022-2023 2 Provider Last Name2 Agohe.. Aikens Provider First Co -Provider Last Co -Provider Name Name First Name Carly Aikens Larisii George �olu Address Street k :ri 22250 County Road 62 Address City/State/Zip �r,. Colorado 80550 Greeley, Colorado 80631 Provider D Type 21.;° , 1718610 Foster Foster A Archuleta ' itah� 4 24th Ayenu ley,: Colorado';8o634 17597613 1745668 17233,58 Foster 4 Arce Armstrong Johanna 5: Nicole Le'Andra Armstrong . Zachary 3038 17th Street, Apartment B 108 North 50thAvenue 5115 West 16th Street Greeley, Colorado 80631 Greeley, Colorado 80634 Greeley, Colorado 80634 Firestone, Colorado 80504 Kinship Foster Kinship Foster 6 Augustin Baldwin 1752483 1:,717778 Tierney; Josephina Jennifer . Baldwin Danny 10377 South Crescent 8 Barraza 4126 Mesquite Lane 442: La Costa Lane Evans, Colorado 80620 Johnstown,; Colorado 80534 Greeley, Colorado 80634 Frederick, Colorado 80504 Mead, Colorado 80542 Windsor,.Colorado.80550 Johnstown, Colorado 80534 Windsor, Colorado 80550 Greeley, Colorado 80634 Greeley, Colorado 80631 Greeley, Colorado 80631 Greeley, Colorado 80631 1760240 9 10 Bauer Berrelez Yvette Bauer =° Berrelez Michael Matthew 247 63rd Avenue 839©`Brandywine Avenue 13611 Wrangler Way x:202 Crescent Chive'` 1775 Laurus Lane 1733364 1728772 Kinship Foster Foster 1; Cynthia 1734868` Foster 12 Bieber Dana Connor Wade Paul'• . 1758807 1745856` 14 ck Braunagel Karen Black 1714402 Kinship Foster Foster 16 ke Brown Samantha n Brown 7aquri:, Dustin 8:5 lea 1114 50th Avenue ive 1739843 1739396 Foster. Foster 18 It Casey Robert Caii Casey castaneda Shaun Elyse Freddy East 28th Street, Road 2330 6th Avenue 1737209 1734522 Foster Foster 1.9 . 20 Castaneda Chavez Clerlt Collins Natalie Sonia 2.837 Avocado Avenue 10437 Butte Drive Longmont, Colorado 80504 Greeley, Colorado 80631 Anchorage , Alaska 99518 Greeley, Colorado 80634 Greeley, Colorado 80631 Eaton, Colorado 80615 LaSalle, Colorado 80645 Mead, Colorado 80542 Windsor, Colorado 80550 Greeley, Colorado 8,0634 Oakdale, California 95361 Evans, Colorado 80620 f 1678403: 1748760 #arlt David 186218th Avenue 1725980 '. Foster Kinship stet: 22 Amie Collins 24 Cowling Crawford Shawn Cowling Rutledge Justin Jeffrey Whitney Ryan Taylor Levi 8211 Mentra Street 48 Coyote Trail 1749447 175621"7' 2534 17th Ave Court 13151st street 1758324 Kinship Foster Foster Gassy; Hannah 174863. Foster 26 Cross Cross 22975 County Road 40 2277 Pineywoods Street 1117 Nantucket Street 5502 West 3rd Street 2763 Mustang Drive 2800 Crescent Cove Drive 2182 Skys End Drive #R-4 111 !Act ntyre.Street 223127th Avenue 4609. Prairie: River Court 1739954 Foster 27 -Cunli fe Anne Cunliffe 1740368 Foster 28 Curley Brett Ochoa Belinda 1745625 Foster 29 Dennis DeSignori Esther' Grigsby. DeSignori Michael 7385 Foster 30 32 Deutsch Dix Melissa !Celine Mclain 1766212 Kinship :Fester Abigail Deetsch Nicolas Windsor, Colorado 80550 Kersey, Colorado80644, Greeley, Colorado 80634 Firestone, Colorado 8i Greeley, Colorado 80634 1751838'' 1763724 17±4413' Foster