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Home My WebLink About20220556.tiffRESOLUTION RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE CHAIR TO SIGN - LIFELONG, INC. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Lifelong, Inc., commencing December 1, 2021, and ending May 31, 2022, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Child Protection Agreement for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and Lifelong, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of February, A.D., 2022, nunc pro tunc December 1, 2021. ATTEST: �j„ W. •.k;1�D•6i Weld County Clerk to the Board BOARD OF COUNTY COMMISSIONERS W D COU TY, COLORADO tt K. James, Chair Mike Freeman, Pro -Tern c`' HSD 2022-0556 HR0094 Ctyj+vac-� ID#5s�o PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: February 1, 2022 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement with Lifelong, Inc. Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement with Lifelong, Inc. The Department is requesting to enter into a Child Protection Agreement for Services for Aftercare Services, Crisis Intervention and Stabilization Services, Anger Management/Domestic Violence, Foster Parent Consultation, Foster Parent Training, Home -Based Intervention, Kinship Services (Therapeutic), Life Skills, Mental Health Services, and Substance Abuse Treatment Service. The term of the agreement shall be from December 1, 2021 through May 31, 2022. A comprehensive list of all services and rates is. attached and labeled as Exhibit D, Rate Schedule within the Agreement. I do not recommend a Work Session. I recommend approval of this Agreement and authorize the Chair to sign. Approve Schedule Reco mendation Work Session Other/Comments: Perry L. Buck Mike Freeman, Pro -Tern Scott K. James, Chair Steve Moreno __ Lori Saine Pass -Around Memorandum; February 1, 2022 - CMS ID 5550 Page 1 2022-0556 ccai I o H -c14 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LIFELQNG, IN�C.� HH This Agreement, made and entered into the/�dayofs��;�ff! , 2022, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department' and Lifelong, Inc., hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B2100042, which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Aftercare Services, Crisis Intervention and Stabilization Services, Anger Management/Domestic Violence, Foster Parent Consultation, Foster Parent Training, Home -Based Intervention, Kinship Services (Therapeutic), Life Skills, Mental Health Services, and Substance Abuse Treatment Service. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: Term This agreement shall become effective on December 1, 2021, upon proper execution of this Agreement and shall expire May 31, 2022, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Response to Request for Proposal and Exhibit C, Scope of Services. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team(HS-CWQualityAssurance(aiweldeov.com). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7`1 of the month, following the month of service, utilizing billing forms required by the Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 71 of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time of service b. Where the service took place c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 4. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 5. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d- 1 et. sec. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. sec.. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E - Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is 4 employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien, shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 9. Insurance Reauirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect within seven (7) days of the date of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 10. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 13. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives 8 of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Lindsey Spraker, Executive Director 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich. Director P.O. Box A Greeley, Colorado 80632 (970) 400-6510 18. Litigation For Contractor: Lindsey Spraker. Executive Director 7175 West Jefferson Avenue. Suite 4000 Lakewood, Colorado 80235 (303) 573-0839 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. sea., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The 9 parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Imoronrieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storane. Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall 10 be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Emnlovee of Weld Coun Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit A, provide proof thereof when requested to do so by County. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner 11 consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 31. Accentance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 32. Emolovee Financial Interest/Conflict of Interest. C.R.S. &S24-18-201 et sea. and X24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Annroval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 36. Attorney's Fees/Legal Costs 12 In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 37. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 38. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Wel By: Depi 13 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Sc t K. James,Chair FEB 1 6 2022 Lifelong, Inc. 7175 West Jefferson Avenue, Suite 4000 Lakewood, Colorado (303) 573-0839 L/h�I2y �%d�q�f6b By: Lindsey Spra er (J n 28, 2022 14:30 PAST) Lindsey Spraker, Executive Director Date: Jan 28, 2022 oZbac,2 - O55 EXHIBIT A WELD COUNTY'S REQUEST FOR PROPOSAL (Weld County's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page intentionally left blank. Exhibit B Contractor's response to the Request for Proposal Exhibit B contains the following documents: • Attachment B — Provider Information Form (PIF) • Attachment C — Proposal • Attachment D — Staff Data Sheet • Certificate of Insurance (COI) EXHIBIT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES — PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: Lifelong, Inc. Trails Provider ID (if known): Provider Contact Full Name: Lindsey Spraker Title: Executive Director 303.573.0839 Primary Phone Number (10 -digit): Primary Contact Email: Lindsey@Lifelonginc.com 303.573.0849 Ext.: Fax Number (10 -digit): Web Address: WWWlifelonginc.com Agency Location Address (Street, city, state, zip): 7175 W. Jefferson Avenue, Suite 4000, Lakewood, CO 80235 same Agency Mailing Address (Street, city, state, zip): Agency Type (pick one): © Public Company rjPrivate Non -Profit F Private for Profit Send Referrals for Service to: Referral Contact Name: Erika DeLeon Title: Program Director 720.660.4549 Erika@Lifelonginc.com Referral Phone Number (10 -digit): Ext.: Email: Vanessa Pagan Billing Contact Name: Billing Phone Number (10 -digit): Billing Contact Title: Office Manager 303.573.0839 . Vanessa@Lifelonginc.com Ext.: Email: -----------------------------------------------------------------------------------------.. CERTIFICATION I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. iThe Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Authorized Rep. Full Name: Lindsey Spraker Title: Executive Director Authorized Rep. Email: Lindsey@Lifelonginc.com Phone (10 -digit): 720.582.3086 Ext.: , , 7175 W. Jefferson Avenue, Suite 4000, Lakewood, CO 80235 Authorized Rep. Address (streetcity state Signature of Authorized Rep.: Date: 1 L--------------------- ---- 10/15/2021 i ---------------------------------------------------- REV. NOVEMBER 2020 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Aftercare Services Number of services offered on this Attachment C (max 5): Program Areas are listed in column I of the table located in Item Xl of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Applied Behavior Analysis (ABA) - BCBA 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list history; DO use bullet points): • Applied Behavior Analysis as primary modality • Trauma —informed • Assessments including but not limited to: FBA (Functional Behavior Assessment), FAST (Functional Assessment Screening Tools), Functional Analysis (only when clinically indicated), skills assessments, adaptive functioning scales, Vineland III, developmental assessments, Autism screening tools, VBMAPP (Verbal Behavior Milestones Assessment and Placement Program), ABLLS (Assessment of Basic Language and Living Skills), AFLS (Assessment of functional living skills), EFLS (Essentials for Living). • All assessments are used to allocate baseline data, identify skill deficits and drive curriculum for treatment goals. • Assessment is ongoing and all treatment decisions are driven by data collected in every session reflecting progress on each eoal and behavior. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Applied Behavior Analysis (ABA) is highly depending on a thorough individualized assessment and recommendations can range from 1 to 40 hours per week of treatment. 2.1c Anticipated duration of service (i.e. 3-4 months): ABA services can range from short term focused treatment for 6 months or less, to several years or lifelong supports depending on the individual's needs and abilities. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Identify skill deficits and develop skill acquisition programming to be taught using the principles of ABA. 2. Mediate and reduce the negative effects of challenging behaviors on the individual and caregivers. 3. Develop and implement behavior intervention strategies to reduce behaviors targeted for reduction. 4. Conduct ongoing parent / caregiver required training on skill teaching and behavior intervention strategies using a trauma -informed / preventative approach. 2.1e Three (3), or more, specific outcomes of service: 1. Prevent or reduce behaviors that put individuals or their caregivers / family members at risk of harm. 2. Prevent or reduce behaviors that limit an individual's ability to access their home, school, community, and establish and maintain meaningful relationships. 3. Increase communication and social skills. 4. Increase independence to the highest level possible and establish skills that contribute to mental and physical health and hygiene. 2.1f Target population of the service, including age and gender: All ages, genders, abilities and diagnoses. Unless clinically contraindicated or involves a symptomology that requires medical intervention as the primary treatment. 2.1g Language's service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES- qualified individuals may access ABA via Medicaid through EPSDT with a doctor's referral prescribing ABA as a medically necessary treatment for individualsspecific diagnosis. Individuals can only access private insurance for ABA funding if they carry an Autism Spectrum Disorder Diagnosis. REV. NOV 2020 1 ATTACHMENT C - PROPOSAL Service #2 Name: Applied Behavior Analysis (ABA) — Behavior Technician 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): • Primary modality being ABA • Behavior Technicians (BT's) work directly with the client, under supervision, to implement the skill teaching program and behavior interventions designed by the board -certified behavior analyst (BCBA). 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Applied Behavior Analysis (ABA) is highly depending on a thorough individualized assessment and recommendations can range from 1 to 40 hours per week of treatment. 2.2c Anticipated duration of service (i.e. 3-4 months): ABA services can range from short term focused treatment for 6 months or less, to several years or lifelong supports depending on the individual's needs and abilities. 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Identify skill deficits and develop skill acquisition programming to be taught using the principles of ABA. 2. Mediate and reduce the negative effects of challenging behaviors on the individual and caregivers. 3. Develop and implement behavior intervention strategies to reduce behaviors targeted for reduction. 4. Conduct ongoing parent / caregiver required training on skill teaching and behavior intervention strategies using a trauma -informed / preventative approach. 2.2e Three (3), or more, specific outcomes of service: 1. Prevent or reduce behaviors that put individuals or their caregivers / family members at risk of harm. 2. Prevent or reduce behaviors that limit an individual's ability to access their home, school, community, and establish and maintain meaningful relationships. 3. Increase communication and social skills. 4. Increase independence to the highest level possible and establish skills that contribute to mental and physical health and hygiene. 2.2f Target population of the service: All ages, genders, abilities, and diagnoses. Unless clinically contraindicated or involving symptomology that requires medical intervention as the primary treatment. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: YES- qualified individuals may access ABA via Medicaid through EPSDT with a doctor's referral prescribing ABA as a medically necessary treatment for individuals' specific diagnosis. Individuals can only access private insurance for ABA funding if they carry an Autism Spectrum Disorder Diagnosis. Service #3 Name: Social Skills Group 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Social skills checklists are utilized to assess skills and identify pairs of groups of individuals who would work effectively together on mutual goals that are appropriate for their age and development. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Social Skills Group held 1-2 times per week for 1 or more hours depending on size of group and abilities. 2.3c Anticipated duration of service (i.e. 3-4 months): 8 weeks per cohort 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 1. Identify individuals who could benefit from facilitated social skills practice in a group setting. 2. Provide safe, monitored, and facilitated activities that support individuals' social skills practice in a group setting. 