Dunn Erickson es Dunn a: � sari. Foster 34 Angela Erickson Bradley 1751923 Foster Ervm. '; Fretwel I Jason 752752 Foster 36 Fretwell Crystal Steven 4121 West 4th Street Road 1749771 Foster na 38 Gonzalez Cara Gonzalez Grgson Rafael rConiah - 167 47th Avenue Court 2139 68th ,AVert 1861 12th Avenue Greeley, Colorado 80634 Greeley,. Colotidn=8flfi34 Greeley, Colorado 80631 1753981 1749221 iiship ;• Foster Kinship Foster G'irigS©l1a;, igan 40 Gross Jennifer Gross Nathan 1718928 laiunta; Colorado', 81050: Grover Y Grover AAndrew: 24474 County :Road 26 1756011 Kinship Weld County Foster and Kinship Provider SFY 2022-2023 Provider Last Name2 42 Hamacher Provider First Co -Provider Last Co -Provider Name Name First Name Tara Purvis Shaun Address Street 7432 Farmdale Street Address City/State/Zip Provider D Type Frederick, Colorado 80530 1757742 Foster Ora 1649 Foster. 44 Hansen Natalie Betting Derrick 2771 Dawner Court Milliken, Colorado 80543 1753111 Foster ti seer ` 46 Hecker Angela Hecker Kaci 2303 76th Avenue Court Greeley, Colorado 80634 1743691 Foster Ve riCISO6Col l Kinship Kinship 48 Hernandez Shelby Hernandez II Matthew 8823 15th Street Greeley, Colorado 80634 1750326 4 e ue' r 50 Jasper Rachel Jasper Jauken Brandon 4907 West 23rd Street Road Greeley, Colorado 80634 Windsor; Colorado 1712735 176379© 1708865 1723996 Foster uddl sv✓ay Drive Itk-4 ; .ter 52 Jeffery 68 Johnson. 54 Johnson Jamie 339 Valley Avenue 1914 84th Avenue: 9981 Bountiful Street 371235, County Road 63 2625 28th Avenue Lochbuie, Colorado 80603 Foster Faster Trevor Alana Johnson Johnson Angela Joshua Colorado: 80634 Firestone, Colorado 80504 Galeton, Colorado 80622 Greeley, Colorado 80634 Kersey, Colorado 80644. Windsor, Colorado 80550 �reeiey, Colorado 81634 Greeley, Colorado 80634 Greeley, Coloradn611631 Firestone, Colorado 80504 Lafayette, Colorado 8fl026' Frederick, Colorado 80504 Casper, Wyoming 82601 Frederick, Colorado 80530 1625365 Foster Kelly Sheila` Kelly Richard 1757029 Foster 56 Klein -Troyer 57 Lazuick-Marin Cynthia Troyer Rodney 98370 Foster Justine Marin Gilbert 25000 County Road 69 501 Dakota Court 1661206 Foster 58 Marcos Shantay Marcos Marcel 59, Maronek 60 Martin Patricia 2929 56th. Avenue 2304 Talon Parkway 102 9th Avenue, Apartment E 4919 St Vrain Road 1732887 3520627`' Foster Foster'.` Sherry Sandra Martin Nicholas 1746250 1:757793 1748208 Foster Kinship Foster 62 McCubbin Crystal John Kennedy NicGukin Jesse kin 64 Meier Stephanie Natalie 442 PlneWood Circle 7428 Ellingwood Circle 1710=Giendale Avenue; 1727904' 1759848 Foster. Foster I(inship 65 Mendoza 66 Menzel lar' 17623568 Kathrina Menzel Jared 6025 Lynx Creek Circle 1707638 Foster ICirshlp 68 Muth Rachel Muth Bryan 2306 Sunset Lane Greeley, Colorado 80634 1742038 Foster !nberger era 70 Nix Amanda Nix Randall Jason 2124 Village Drive Milliken, Colorado 80543 1747311 Foster vary .o osier 72 Oakleaf Catherine 708 Moonglow Drive Windsor, Colorado 80550 1756923 Foster ardsh - Nicholas 0 Graphite Colorado. `8b547 ' 