3. Provide peer modeling opportunities for individuals with social skills deficits. 4. Promote the development of necessary social skills and safe ways to connect and interact with peers. 2.3e Three (3), or more, specific outcomes of service: 1. Increase clients' access to safe opportunities to practice social skills and develop meaningful relationships. 2. Increase clients' ability to generalize social skills to new individuals in a new setting. 3. Increase the connections and opportunities to create a community for individuals with intellectual disabilities. REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.3f Target population of the service: Children and adults with specialized social needs, on the Autism Spectrum , with intellectual disability or traumatic brain 2.3g Languages service is available in (please list proficiency and if interpreter services are availab English and Spanish (proficient) — no interpreter services available 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Not at this time Service #4 Name: Trauma Processing Group 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Trauma informed approaches and materials, depression and anxiety scales, PTSD assessments as prescribed by the group facilitators as needed. 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: One time per week for 1-2 hours 2.4c Anticipated duration of service (i.e. 3-4 months): 3-6 months 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide a safe setting for individuals who have been assessed and identified as a candidate for which group processing may be beneficial. 2. Facilitate the development of a supportive working group in which individuals can share, relate to others and process traumatic experiences. 3. Provide psychoeducation to group members to promote skill development for management of symptoms of Post - Traumatic Stress Disorder and other trauma related behaviors and symptomology. 2.4e Three (3), or more, specific outcomes of service: 1. Individuals access opportunities to process trauma and begin a heating process in a safe and supportive group that is goal oriented and facilitated. 2. Individuals demonstrate the ability to establish and maintain self -care and coping practices while sharing connection and accountability with their group peers. 3. Individuals experience safety and acceptance that allows for integration of skills and mental health treatment. 2.4f Target population of the service: Youth and adults that have been assessed and identified as a candidate for group processing. 2.4g Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish, Mandarin Chinese (proficient) — no interpreter services available 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Not at this time. Service #5 Name: 2.5a Modalities, curricul tools used in delivery of service (DO NOT list DO use bullet 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Antici 2.5d Three C 2.5e Three F 2.5f Target 2.5g Langu duration of service (i.e. 3-4 month or more. soecific goals of the service or more. soecific outcomes of service: 2.5h Medicaid e ulation of the service: use bullet service is available in (please list proficiency and if interpreter services are avai ligibility — list whether the service is eligible for Medicaid in whole or in part REV. NOV 2020 3 ATTACHMENT C - PROPOSAL Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: N YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: 0 YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES N NO 3.4 How many miles are you willing to travel round trip? List a specific number of 40 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Applied Behavior Analysis (ABA) - BCBA $ Amount Unit Type 4.1a In-Office/Video: $125 per Hour 4.1b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: $130 per Hour No. of miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: $100 per Hour 4.1d No show: per No Show 4.le Mileage rate: .56 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Applied Behavior Analysis (ABA) — Behavior Technician $ Amount Unit Type 4.2a In-Office/Video: $85 per Hour 4.2b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.2c In -Home or Community: $90 per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: $75 per Hour 4.2e No show: per No Show 4.2f Mileage rate: .56 per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: Social Skills Group $ Amount Unit Type 4.3a In-Office/Video: $45 per Hour 4.3b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.3c In -Home or Community: $50 per Hour No. of miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: $100 per Hour 4.3e No show: per No Show 4.3f Mileage rate: .56 per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: Trauma Processing Group $ Amount Unit Type 4.4a In-Office/Video: $45 per Hour 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: $50 per Hour No. of miles included in rate: miles REV. NOV 2020 4 ATTACHMENT C - PROPOSAL 4.4c 4.4d 4.4e FTM, TDM, Prof. Staffing: No show: Mileage rate: $100 per per per Hour No Show Mile This is paid after the miles listed above. .56 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.5b In -Office with Transportation: 4.5c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of No. of This is miles included in rate: miles included in rate: paid after the miles listed 0 miles 0 miles above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA Provider special notes: All bilingual services are +$15/hour or +$15/group REV. NOV 2020 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Anger Management/Domestic Violence Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): 5 You may complete another Attachment C if you have more than 5. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Domestic Violence Group Treatment 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): CBT, DBT, TF-CBT, MI, Duluth model, multimodal approaches 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: One group per week 2.1c Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Increase the ability to demonstrate understanding of cycle of violence, power and control. 3. Increase ability to demonstrate self-awareness and identify triggers. 4. Increase ability to reflect on self in the group setting. 5. Interact with peers in the group setting, demonstrating accountability, competency achievement, and vulnerability. 6. Identify precursors to violence and engage in preventive strategies to self -regulate and manage impulses. 2.1e Three (3), or more, specific outcomes of service: 1. Successful engagement in the group therapy dynamic. 2. Successful daily practice of self -care and coping skills. 3. Successful use of coping skills during conflict or crisis. 4. Successful reunification or other successful case closure. 2.1f Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 4-100, individuals, dyads, or families 2.1g Language's service is available in (please list proficiency and if interpreter services are available): English. In 2022: Spanish and Mandarin Chinese — both fluent offerings — interpreter services are not available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Lifelong, Inc. is applying for agency Medicaid credentialing and currently only a few clinicians are individually credentialed. Service #2 Name: Domestic Violence Individual Treatment 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): CBT, DBT, TF-CBT, MI, Duluth model, multimodal approaches 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 sessions/week depending on individual's needs. 2.2c Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage mental health triggers. 2. Increase the ability to demonstrate understanding of cycle of violence, power and control. 3. Increase ability to demonstrate self-awareness and identify triggers. 4. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage in preventive strategies to self -regulate and manage impulses. REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 5. Increase ability to identify criteria for safe and healthy interactions and relationships. 6. Increase ability to demonstrate protective skills of self and dependents. 2.2e Three (3), or more, specific outcomes of service: 1. Successful engagement in the group therapy dynamic. 2. Successful daily practice of self -care and coping skills. 3. Successful use of coping skills during conflict or crisis. 4. Successful reunification or other successful case closure. 2.2f Target population of the service: Clients age 4-100 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English. In 2022: Spanish and Mandarin Chinese — both fluent offerings — interpreter services are not available 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #3 Name: Caring Dads 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): The Caring Dads parenting group is a curriculum driven and facilitated opportunity for men to obtain and practice parenting skills and connect with other men as fathers. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: The Caring Dads group takes place 1x per week for 17 weeks. 2.3c Anticipated duration of service (i.e. 3-4 months): 17 weeks. 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 1. 2. 3. 2.3e Three Improve and strengthen the father / child relationship. Learn child centered parenting skills and strategies to manage stress and frustration. Identify and self -reflect on the impact of previous conflictual strategies on familial relationships. I, or more, specific outcomes of service: 1. Reduce recidivism of child welfare contact for participating families. 2. Successful case closure via reunification or maintenance of custody or in -home placement. 3. Create community connections and relationships for fathers. 2.3f Target population of the service: Parents with children, fathers who have demonstrated parenting challenges that resulted in child protection concerns, fathers struggling with parenting children with challenging behaviors or special behavioral needs. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #4 Name: High Conflict Co -Parenting 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list comnanv history: DO use bullet points): • Group therapy • Curriculum driven and skill acquisition focused • Parents in high -conflict separations, child welfare cases, divorces, or requiring mediation attend the groups separately. • Skills focused on conflict resolution, communication skills, stress management, and protection of involved children. 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Groups take place one time per week. 12 weeks 2.4d Three d duration of service (i.e. 3-4 months): or more. specific goals of the service (DO use bullet points): 1. Provide a safe environment for parents to connect, reflect, and learn ways to manage co -parenting challenges. 2. Parents will develop skills to co -parent and communicate effectively, minimizing conflict. 3. Parents will learn strategies to mediate stress and implement protective strategies to reduce emotional harm to involved children. REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.4e Three (3), or more, specific outcomes of service: 1. Reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. 2. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. 3. Reduce emotional / physical harm to involved children. 2.4f Target population of the service: Parents identified as having co -parenting conflict that is unable to resolved without proper supports. 2.4g Languages service is available in (please list proficiency and if interpreter services are available): English. 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: This service is not currently covered by Medicaid. Service #5 Name: [ DV Intake or DV Evaluation 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): DVOMB Approved intake and assessment materials are utilized. 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Intake or Evaluation is typically completed in 1-2 sessions with client. 2.5c Anticipated duration of service (i.e. 3-4 months): Evaluation and assessment summary with treatment recommendations can take up to 10 service hours with a 15-30 day turn around for complete report. 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 1. Assess and identify treatment needs of the client. 2. Determine the level of severity of domestic violence and identify all effected parties. 3. Establish recommendations for immediate and long-term safety planning. 4. Develop treatment recommendations for both victims and offenders. 2.5e Three (3), or more, specific outcomes of service: 1. Identify and intervene in current domestic violence situations. 2. Provide treatment recommendations that address both immediate needs for safety and long-term treatment to address relational trauma, cycles of violence, and rehabilitating offenders. 3. Provide treatment recommendations that empower victims to establish and maintain safety so they can access treatment and reduce likelihood of future domestic violence. 2.5f Target population of the service: Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. 2.Sg Languages service is available in (please list proficiency and if interpreter services are available): English. In 2022: Spanish and Mandarin Chinese — both fluent offerings — interpreter services are not available 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Not currently enrolled in Medicaid. Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ❑ YES ® NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES REV. NOV 2020 3 ATTACHMENT C - PROPOSAL All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: I Domestic Violence Group Treatment $ Amount Unit Type 4.1a In-Office/Video: $45 per Hour 4.1b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: $100 per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Domestic Violence Individual Treatment $ Amount Unit Type 4.2a In-Office/Video: $125 per Hour 4.2b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.2c In -Home or Community: per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: $100 per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: Caring Dads $ Amount Unit Type 4.3a In-Office/Video: $45 per Hour 4.3b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.3c In -Home or Community: per Hour No. of miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: $100 per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: High Conflict Co -Parenting $ Amount Unit Type 4.4a In-Office/Video: $45 per Hour 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: $100 per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: DV Intake or DV Evaluation $ Amount Unit Type 4.5a In-Office/Video: $275/500 per Hour 4.5b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.5c In -Home or Community: per Hour No. of miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: $100 per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. REV. NOV 2020 4 ATTACHMENT C - PROPOSAL Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.61 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. UA $7 BA Provider special notes: All bilingual services are +$15/hour or REV. NOV 2020 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Anger Management/Domestic Violence Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): 2 You may complete another Attachment C if you have more than 5. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Domestic Violence Intake 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history, DO use bullet points): DVOMB Approved intake and assessment materials. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2-5 hours 2.1c Anticipated duration of service (i.e. 3-4 months): 1-2 sessions 2.1d Three (3), or more, specific goals of the service (DO use bullet Completion of Intake 2.1e Three (3), or more, specific outcomes of service: Completion of Intake 2.1f Target population of the service, including age and gender: Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. 2.1g Language's service is available in (please list proficiency and if interpreter services are availab 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Service #2 Name: Domestic Violence Evaluation 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list Clinical Assessment Interview DO use bullet Domestic Violence Risk and Needs Assessment (DVRNA) Spousal Assault Risk Assessment Guide —3 (SARA — 3) CAGE -AID Substance Abuse Screening Tool Alcohol Use Disorders Identification Test (AUDIT) Scoring the States of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A/8D) Ohio State University Traumatic Brain Injury Identification Method (OSU-TBI) Mini -Mental State Examination (MMSE) Brief Resiliency Scale (BRS) Beck Anxiety Inventory (BAI) Beck Depression Inventory (BDI) Level 2 - Anger — Adult Substance Abuse Subtle Screening Inventory (SASSI) Personality Inventory for DSM-5 — Brief Form (PID-BF) — Adult World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Personality Assessment Screener (PAS) Adverse Childhood Experiences (ACE) Questionnaire 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 3-7 hours 2.2c Anticipated duration of service (i.e. 3-4 months): REV. NOV 2020 1 ATTACHMENT C - PROPOSAL Evaluation and assessment summary with treatment recommendations with a 15-30 day turn around for complete report. 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Assess and identify treatment needs of the client. 2. Determine the level of treatment intensity required for domestic violence services. 3. Establish recommendations for immediate and long-term safety planning. 2.2e Three (3), or more, specific outcomes of service: Completion of Evaluation 2.2f Target population of the service: Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid el Service #3 Name: — list whether the service is eligible for Medicaid in whole or in 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 2.3d Three (3), or more, specific goals of the service (DO use bullet 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 m 2.4d Three (3), or more, specific goals of the service 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list profit 2.4h Medicaid eligibility — list whether the service is el use bullet and if interpreter services are availa le for Medicaid in whole or in part: Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Antici 2.5d Three 2.5e Three 2.5f Targe 2.5g Langu duration of service (i.e. 3-4 m or more, specific goals of the service (DO use bullet or more, specific outcomes of service: 2.5h Medicaid e lation of the service: service is available in (please list — list whether the service is and if interpreter services are availabl ble for Medicaid in whole or in Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: N YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ❑ YES N NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES N NO 3.4 How many miles are you willing to travel round trip? List a specific number of Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testine. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Domestic Violence Intake $ Amount Unit Type 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Domestic Violence Evaluation $ Amount Unit Type 4.2a In-Office/Video: $500 per Hour 4.2b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.2c In -Home or Community: per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: $100 per Hour 4.2e No show: per No Show REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.2f Mileage rate: II per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.3c In -Home or Community: per Hour No. of miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.5c In -Home or Community: per Hour No. of miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA $15 Confirmation Test Provider special notes: All bilingual services are +S15/hour or REV. NOV 2020 4 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Foster Parent Consultation Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): You may complete another Attachment Cif you have more than 5. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name Foster Parent Consultation — Individuals/Families 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): • Modality may include Trauma Informed ABA (Applied Behavior Analysis) or other parent coaching curriculums specialized for parents fostering children. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Frequency is highly dependent on specific needs and behaviors the family identifies during assessment. 2.1c Anticipated duration of service (i.e. 3-4 months): Duration is highly dependent on specific needs and behaviors the family identifies during assessment and if child(ren) are also receiving services. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide foster parents with psychoeducation and resources that will prevent or limit burnout and stress. 2. Work with foster parents to identify preventative and environmental modifications that will enhance structure and predictability in their home. 3. Connect foster parents with other necessary resources or services. 2.1e Three (3), or more, specific outcomes of service: 1. Prevent placement disruptions for involved children. 2. Support the placement to improve health and safety for the family unit. 3. Identify the need for additional or longer -term support and services. 2.1f Target population of the service, including age and gender: Foster parents in need of consultation to address a specific concern or improve the overall placement success of their home. 2.1g Language's service is available in (please list proficiency and if interpreter services are availa English or Spanish (fluent) 2.1h Medicaid eligibility— list whether the service is eligible for Medicaid in whole or in part: Service #2 Name: Foster Parent Consultation — Groups 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Modality may include Trauma Informed ABA (Applied Behavior Analysis) or other parent coaching curriculums specialized for parents fostering children. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Frequency is highly dependent on specific needs and behaviors the family identifies during assessment. 2.2c Anticipated duration of service (i.e. 3-4 months): Duration is highly dependent on specific needs and behaviors the family identifies during assessment and if child(ren) are also receiving services. 2.2d Three (3), or c goals of the service (DO use bullet 1. Provide foster parents with psychoeducation and resources that will prevent or limit burnout and stress. 2. Work with foster parents to identify preventative and environmental modifications that will enhance structure and predictability in their home. Connect foster parents with other necessary resources or services. REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2.2e Three (3), or more, specific outcomes of service: 1. Prevent placement disruptions for involved children. 2. Support the placement to improve health and safety for the family unit. Identify the need for additional or longer -term support and services. 2.2f Target population of the service: Foster parents in need of consultation to address a specific concern or improve the overall placement success of their home. 2.2g Languages service is available in (please list proficiency and if interpreter services are avai English or Spanish (fluent) 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet 2.3e Three 2.3f or more, specific outcomes of service: lation of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are availabi 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c 2.4d Three duration of service (i.e. 3-4 month or Is of the service 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list prof 2.4h Medicaid eligibility — list whether the service is use bullet and if interpreter services are available): e for Medicaid in whole or in part: Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are avai 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 0 YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of 60 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode. except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Foster Parent Consultation — Individual/Family $ Amount Unit Type 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Foster Parent Consultation — Group $ Amount Unit Type 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.3a 4.3b 4.3c 4.3d 4.3e 4.3f In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: per per per per per per Hour Hour Hour Hour No Show Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed miles miles above. 4.4 Hourly 4.4a 4.4b 4.4c 4.4d 4.4e Service #4 Name: $ Amount In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed miles miles above. 4.5 Hourly 4.5a 4.5b 4.5c 4.5d 4.5e 4.5f Service #5 Name: $ Amount In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed 0 miles 0 miles above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA$7BA Provider special notes: All bilingual services are +$15/hour or REV. NOV 2020 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Foster Parent Training Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5) You may complete another Attachment C if you have more than 5. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Foster Parent Training - Various 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list DO use bullet • Modality may include Trauma Informed ABA (Applied Behavior Analysis), parent coaching curriculums specialized for parents fostering children, trauma informed trainings, etc. • Attachment / trauma focused therapy and psvchoeducation 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Dependent upon identified needs. 2.1c Anticipated duration of service (i.e. 3-4 months): Dependent upon identified needs. 2.1d Three (3), or more, specific goals of the service (DO use bullet 1. 2. 3. 2.1e Three 1. 2. 3. 2.1f Targel Foster 2.1g Languw Provide psychoeducation to foster parents regarding attachment trauma and associated symptoms and behaviors. Provide foster parents with skills and training to support the development and maintenance of strategies that promote safety and prevent or limit the occurrence of behavioral challenges that can lead to additional trauma and / or disruption of the placement. Provide foster parents with a safe and understanding support system in which they can process the challenges of foster parenting and learn self -care and coping skills. ). or more. specific outcomes of service: Preservation of placement Reduce the number of placement changes a child experiences while in foster care. Reduce foster parent burn out and stressors associated with foster care. 2.1h Medicaid ulation of the service, including age and ants service is available in (please list orofici bilitv — list whether the service is ency and if interpreter services are ava ible for Medicaid in whole or in part: Service #2 Name: 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.2c Anticipated duration of service (i.e. 3-4 2.2d Three (3), or more, specific goals of the service (DO use bullet 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility— list whether the service is eligible for Medicaid in whole or in Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 2.3d Three (3), or more, specific goals of the service (DO use bullet 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list prc 2.3h Medicaid eligibility — list whether the service is and if interpreter services are e for Medicaid in whole or in Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipat 2.4d Three (3), 2.4e Three (3), 2.4f Target pc 2.4g Language 2.4h Medicaid duration of service 3-4 of the service or more, specific outcomes of service: lation of the service: use bullet service is available in (please list oroficiencv and if interpreter services are availabl Service #5 Name: — list whether the service is e for Medicaid in whole or in part: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list DO use bullet 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 2.5d Three (3), or more, specific goals of the service (DO use bullet 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: REV. NOV 2020 L) ATTACHMENT C - PROPOSAL 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES O NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of 60 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode. except for home studies and monitored sobriety testine. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Foster Parent Training $ Amount Unit Type 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. REV. NOV 2020 3 ATTACHMENT C a PROPOSAL 4.4 Hourly Service #4 Name: 4.4a In-Office/Video: 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Prof. Staffing: 4.4d No show: 4.4e Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed miles miles above. 4.5 Hourly 4.5a 4.5b 4.5c 4.5d 4.5e 4.5f Service #5 Name: In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed 0 miles 0 miles above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4,6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21UA$7BA Provider special notes: All bilingual services are +$15/hour or +$15/group REV. NOV 2020 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Home Based Intervention Number of services offered on this Attachment C (max 5): Program Areas are listed in column I of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name Home -Based Interventions — Intensive 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Individual and / or family therapy, therapeutic life skills, Applied Behavior Analysis, and a variety of our services provided by masters level clinicians in the home environment of the individual. Modality for therapeutic interventions determined by clinician and based on clients' individual needs and abilities. Skills assessments may be utilized to determine curriculum and programming. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Minimum is typically 3-8 hours per week, based on individual needs and goals. 2.1c Anticipated duration of service (i.e. 3-4 months): Minimum 12 weeks, based on individual need and goals. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide most accessible therapeutic level interventions in client home. 2. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. 3. Individuals will reflect on and process stressors, traumatic experiences, and associated emotions and behaviors. 4. Individuals will develop and maintain self -care and coping practices. 2.1e Three (3), or more, specific outcomes of service: 1. Increased ability to generalize and maintain learned skills over time in their home environments. 2. Reduce likelihood of out of home placement and court involvement for child protection concerns. 3. Reduce recidivism for child welfare contact and involvement. 2.1f Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 12-100, individuals, dyads, or families 2.1g Language's service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #2 Name: Home -Based Interventions — High 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Therapeutic life skills, Applied Behavior Analysis, Parent Training and Coaching and a variety of our services provided by masters level clinicians -in -training in the home environment of the individual. Modality for therapeutic interventions determined by clinician and based on clients' individual needs and abilities. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 3-6 hours per week 2.2c Anticipated duration of service (i.e. 3-4 months): Minimum 8 weeks, based on individual needs and goals. 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide most accessible therapeutic level interventions in client home. REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. 3. Individuals will develop and maintain self -care and coping practices. 2.2e Three (3), or more, specific outcomes of service: 1. Increased ability to generalize and maintain learned skills over time in their home environments. 2. Reduce likelihood of out of home placement and court involvement for child protection concerns. 3. Reduce recidivism for child welfare contact and involvement. 2.2f Target population of the service: Client with various diagnosed or suspected disabilities, ages 12-100, individuals, dyads, or families 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #3 Name: Home -Based Interventions — Moderate 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Can include life skills coaching, applied behavior analysis, parenting skills, child development psychoeducation, and mentoring provided in the individual's home. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Minimum is typically 2-6 hours per week, based on individual needs and goals. 2.3c Anticipated duration of service (i.e. 3-4 months): 8— 12 weeks, based on individual needs and goals. 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 1. Individuals will engage in skill acquisition opportunity to demonstrate and maintain skills in their home environment. 2. Individuals will develop and maintain self -care and coping practices. 3. Individuals will demonstrate an increased knowledge of safe parenting practices, awareness of child development, and the impact of trauma / abuse and neglect 2.3e Three (3), or more, specific outcomes of service: 1. Increased ability to generalize and maintain learned skills over time in their home environments. 2. Reduce likelihood of out of home placement and court involvement for child protection concerns. 3. Reduce recidivism for child welfare contact and involvement. 2.3f Target population of the service: Client with various diagnosed or suspected disabilities, ages 12-100, individuals, dyads, or families 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #4 Name: 2.4a Modalities, curriculum, tools used in of service (DO NOT list comoanv history: DO use bullet 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Antici C 2.4d Three 2.4e Three C 2.4f Targed C 2.4g Langu REV. NOV 2020 duration of service (i.e. 3-4 m or more, specific goals of the service (DO use bullet or more, specific outcomes of service: lation of the service: service is available in (please list proficiency and if i ntsl: reter services are availab 2 ATTACHMENT C - PROPOSAL 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #5 Name: 2.5a Modalities, curriculum, tools used in del of service (DO NOT list DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 month 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3). or more. specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list profli 2.5h Medicaid eligibility — list whether the service is el and if services are availa for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of 60 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode. except for home studies and monitored sobriety testine. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Home Based Intervention - Intensive $ Amount Unit Type 4.1a In-Office/Video: $125 per Hour 4.1b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: $130 per Hour No. of miles included in rate: 30 miles 4.1c FTM, TDM, Prof. Staffing: $100 per Hour 4.1d No show: per No Show 4.1e Mileage rate: .56 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Home Based Intervention - High $ Amount Unit Type REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.2a 4.2b 4.2c 4.2d 4.2e 4.2f In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $85 per per per per per per Hour Hour Hour Hour No Show Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed miles 30 miles above. $90 $75 .56 4.3 Hourly 4.3a 4.3b 4.3c 4.3d 4.3e 4.3f Service #3 Name: Home Based In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: Intervention $ Amount $70 $75 $75 .56 - Moderate Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed miles 30 miles above. 4.4 Hourly 4.4a 4.4b 4.4c 4.4d 4.4e Service #4 Name: In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed miles miles above. 4.5 Hourly 4.5a 4.5b 4.5c 4.5d 4.5e 4.5f Service #5 Name: In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. No. This of of is miles included in rate: miles included in rate: paid after the miles listed 0 miles 0 miles above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA Provider special notes: REV. NOV 2020 4 ATTACHMENT C - PROPOSAL All bilingual services are+$15/hour or +$15/group REV. NOV 2020 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Kinship Services (Therapeutic) Number of services offered on this Attachment C (max 5): Program Areas are listed in column I of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Kinship Services (Therapeutic) 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Modalities may include Intensive Family Therapy, Applied Behavior Analysis, Caregiver Consultation, Caregiver Training. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Typically 2 hours per week at a minimum. 2.1c Anticipated duration of service (i.e. 3-4 months): Highly dependent on case specifics, children's needs, and engagement of involved parties. Minimum 12 weeks. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide supportive and comprehensive services to kinship placement providers. 2. Provide psychoeducation, therapy, skill acquisition, and prevention strategies to mediate challenges presented in kinship care. 3. Provide Kinship caregivers with resources, community connections, and skills to develop coping practices. 2.1e Three (3), or more, specific outcomes of service: 1. Preservation of Kinship placement. 2. Improve quality and stability of relationships within kinship placement. 3. Prevent kinship provider burnout and reduce risk of harm in placement. 2.1f Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 12-100, individuals, dyads, or families 2.1g Language's service is available in (please list proficiency and if interpreter services are available): 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Service #2 Name: 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list DO use bullet 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.2c Anticipated duration of service (i.e. 3-4 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet 2.2e Three 2.2f or more, specific outcomes of service: ulation of the service: 2.2g Languages service is available in (please list prc 2.2h Medicaid eligibility — list whether the service is and if interpreter services are availab e for Medicaid in whole or in part: REV. NOV 2020 1 ATTACHMENT C - PROPOSAL Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anti 2.3d Three 2.3e Three 2.3f T duration of service (i.e. 3-4 month or more, specific goals of the service (DO use bullet or more, specific outcomes of service: ulation of the service: 2.3g Languages service is available in (please list prc 2.3h Medicaid eligibility — list whether the service is Service #4 Name: and if interpreter services are availa ble for Medicaid in whole or in 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list DO use bullet 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part REV. NOV 2020 2 ATTACHMENT C - PROPOSAL Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 0 YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: 0 YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of 60 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode. except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Kinship Services (Therapeutic) $ Amount Unit Type 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $125/hour $130/hour $100/hour .56 Amount per Hour per Hour No. of miles included in rate: 30 miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. Unit Type per Hour per Hour per Hour per Hour per No Show per Mile 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: No. of miles included in rate: miles No. of miles included in rate: � miles This is paid after the miles listed above. per Hour per Hour No. of miles included in rate: miles per Hour No. of miles included in rate: miles per Hour per No Show per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of miles included in rate: miles REV. NOV 2020 3 4.4c 4.4d 4.4e In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: per per per per Hour Hour No Show Mile No. of This is miles included paid after the in rate: miles listed II miles above. 4.5 Hourly Service #5 Name: 4.5a In-Office/Video: 4.5b In -Office with Transportation: 4.5c In -Home or Community: 4.5d FTM, TDM, Prof. Staffing: 4.5e No show: 4.5f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of No. of This is miles included in rate: miles included in rate: paid after the miles listed 0 miles 0 miles above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA Provider special notes: All bilingual services are +$15/hour or REV. NOV 2020 4 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name Lifelong, Inc. Program Area: Life Skills Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): ❑3 You may complete another Attachment C if you have more than 5. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Therapeutic Life Skills 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. May include but not limited to role play practice of skills, direct support, prompting and prompt fading strategies, naturalistic in - situation instruction. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Minimum 2 hours per week, 1-3 sessions depending on client needs. 2.1c Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks 2.1d Three (3), or more, specific goals of the service (DO use bullet points) 1. Provide skill acquisition training to individuals. 2. Provide safe therapeutic support in which clients social / emotional needs are respected and addressed in ways that will allow learning of skills and processing the emotions related to their challenges. 3. Individuals will increase their independence to the maximum potential possible for their abilities. 4. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. 5. Individuals will improve the quality of their relationships, develop leisure skills that are healthy and sustainable. 6. Successful mental health management during stressful or triggering life skill activities. 2.1e Three (3), or more, specific outcomes of service: 1. Successful reunification or other successful case closure. 2. Increased ability to access home and community resources. 3. Increased independence and ability to establish and maintain meaningful healthy relationships. 4. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. 2.1f Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 12-100, individuals, dyads, or families 2.1g Language's service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #2 Name: Life Skills 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. May include but not limited to role play practice of skills, direct support, prompting and prompt fading strategies, naturalistic in - situation instruction. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Minimum 2 hours per week, 1-3 sessions depending on client needs. 2.2c Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 2.2d Three (3), or more, specific goals of the service (DO use bullet points): REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 1. Provide skill acquisition training to individuals. 2. Individuals will increase their independence to the maximum potential possible for their abilities. 3. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. 2.2e Three (3), or more, specific outcomes of service: 1. Successful reunification or other successful case closure. 2. Increased ability to access home and community resources. 3. Increased independence and ability to establish and maintain meaningful healthy relationships. 4. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. 2.2f Target population of the service: Client with various diagnosed or suspected disabilities, ages 12-100, individuals, dyads, or families 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Service #3 Name: Specialized Mentorship 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Based on intake assessment, modalities or curriculum may include but not limited to adventure based activities, participation and engagement in community activities, modeling, skill acquisition, role playing, and development of hobbies and interests. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: At a. minimum 2 hours per week. Typically up to 3 times per week. 2.3c Anticipated duration of service (i.e. 3-4 months): 6-12 months. 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 1. Provide a safe, stable, consistent connection to individuals. 2.. Individuals will develop and maintain skills that promote stability, independence, and physical / mental wellbeing. 3. Individuals will develop and maintain healthy leisure skills and increase self-worth and self-confidence by reducing 2.3e 2.3f 2.3g 2.3h risk taking behavior, acting out, substance use, and negative self -statements. Three (3), or more, specific outcomes of service: 1. Reduce future police contact or juvenile justice system involvement. 2. Maintain placement in home or current stable living situation. 3. Increase school attendance and completion. 4. Increase awareness of mental health and resources to secure supports necessary to maintain wellbeing. 5. Increase social / emotional skills and self -management. 6. Increase ability to advocate for self. 7. Increased communication skills. 8. Reduce symptoms of anxiety and depression. 9. Reduce self harm. Target population of the service: Youth ages 8 to 21 with or without suspected or diagnosed disability, criminal involvement, or child welfare involvement. Languages service is available in (please list proficiency and if interpreter services are available): English Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #4 Name: 2.4a Modalities, curriculum, tools used in of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 m 2.4d Three (3), or more, specific goals of the service (DO use bullet points): REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.4e Three (3). or more. specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list prc 2.4h Medicaid eligibility — list whether the service is Service #5 Name: and if interpreter services are availab e for Medicaid in whole or in part: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c duration of service 2.5d Three (3), or more, specific 2.5e Three 2.5f 3-4m of the service (DO use bullet or more, specific outcomes of service: lation of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are availa 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check ® YES one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check ® YES one: (specialized mentorship) 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? ❑ NO YES ❑ NO ® NO 60 Miles The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.1 Hourly Service #1 Name: Therapeutic Life Skills $ Amount Unit Type 4.1a In-Office/Video: $125 per Hour 4.1b In -Office with per Hour No. of miles included in rate: miles Transportation: In -Home or Community: $130 per Hour No. of miles included in rate: 30 miles 4.1c FTM, TDM, Prof. Staffing: $100 per Hour 4.1d No show: per No Show 4.1e Mileage rate: .56 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: Life Skills $ Amount Unit Type 4.2a In-Office/Video: $85 per Hour 4.2b In -Office with per Hour No. of miles included in rate: miles Transportation: 4.2c In -Home or Community: $90 per Hour No. of miles included in rate: 30 miles 4.2d FTM, TDM, Prof. Staffing: $75 per Hour 4.2e No show: per No Show 4.2f Mileage rate: .56 per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: Specialized Mentorship $ Amount Unit Type 4.3a In-Office/Video: $85 per Hour 4.3b In -Office with per Hour No. of miles included in rate: miles Transportation: 4.3c In -Home or Community: $90 per Hour No. of miles included in rate: 30 miles 4.3d FTM, TDM, Prof. Staffing: $75 per Hour 4.3e No show: per No Show 4.3f Mileage rate: .56 per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with per Hour No. of miles included in rate: miles Transportation: In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with per Hour No. of miles included in rate: miles Transportation: 0 4.5c In -Home or Community: per Hour No. of miles included in rate: 0 miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. REV. NOV 2020 4 ATTACHMENT C - PROPOSAL 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA Provider special notes: All bilingual services are +S15/hour or REV. NOV 2020 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1 Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Mental Health Services Number of services offered on this Attachment C (max 5): ❑5 Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Mental Health Therapy 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): CBT, DBT, TF-CBT, ABT, AAT, MFT, M1, PCIT, etc. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Very case specific — some client or families will need 1 hour week, some will need 4, etc., depending on the severity of need/trauma/crisis. 2.1c Anticipated duration of service (i.e. 3-4 months): Very case specific with recommendations based on assessment, client goals, and abilities in addition to level of 2.1d Three (3). or Is of the service (DO use bullet 1. Reduce and manage mental health triggers. 2. Reduce skill deficits within emotional regulation and coping practices. 3. Increase self-awareness and self -management skills. 4. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. 5. Increase the ability of the client to identify emotional, mental, and physical needs and advocate for themselves. 2.1e Three (3). or more. specific outcomes of service: 1. Successful use of coping skills during day-to-day interactions, conflict or crisis. 2. Increased independence in accessing community activities, resources, and services. 3. Increased ability to demonstrate independent engagement in pro -social and safe leisure skills. 4. Ability to establish and maintain healthy and safe relationships. 5. Successful achievement of court recommended goals. 6. Successful reunification or other successful case outcome. 2.1f Target population of the service, including age and gender: Individuals with various diagnosed or suspected intellectual / developmental disabilities, ages 4-100, individuals, dyads, or families. 2.ig Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Lifelong, Inc. Is applying for agency Medicaid credentialing and currently only a few clinicians are individually credentialed. Service #2 Name: 2.2a Modalities. CL Psychological Evaluation tools used in delivery of service (DO NOT list company history; DO use bullet Diagnostic tools, screeners, and assessments as determined by psychologist. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 10-12 hours total including report preparation and feedback session. 2.2c Anticipated duration of service (i.e. 3-4 months): 1-3 appointments 2.2d Three (3). or more. specific goals of the service (DO use bullet nointsl 1. Generate accurate assessment of clients' diagnosis, strengths, needs, and areas of skill deficits. REV. NOV 2020 1 ATTACHMENT C - PROPOSAL 2. Generate a complete report of specialized recommendations for treatment and services tailored to the social/emotional, mental health, and learning needs of the individual. 3. Identify and determine course of treatment, treatment goals, and modality that is best suited for the individual. 2.2e Three (3), or more, specific outcomes of service: Evaluation will provide data, summary, and outcome suggestions for client's learning, developmental, and mental health needs. 2.2f Target population of the service: Clients age 4-100 2.2g Languages service is available in (please list proficiency and if interpreter services are availa English and Spanish (proficient) — no interpreter services available 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #3 Name: Neuropsychological Evaluation 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Diagnostic tools, testing, screeners, and assessments as determined by the psychologist. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 10-15 hours total, (1-3 appointments) for testing and interview 2.3c Anticipated duration of service (i.e. 3-4 months): 1. Assess clients' strengths and areas of skill deficits. 2. Conduct neuropsychological testing as prescribed. 3. Accurately test clients' current functioning and gather full history of the whole person. 4. Generate tailored recommendations for specialized services and modalities that will best support the client. 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 1. Accurate holistic understanding of client needs, diagnosis, and abilities. 2. Recommendations for specialized services. 3. Individualized and thorough report. 2.3e Three (3), or more, specific outcomes of service: Individuals ages 4-100 years. 2.3f Target population of the service: Clients age 4-100 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Service #4 Name: Pediatric Diagnostic Evaluation 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): The pediatric diagnostic evaluation consists of systematic observations, assessments, collateral documentation review, and testing that will yield evidence to support a diagnosis of an autism spectrum diagnose or another disorder. 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 10-15 hours of observation, interviewing, testing and collateral review. 2.4c Anticipated duration of service (i.e. 3-4 months): 1-3 appointments 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 1. Obtain or rule out a diagnosis of a developmental disorder. 2. Procure a thorough assessment of where a child falls along the Autism Spectrum. 3. Gain an understanding of a child's intellectual potential. 2.4e Three (3), or more, specific outcomes of service: 1. Provide a treatment and education plan specifically geared towards the child's needs. 2. Provide education and resources to those providing care for the child. 3. Identify and connect the family with specialized support services and treatment options. 2.4f Target population of the service: Children up to age 18 with suspected developmental disabilities or Autism Spectrum Disorder. 2.4g Languages service is available in (please list proficiency and if interpreter services are available): REV. NOV 2020 2 ATTACHMENT C - PROPOSAL English 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #5 Name: Parent Child Interaction Assessment 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Parent child interaction assessment utilizes prescribed evidence based tools, observation techniques, and structured play scenarios based on the assessors training and current research. 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2-3 hours of direct observation plus interviews and collateral documentation review 2.5c Anticipated duration of service (i.e. 3-4 months): 10-12 hours including report preparation and feedback session. 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 1. Gather data about parental attunement, attachment, relationship dynamics between parent and child. 2. Identify harmful or dysfunctional parenting attributes. 3. Present a thorough representation of the parent child relationship. 2.5e Three (3), or more, specific outcomes of service: 1. Generate specialized recommendations for therapeutic supports to improve the quality of the parent / child relationship. 2. Reduce the likelihood of future child welfare contact. 3. Predict likelihood of potential for future abuse and neglect. 2.5f Target population of the service: Individuals with various diagnosed or suspected intellectual / developmental disabilities, individuals, dyads, and families. 