1664299 Foster 74 Piccarreto Timothy 10210 19th Street Road Greeley, Colorado 80634 1741936 Kinship Plante,: Jacques 6 nship-; 76 Pribble Kelly 2000 80th Ave Court Greeley, Colorado 80634 1659978 Foster 7 78 Purtell wer Purtell Justin: c -Drive: 8985 Nicole Christopher 2391 Tate Avenue Fort Lupton, Colorado 80620 Windsor; i Frederick, Colorado 80504 1708813 1:764590 Foster Istoo each Road Foster 80 Rickard Carmen Rickard Jeff 5938 East Conservation Drive 1751416 Foster 5elre.rence, Colorado i Evans, Colorado 80620 1713,N1a>seca. Plaza •Way 4367 37th Street 1754586 riguez-Caro , ;AsF g Alberto ;Foster 82 Rojas Kathleen Rojas Munoz Jose 1553794 Foster Weld County Foster and Kinship Provider SFY 2022-2023 Provider Last Name2 Rosales:;; Sanchez Provider First Co -Provider Last Co -Provider Name Name First Name ez` smeralt#a Address Street pth .Street Read Address City/State/Zip hey;° Co Provider D Type .6676. Kinship 84 Tracy Stephanie Artemisa Sanchez Isidro 423 28th Avenue Greeley, Colorado 80634 Greeley, Colorado 806: Evans, Colorado 80634 1687293 Foster 86 Sanchez Perez Cervantes Jose Jesus 20th Ave G 3407 Riesling Court 1906 Covered Bridge Parkway 747 Rock Road 1571 Red "rail Road 7661 1751829 1747'566 Kinship Foster 88 Scudder ss; Mistie Scudder Richard Nathan dsor, Coli Eaton, Colorado 80615 1521113 1.725981 Faster Foster Foster 90 Shultzabe Skov p Susan kzaberger Skov Shawn Terry Austin 461 Stagecoach Drive 1706 Bounty ©;rive :on, Colorado:80615 Milliken, Colorado 80543 1754279 Kinship Foster 92 Soto -Feliciano Nich©le. Veronica Patrick Snow Vega-Cubero Sdrrarners Francisco 6232 Bauer Drive 5898 Maidenhead. Drive > 4138 West 31st Street Windsor, Colorado 80550 Frederick, Colorado 80504 1745854 1761984 Foster 94 Thurman Lauren Thurman el Joel Jeannie Windsor, Colorado 8(]550 Greeley, Colorado 80634 1740805 1708802 Foster. Foster Torres Daniel Torres 6756 Sag Avenue Firestone; Colorado 80504 Firestone, Colorado 80504 Kersey, Colorado 80644 Greeley, Colorado 80634 Greeley, Colorado 80634 Eaton, Colorado 80615 Severance, Colorado 80550 155.6847 Foster Kinship Foster 96 Tupper Vance Jennifer Tupper Donald 6877 St Vrain Ranch Boulevard 500 Campbell Street 5819 West 16th Street Lane 1759758 Misr Dawn n Irdyatl Brandon 1703052 98 Vandenelzen 44282 Foster 99 Vargas Veyette Wahr Pena Maria -` Brandon 70130th Avenue, Apartment A 316 Cottonwood Avenue 1757821' Kinship 100 Amanda Veyette Wltar 1733697 Foster 101: 102 Walker Laura Kayla Walker Harold Renae 1740 Avery Plaza Street 235 West Shafer Avenue 7681 Carlson Court Pierce, Colorado 80650 Fort ;Collins, Colcredo .80524 , Windsor, Colorado 80550 Brighton,, Colorado 80.602 Eaton, Colorado 80615 Johnstown, Colorado 80534 757568. 1693525 15446248,' Foster Foster :er 44< Walker Jennifer' Foster 104 White Kristen 1651 Kelmsley Court 15670 Havana Way 230 Platte Court 1711814 Foster 11 'Ise Shelby Stephanie Rebecc Brian 1751247 Fs? r 106 1.07 Young 1746103 Foster Zetye 2e#ye Kenneth 2350 Black Duck avenue 1750254 Foster Hello