2.5g Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of 60 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: 1 Mental Health Therapy $ Amount Unit Type REV. NOV 2020 3 !A111 ttCWd1fltCItis1Jflti1i 4.1a In-Office/Video: 125 per Hour 4.1b In -Office with Transportation: per Hour No. of miles included in rate: miles In -Home or Community: per Hour No. of miles included in rate: 30 miles 130 4.1c FTM, TDM, Prof. Staffing: 100 per Hour 4.1d No show: per No Show .56 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: I Psychological Evaluation $ Amount Unit Type 4.2a In-Office/Video: 175 per Hour 4.2b In -Office with Transportation: ($1750 per Hour No. of miles included in rate: miles total) 4.2c In -Home or Community: per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: 150 per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: I Neuropsychological Evaluation $ Amount Unit Type 4.3a In-Office/Video: $200 per Hour 4.3b In -Office with Transportation: ($2350 per Hour No. of miles included in rate: miles total) 4.3c In -Home or Community: per Hour No. of miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: 150 per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: Pediatric Diagnostic Evaluation $ Amount Unit Type 4.4a In-Office/Video: 200 per Hour 4.4b In -Office with Transportation: ($2350 per Hour No. of miles included in rate: miles total) In -Home or Community: per Hour No. of miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: 150 per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: I Parent Child Interaction Assessment $ Amount Unit Type 4.5a In-Office/Video: 150 per Hour 4.5b In -Office with Transportation: ($1500 per Hour No. of miles included in rate: miles total) 4.5c In -Home or Community: per Hour No. of miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: 150 per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f REV. NOV 2020 4.6g 4.6h 4.61 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA Provider special notes: All bilingual services are +S15/hour or REV. NOV 2020 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1- Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Mental Health Services Program Areas are listed in column I of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): ❑3 You may complete another Attachment C if you have more than 5. SECTION 2 — Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must Service #1 Name: state a specific minimum number of direct service hours. Mental Health Evaluation 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Clinical Interview, ACE, BRS, OSU-TBI, DSM-V, MMPI, TSI, mental status exam, or others as determined during interview. 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 appointments 2.1c Anticipated duration of service (i.e. 3-4 months): 1-2 appointments 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Conduct a thorough assessment of individuals' mental status, social / emotional skills and deficits, and adaptive functioning. 2. Identify individuals' current mental functioning and mental health diagnosis if indicated. 3. Assist individual in identifying areas of strength and need with regard to their mental / emotional health. 2.1e Three (3), or more, specific outcomes of service: 1. Provide client and authorized service providers with a comprehensive assessment summary. 2. Provide client and authorized service providers with specialized treatment recommendations for modalities and treatment options that are most effective for client's abilities and needs. 3. Provide psychoeducation to the client and/ or guardian regarding client's mental status, symptomology, and diagnosis. 4. Connect client with resources which can meet their needs. 2.1f Target population of the service, including age and gender: Individuals with various diagnosed or suspected intellectual / developmental disabilities, ages 6-100, exhibiting challenges with mental or behavioral health. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English and Spanish (proficient) — no interpreter services available 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Potentially. yes. Service #2 Name: Treatment Groups 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Seeking Safety, CBT, DBT, High Conflict Co -Parenting, Caring Dads, SSC/SSIC, Affective Education and Health Relationships, Veteran Group, Social Skills, Trauma -Processing, and others. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.2c Anticipated duration of service (i.e. 3-4 months): 16-52 weeks, depending on client progress and needs 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Complete treatment group assigned. 2.2e Three 1. 2. arm outcomes of service: Complete accurate assessment of clients' treatment, strengths, needs, and areas of skill deficits. Complete designated curriculum specialized for the service type. REV. NOV 2020 1 3. Reduce and/or eliminate concerns of recidivism, relapse, and other risk factors. 4. Increase coping capacity, safety tools, safe relationships, problem -solving, communication, and decision -making. 2.2f Target population of the service: individuals with various diagnosed or suspecte, 2.2g Languages service is available in (please list prc English and Spanish (proficient) — no interprete 2.2h Medicaid eligibility — list whether the service is Some, yes. intellectual / developmental disabilities, ages 6-100. ciency and if interpreter services are available): services available ligible for Medicaid in whole or in part: Service #3 Name: Consultation 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Case consult, document review, etc. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: As needed 2.3c Anticipated duration of service (i.e. 3-4 months): As needed 2.3d Three (3), or more, specific goals of the service (DO use bullet points): Identify correct course for client treatment, needs, and dynamics. 2.3e Three (3), or more, specific outcomes of service: Successful direction achieved. 2.3f Target population of the service: 2.3g Languages service is available in (please list 2.3h Medicaid eligibility — list whether the service is and if interpreter services are availab for Medicaid in whole or in part: Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Antici duration of service (i.e. 3-4 orm Is of the service 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list prof use bullet and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Antici 2.5d Three duration of service (i.e. 3-4 month or more, s of the service (DO use bullet REV. NOV 2020 2 ATTACHMENT C - PROPOSAL 2.5e Three 2.5f Ta 2.5g La or more, specific outcomes of service: 2.5h Medicaid e ation of the service: service is available in (please list proficiency and if interpreter services are avai — list whether the service is eligible for Medicaid in whole or in Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: Z YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES Z NO 3.4 How many miles are you willing to travel round trip? List a specific number of 60 Miles miles. 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode. except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: 4.1a 4.1b 4.1c 4.1d 4.1e I Mental Health Evaluation $ Amount Unit Type In-Office/Video: $500/eval per In -Office with Transportation: per In -Home or Community: per FTM, TDM, Prof. Staffing: $100 per No show: per Mileage rate: per Hour Hour No. of miles included in rate: miles Hour No. of miles included in rate: miles Hour No Show Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: I Treatment Groups $ Amount Unit Type 4.2a In-Office/Video: $45 per Hour 4.2b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.2c In -Home or Community: per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: $100 per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: I Consultation $ Amount Unit Type 4.3a In-Office/Video: 125 per Hour 4.3b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.3c In -Home or Community: per Hour No. of miles included in rate: miles REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.3d 4.3e 4.3f FTM, TDM, Prof. Staffing: No show: Mileage rate: 100 per per per Hour No Show Mile This is paid after the miles listed above. 4.4 Hourly 4.4a 4.4b 4.4c 4.4d 4.4e Service #4 Name: In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of No. of This is miles included in rate: miles included in rate: paid after the miles listed miles miles above. 4.5 Hourly 4.5a 4.5b 4.5c 4.5d 4.5e 4.5f Service #5 Name: In-Office/Video: In -Office with Transportation: In -Home or Community: FTM, TDM, Prof. Staffing: No show: Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of No. of This is miles included in rate: miles included in rate: paid after the miles listed 0 miles 0 miles above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA $15 Confirmation Test Provider special notes: All bilingual services are +$15/hour or REV. NOV 2020 4 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1- Provider and Program Area Information Bidder's Legal Name: Lifelong, Inc. Program Area: Number of services offered on this Attachment C (max Substance Abuse Treatment Services 5): 5 Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than S. for Proposal starting on page 13. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name Substance Abuse Treatment — Group Treatment (E.g. Relapse Prevention, SSIC/SSC, Seeking Safety, etc.) 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): CBT, DBT, TF-CBT, MI, multimodal approaches 2.1b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: One group per week 2.1c Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce and manage substance use or substance misuse. 2. Reach a goal of being alcohol or substance use free. 3. Maintain abstinence from all substances. 2.1e Three (3), or more, specific outcomes of service: 1. Successful daily practice of self -care and coping skills. 2. Successful establishment and maintenance of pro -social relationships. 3. Successful reunification or other successful case closure. 2.1f Target population of the service, including age and gender: Client with various diagnosed or suspected disabilities, ages 12-100 2.1g Language's service is available in (please list proficiency and if interpreter services are available): 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #2 Name: Substance Abuse Treatment - Individual Treatment 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): CBT, DBT, TF-CBT, MI, multimodal approaches 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-3 sessions/week depending on individual's needs. 2.2c Anticipated duration of service (i.e. 3-4 months): Case specific — ranges for each case needs (i.e., 16 weeks to 52 weeks) 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 4. Reduce and manage substance use or substance misuse. 5. Reach a goal of being alcohol or substance use free. 1. Maintain abstinence from all substances. 2.2e Three (3), or more, specific outcomes of service: 1. Successful daily practice of self -care and coping skills. 2. Successful establishment and maintenance of pro -social relationships. 3. Successful reunification or other successful case closure. 2.2f Target population of the service: Client with various diagnosed or suspected disabilities, ages 12-100 2.2g Languages service is available in (please list proficiency and if interpreter services are available): REV. NOV 2020 1 ATTACHMENT C - PROPOSAL English 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in Hart: Service #3 Name: Urinalysis and Breathalyzer 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Secure and protected drug panel screening tools Substances tested for: AMP,BAR,BUP,BZO,COC,CR,ETG,FEN,MTD,OPI,OXY,THC,TRAMADOL 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: As needed or required by treatment 2.3c Anticipated duration of service (i.e. 3-4 months): Length of SUD treatment 2.3d Three (3), or more, specific goals of the service (DO use bullet 2.3e 2.3f 2.3g Complete sobriety testing successfully Three (3), or more, specific outcomes of service: Provide negative sobriety test results when scheduled Target population of the service: Clients in SUD treatment Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is for Medicaid in whole or in Dart: Service #4 Name: I Substance Treatment Intake 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Intake Assessment and Screening Tools 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 sessions 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet point Complete SUD intake 2.4e Three (3), or more, specific outcomes of service: SUD intake report generated and released 2.4f Target population of the service: Client with various diagnosed or suspected disabilities, ages 12-100 2.4g Languages service is available in (please list proficiency and if intern services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service #5 Name: Substance Treatment Evaluation 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Evaluation Assessment and Screening Tools 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-2 sessions 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific Completed SUD evaluation of the service (DO use bullet 2.5e Three (3), or more, specific outcomes of service: SUD evaluation report generated and released. 2.5f Target population of the service: Client with various diagnosed or suspected disabilities, ages 12-100 REV. NOV 2020 ATTACHMENT C - PROPOSAL 2.5g Languages service is available in (please list prc English 2.5h Medicaid eligibility — list whether the service is and if interpreter services are availa ble for Medicaid in whole or in Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: ® YES ❑ NO 3.2 Will you conduct services in a client's home or in the community? Check one: ❑ YES ® NO 3.3 Will you transport clients to and/or from services? Check one: ❑ YES ® NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. Miles 3.5 When you calculate mileage, what is your starting point address? The office or the first appointment location of the day 4.1 SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be oer episode. except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. Hourly Service #1 Name: Substance Abuse Group Treatment $45 $100 $ Amount 4.2 Hourly Service #2 Name: Substance Abuse Individual Treatment $ Amount Unit Type 4.2a In-Office/Video: $110 per Hour 4.2b In -Office with Transportation: per Hour No. of miles included in rate: miles 4.2c In -Home or Community: per Hour No. of miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: $100 per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: Urinalysis and Breathalyzer - confirmation test additional ($15) $ Amount Unit Type 4.3a In-Office/Video: UA - $21 BA per Hour -$7 confirmation -$15 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: per Hour per Hour per Hour per No Show No. of miles included in rate: miles No. of miles included in rate: miles REV. NOV 2020 3 ATTACHMENT C - PROPOSAL 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: Substance Treatment Intake $ Amount 4.4a In-Office/Video: $225 4.4b In -Office with Transportation: In -Home or Community: 4.4c FTM, TDM, Prof. Staffing: $100 4.4d No show: 4.4e Mileage rate: Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of No. of This is miles included miles included paid after the in rate: miles in rate: miles miles listed above. 4.5 Hourly Service #5 Name: I Substance Treatment Evaluation $ Amount Unit Type 4.5a In-Office/Video: $375 per Hour 4.5b In -Office with Transportation: per Hour 4.5c In -Home or Community: per Hour 4.5d FTM, TDM, Prof. Staffing: $100 per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile No. of No. of This is miles included miles included paid after the in rate: miles in rate: miles miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. $21 UA $7 BA $15 confirmation Provider special notes: All bilingual services are +$15/hour or REV. NOV 2020 ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Lindsey Spraker Lifelong, Inc. PHONE NUMBER: (303)573-0839 EMAIL: Lindsey@Lifelonginc.com PROPOSED SERVICE(S): Crisis Intervention and Stabilization, Domestic Violence Services, Foster Parent Consultation, Foster Parent Training, Home Based Intervention, Aftercare Services, Kinship Services (Therapeutic), Life Skills, Mental Health Services, Substance Abuse Treatment Services Legal Last Name Middle Initial Previous Legal Last Name (If applicable) Legal First Name Service Type Licensure/ Credentials DORA # (If applicable) Spraker Lindsey various LCSW, CTRS 2081 Bickelhaupt Krista various LPC, BCBA 13521 Byrne Camryn various CAS, NLC 21020, 110489 Fann Jess various NLC 105704 Finn Jordyn various BCJ Grajeda Karina various MCJ Greive Elliot various LPC, LAC 17582, 1622 Gutierrez Stephanie various BA Jorden Jeffrey various LPC 13469 McLaughlin Meaghan various MFT Mendez Jose various MA Murphy Brandon various CAT 8148 Pagan Vanessa Office Manager MHCA Schell Kenneth various BA Spraker Erika various LSW, CAT 9923985, 8035 Wilcox Alexa various LPC 14456 Owen Jesse various PhD 4340 Quirk Kelley various PhD 4510 Allen Korrie various PhD 5290 Martinich Matthew various PhD 4951 Barnhart Kristine various MS CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ACORO® CERTIFICATE OF LIABILITY INSURANCE �� DATE (MM/DD/YYYY) 01/25/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Allyson Ingram NAME: CenterPoint Insurance Group (303) 333-0375 FAX (303) 333-1391 PHONE AIC No Ext): , No): AIC 8400 E Prentice Ave Suite 735 E-MAIL ADDRESS: allyson.ingram@cptins.com INSURER(S) AFFORDING COVERAGE NAIC # Greenwood Village CO 80111 INSURERA: Philadelphia Insurance Companies 006 INSURED INSURERS: Pinnacol Assurance Company 20 Lifelong, Inc. INSURER C: North American Specialty Insurance 7175 W. Jefferson Ave #4000 INSURER D: INSURER E: Lakewood CO 80235 INSURER F: COVERAGES CERTIFICATE NUMBER: 2021-2022 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ILT TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD MMIPODY EXP LIMITS >4 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrencel $ 100,000 X Prof. Liability $1 MM/$3MM MED EXP (Any one person) $ 5,000 )'( Sex Abuse $1 MM/$2MM PERSONAL &ADV INJURY $ 1,000,000 A PHPK2293074 07/01/2021 07/01/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ❑ PRO- ❑ LOC JECT PRODUCTS-COMP/OPAGG $ 3,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED Il SCHEDULED AUTOS ONLY I I AUTOS PHPK2293074 07/01/2021 07/01/2022 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY /� AUTOS ONLY UMBRELLA LIAB Li OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ B WORKERS COMPENSATION EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? jj (Mandatory in NH) N/A 4193499 07/01/2021 07/01/2022 X OTH-AND E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 500,000 $ C Cyber Liability C-4MZ6-071907-CYBER-2021 01/01/2022 01/01/2023 Limit $1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Board of County Commissioners of Weld County and its Officers/Employees are listed as additional insured with regards to Commercial General Liability. Weld County 1150O St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Greeley CO 80631 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD EXHIBIT C SCOPE OF SERVICES Contractor will provide Aftercare Services, Crisis Intervention and Stabilization Services, Anger Management/Domestic Violence, Foster Parent Consultation, Foster Parent Training, Home -Based Intervention, Kinship Services (Therapeutic), Life Skills, Mental Health Services, and Substance Abuse Treatment Services, as referred by the Department. Program Area: Aftercare Services 1. Applied Behavior Analysis (ABA) — Board Certified Behavior Analyst (BCBA) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Applied Behavior Analysis (ABA) as primary modality ii. Trauma -informed iii. Assessments including but not limited to: Functional Behavior Assessment (FBA), Functional Assessment Screening Tools (FAST), Functional Analysis (only when clinically indicated), skills assessments, adaptive functioning scales, Vineland III, developmental assessments, Autism screening tools, Verbal Behavior Milestones Assessment and Placement Program (VBMAPP), Assessment of Basic Language and Living Skills (ABLLS), Assessment of functional living skills (AFLS), Essentials for Living (EFLS). iv. All assessments are used to allocate baseline data, identify skill deficits, and drive curriculum for treatment goals. v. Assessment is ongoing and all treatment decisions are driven by data collected in every session reflecting progress on each goal and behavior. b. Anticipated Frequency of Services: i. ABA is highly dependent on a thorough, individualized assessment. Service recommendations can range from one (1) to forty (40) hours per week of treatment. c. Anticipated Duration of Services: i. ABA services can range from a short term focused treatment for six (6) months or may extend longer depending on the individual's needs and abilities. d. Goals of Services: i. Identify skill deficits and develop skill acquisition programming to be taught using the principles of ABA. ii. Mediate and reduce the negative effects of challenging behaviors on the individual and caregivers. iii. Develop and implement behavior intervention strategies to reduce behaviors targeted for reduction. iv. Conduct ongoing parent/caregiver required training on skill teaching and behavior intervention strategies using a trauma-informed/preventative approach. e. Outcomes of Services: i. Prevent or reduce behaviors that put individuals or their caregivers/family members at risk of harm. ii. Prevent or reduce behaviors that limit an individual's ability to access their home, school, community, and establish and maintain meaningful relationships. iii. Increase communication and social skills. iv. Increase independence to the highest level possible and establish skills that contribute to mental and physical health and hygiene. f. Target Population: i. Individuals of all ages, genders, abilities and diagnoses, unless clinically contraindicated or a diagnosis for the person or child involves a symptomology that requires medical intervention as the primary treatment. g. Language: i. English and Spanish (proficient) — no interpreter services are available. h. Medicaid Eligibility: i. This service may be Medicaid eligible for qualified individuals through EPSDT with a doctor's referral prescribing ABA as a medically necessary treatment for individuals' specific diagnosis. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 2. Applied Behavior Analysis (ABA) — Behavior Technician a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Primary modality being ABA. ii. Behavior Technician's (BT's) work directly with the client, under supervision, to implement the skill teaching program and behavior interventions designed by the Board - Certified Behavior Analyst (BCBA). b. Anticipated Frequency of Services: i. ABA is highly dependent on a thorough individualized assessment. Service recommendations can range from one (1) to forty (40) hours per week. c. Anticipated Duration of Services: i. ABA services can range from a short term focused treatment for six (6) months or may extend longer depending on the individual's needs and abilities. d. Goals of Services: i. Identify skill deficits and develop skill acquisition programming to be taught using the principles of ABA. ii. Mediate and reduce the negative effects of challenging behaviors on the individual and caregivers. iii. Develop and implement behavior intervention strategies to reduce behaviors targeted for reduction. iv. Conduct ongoing parent/caregiver required training on skill teaching and behavior intervention strategies using a trauma -informed / preventative approach. e. Outcomes of Services: i. Prevent or reduce behaviors that put individuals or their caregivers/family members at risk of harm. ii. Prevent or reduce behaviors that limit an individual's ability to access their home, school, community, and establish and maintain meaningful relationships. iii. Increase communication and social skills. iv. Increase independence to the highest level possible and establish skills that contribute to mental and physical health and hygiene. f. Target Population: i. Individuals of all ages, genders, abilities and diagnoses, unless clinically contraindicated or a diagnosis for the person or child involves a symptomology that requires medical intervention as the primary treatment. g. Language: i. English and Spanish (proficient) — no interpreter services are available. h. Medicaid Eligibility: i. This service may be Medicaid eligible for qualified individuals through EPSDT with a doctor's referral prescribing ABA as a medically necessary treatment for individuals' specific diagnosis. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Social Skills Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Social skills checklists are utilized to assess skills and identify pairs or groups of individuals who would work effectively together on mutual goals that are appropriate for their age and development. b. Anticipated Frequency of Services: i. One (1) to two (2) times per week for one (1) or more hours depending on size of group and abilities. c. Anticipated Duration of Services: i. Eight (8) weeks per cohort. d. Goals of Services: i. Identify individuals who could benefit from facilitated social skills practice in a group setting. ii. Provide safe, monitored, and facilitated activities that support individuals' social skills practice in a group setting. iii. Provide peer modeling opportunities for individuals with social skills deficits. iv. Promote the development of necessary social skills and safe ways to connect and interact with peers. e. Outcomes of Services: i. Increase clients' access to safe opportunities to practice social skills and develop meaningful relationships. ii. Increase clients' ability to generalize social skills to new individuals in a new setting. iii. Increase the connections and opportunities to create a community for individuals with intellectual disabilities. f. Target Population: i. Children and adults that have been assessed and identified as a candidate for group processing. g. Language: i. English, Spanish, (proficient) — no interpreter services available h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Trauma Processing Group a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma informed approaches and materials, depression and anxiety scales, Post - Traumatic Stress Disorder (PTSD) assessments as prescribed by the group facilitators as needed. b. Anticipated Frequency of Services: i. One (1) time per week for one (1) to two (2) hours. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Provide a safe setting for individuals who have been assessed and identified as a candidate for which group processing may be beneficial. ii. Facilitate the development of a supportive working group in which individuals can share, relate to others and process traumatic experiences. iii. Provide psychoeducation to group members to promote skill development for management of symptoms of PTSD and other trauma related behaviors and symptomology. e. Outcomes of Services: i. Individuals access opportunities to process trauma and begin a healing process in a safe and supportive group that is goal oriented and facilitated. ii. Individuals demonstrate the ability to establish and maintain self -care and coping practices while sharing connection and accountability with their group peers. iii. Individuals experience safety and acceptance that allows for integration of skills and mental health treatment. f. Target Population: i. Youth and adults that have been assessed and identified as a candidate for group processing. g. Language: i. English, Spanish, (proficient) — no interpreter services available h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235, virtually, or in the client's home. ii. The provider will not be transporting clients. Program Area: Anger Management 1. Domestic Violence Intake a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: I. Domestic Violence Offender Management Board (DVOMB) approved intake and assessment materials. b. Anticipated Frequency of Services: i. Two (2) to five (5) hours. c. Anticipated Duration of Services: i. One (1) to two (2) sessions. d. Goals of Services: i. Completion of intake. e. Outcomes of Services: i. Completion of intake. f. Target Population: i. Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 2. Domestic Violence Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Clinical Assessment Interview. ii. Domestic Violence Risk and Needs Assessment (DVRNA). iii. Spousal Assault Risk Assessment Guide —3 (SARA - 3). iv. CAGE -AID Substance Abuse Screening Tool. v. Alcohol Use Disorders Identification Test (AUDIT). vi. Scoring the States of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A/8D). vii. Ohio State University Traumatic Brain Injury Identification Method (OSU-TBI). viii. Mini -Mental State Examination (MMSE). ix. Brief Resiliency Scale (BRS). x. Beck Anxiety Inventory (BAI). xi. Beck Depression Inventory (BDI). xii. Level 2 - Anger — Adult. xiii. Substance Abuse Subtle Screening Inventory (SASSI). xiv. Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) — Brief Form (PID-BF) — Adult. xv. World Health Organization Disability Assessment Schedule (WHODAS) 2.0. xvi. Personality Assessment Screener (PAS). xvii. Adverse Childhood Experiences (ACE) Questionnaire. b. Anticipated Frequency of Services: i. Three (3) to seven (7) hours. c. Anticipated Duration of Services: i. Each evaluation and assessment summary and recommendations will be completed within fifteen (15) to thirty (30) days of the first appointment. d. Goals of Services: i. Assess and identify treatment needs of the client. ii. Determine the level of treatment intensity required for domestic violence services. iii. Establish recommendations for immediate and long-term safety planning. e. Outcomes of Services: i. Completion of evaluation. f. Target Population: i. Persons identified as at risk of or known domestic violence involvement with or without police contact or child welfare involvement. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 3. Domestic Violence Group Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavior Therapy (CBT). ii. Dialectical Behavioral Therapy (DBT). iii. Trauma Focused Cognitive Behavioral Therapy (TF-CBT). iv. Motivational Interviewing (MI). v. Duluth model. vi. Multimodal approaches. b. Anticipated Frequency of Services: i. One (1) group per week. c. Anticipated Duration of Services: i. Duration will be case specific. d. Goals of Services: i. Reduce and manage mental health triggers. ii. Increase the ability to demonstrate understanding of cycle of violence, power and control. iii. Increase ability to demonstrate self-awareness and identify triggers. iv. Increase ability to reflect on self in the group setting. v. Interact with peers in the group setting, demonstrating accountability, competency achievement, and vulnerability. vi. Identify precursors to violence and engage in preventive strategies to self -regulate and manage impulses. e. Outcomes of Services: i. Successful engagement in the group therapy dynamic. ii. Successful daily practice of self -care and coping skills. iii. Successful use of coping skills during conflict or crisis. iv. Successful reunification or other successful case closure. f. Target Population: i. Clients with various diagnosed or suspected disabilities, age four (4) to one hundred (100). ii. Individuals, dyads, and families. g. Language: i. English and Spanish (proficient) — no interpreter services are available. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 4. Domestic Violence Individual Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavior Therapy (CBT). ii. Dialectical Behavioral Therapy (DBT). iii. Trauma Focused Cognitive Behavioral Therapy (TF-CBT). iv. Motivational Interviewing (MI). v. Duluth model. vi. Multimodal approaches. b. Anticipated Frequency of Services: i. One (1) to two (2) sessions per week, dependent on individual needs. c. Anticipated Duration of Services: i. Duration will be case specific. d. Goals of Services: i. Reduce and manage mental health triggers. ii. Increase the ability to demonstrate understanding of cycle of violence, power and control. iii. Increase ability to demonstrate self-awareness and identify triggers. iv. Increase ability to reflect and self -evaluate, identify precursors to violence, and engage in preventive strategies to self -regulate and manage impulses. v. Increase ability to identify criteria for safe and healthy interactions and relationships. vi. Increase ability to demonstrate protective skills of self and dependents. e. Outcomes of Services: i. Successful engagement in individual therapy process regarding offense specific behavior reduction. ii. Successful daily practice of self -care and coping skills. 7 iii. Successful use of coping skills during conflict or crisis. iv. Successful reunification or other successful case closure. f. Target Population: i. Clients age four (4) to one hundred (100). g. Language: i. English and Spanish (proficient) — no interpreter services are available. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 5. Caring Dads a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The Caring Dads parenting group is a curriculum driven and facilitated opportunity for men to obtain and practice parenting skills and connect with other men as fathers. b. Anticipated Frequency of Services: i. One (1) time per week. c. Anticipated Duration of Services: i. Seventeen (17) weeks. d. Goals of Services: i. Improve and strengthen the father/child relationship. ii. Learn child centered parenting skills and strategies to manage stress and frustration. iii. Identify and self -reflect on the impact of previous conflictual strategies on familial relationships. e. Outcomes of Services: i. Reduce recidivism of child welfare contact for participating families. ii. Successful case closure via reunification or maintenance of custody or in -home placement. iii. Create community connections and relationships for fathers. f. Target Population: i. Parents with children, fathers who have demonstrated parenting challenges that resulted in child protection concerns, fathers struggling with parenting children with challenging behaviors or special behavioral needs. g. Language: i. English j. Medicaid Eligibility: ii. This service is not Medicaid eligible. k. Service Access and Transportation: iii. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. iv. The provider will not be transporting clients. High Conflict Co -Parenting a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Group therapy. ii. Curriculum driven and skill acquisition focused. iii. Parents in high -conflict separations, child welfare cases, divorces, or requiring mediation attend the groups separately. iv. Skills focused on conflict resolution, communication skills, stress management, and protection of involved children. b. Anticipated Frequency of Services: i. One (1) time per week. c. Anticipated Duration of Services: i. Twelve (12) weeks. d. Goals of Services: 1. ii. 1. Provide a safe environment for parents to connect, reflect, and learn ways to manage co -parenting challenges. iii. 2. Parents will develop skills to co -parent and communicate effectively, minimizing conflict. iv. 3. Parents will learn strategies to mediate stress and implement protective strategies to reduce emotional harm to involved children. e. Outcomes of Services: i. Reduce the occurrence of severe conflictual parenting interactions that result in violence, child protection involvement, and/or police contact. ii. Support parents to resolve contentious custody battles and resolve disagreements independently after supports fade. iii. Reduce emotional / physical harm to involved children. f. Target Population: i. Parents who have been identified as having co -parenting conflict that is unable to resolved without proper supports. h. Language: ii. English 1. Medicaid Eligibility: iii. This service is not Medicaid eligible. m. Service Access and Transportation: v. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. vi. The provider will not be transporting clients. Program Area: Foster Parent Consultation 1. Foster Parent Consultation — Individuals/Families a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: �7 i. Modality may include trauma informed ABA (Applied Behavior Analysis) or other parent coaching curriculums specialized for parents fostering children. b. Anticipated Frequency of Services: i. Frequency is highly dependent on specific needs and behaviors the family identifies during assessment. c. Anticipated Duration of Services: i. The duration of services depends on the specific needs and behaviors the family identifies during the assessment and if child(ren) are also receiving services. d. Goals of Services: i. Provide foster parents with psychoeducation and resources that will prevent or limit burnout and stress. ii. Work with foster parents to identify preventative and environmental modifications that will enhance structure and predictability in their home. iii. Connect foster parents with other necessary resources or services. e. Outcomes of Services: i. Prevent placement disruptions for involved children. ii. Support the placement to improve health and safety for the family unit. iii. Identify the need for additional or longer -term support and services. f. Target Population: i. Foster parents in need of consultation to address a specific concern or improve the overall placement success of their home. g. Language: i. English and Spanish (fluent). h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 2. Foster Parent Consultation — Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Modality may include Trauma Informed ABA (Applied Behavior Analysis) or other parent coaching curriculums specialized for parent groups fostering children. b. Anticipated Frequency of Services: i. Frequency is highly dependent on specific needs and behaviors of the groups of families identified during/after assessment. Anticipated Duration of Services: i. The duration of services depends on the specific needs and behaviors of each of the families identified during/after assessment and if child(ren) are also receiving services. d. Goals of Services: i. Provide foster parent groups with psychoeducation and resources that will prevent or limit burnout and stress. 10 ii. Work with foster parent groups to identify preventative and environmental modifications that will enhance structure and predictability in their home. iii. Connect foster parent groups with other necessary resources or services. e. Outcomes of Services: i. Prevent placement disruptions for involved children. ii. Support the placement to improve health and safety for the family unit. iii. Identify the need for additional or longer -term support and services. f. Target Population: i. Foster parent groups in need of consultation to address a general concern or improve the overall placement success of their home. g. Language: i. English and Spanish (fluent). h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Program Area: Foster Parent Training 1. Foster Parent Training— Various a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Trauma informed ABA (Applied Behavior Analysis), parent coaching curriculums specialized for parents fostering children, and trauma informed trainings. ii. Attachment/trauma focused therapy and psychoeducation. b. Anticipated Frequency of Services: i. Frequency will depend on the needs as requested by the Department. c. Anticipated Duration of Services: i. Duration will depend on the needs as identified by the Department. d. Goals of Services: i. Provide psychoeducation to foster parents regarding attachment trauma and associated symptoms and behaviors. ii. Provide foster parents with skills and training to support the development and maintenance of strategies that promote safety and prevent or limit the occurrence of behavioral challenges that can lead to additional trauma and /or disruption of the placement. iii. Provide foster parents with a safe and understanding support system in which they can process the challenges of foster parenting and learn self -care and coping skills. e. Outcomes of Services: i. Preservation of placement. ii. Reduction in the number of placement changes a child experiences while in foster care. iii. Reduction in foster parent burn out and stressors associated with foster care. f. Target Population: i. Foster Parents. 11 g. Language: iii. English and Spanish (fluent). h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Program Area: Home -Based Intervention 2. Home -Based Interventions — Intensive a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual and/or family therapy, therapeutic life skills, Applied Behavior Analysis, and a variety of our services provided by master level clinicians in the home environment of the individual. Modality for therapeutic interventions determined by clinician and based on clients' individual needs and abilities. Skills assessments may be utilized to determine curriculum and programming. b. Anticipated Frequency of Services: i. Three (3) to eight (8) hours per week, frequency will be based on individual needs and goals. c. Anticipated Duration of Services: i. Minimum of twelve (12) weeks based on individual needs and goals. d. Goals of Services: i. Provide most accessible therapeutic level interventions in client home. ii. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. iii. Individuals will reflect on and process stressors, traumatic experiences, and associated emotions and behaviors. iv. Individuals will develop and maintain self -care and coping practices. e. Outcomes of Services: i. Increased ability to generalize and maintain learned skills over time in their home environments. ii. Reduced likelihood of out of home placement and court involvement for child protection concerns. iii. Reduced recidivism for child welfare contact and involvement. f. Target Population: i. Clients with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). ii. Individuals, dyads, and families. g. Language: i. English and Spanish (proficient) — no interpreter services are available. h. Medicaid Eligibility: iv. This service is not Medicaid eligible. 12 i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 3. Home -Based Interventions — High a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapeutic life skills, Applied Behavior Analysis, Parent Training and Coaching and a variety of our services provided by master's level clinicians -in -training in the home environment of the individual. Modality for therapeutic interventions determined by clinician and based on clients' individual needs and abilities. b. Anticipated Frequency of Services: i. Three (3) to six (6) hours per week, frequency will be based on individual needs and goals. c. Anticipated Duration of Services: i. Minimum of eight (8) weeks based on individual needs and goals. d. Goals of Services: i. Provide most accessible therapeutic level interventions in client home. ii. Individuals will engage in skill acquisition and therapy with opportunity to demonstrate and maintain skills in their home environment. iii. Individuals will develop and maintain self -care and coping practices. e. Outcomes of Services: i. Increased ability to generalize and maintain learned skills over time in their home environments. ii. Reduced likelihood of out of home placement and court involvement for child protection concerns. iii. Reduced recidivism for child welfare contact and involvement. f. Target Population: i. Clients with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). ii. Individuals, dyads, or families. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 7. Home -Based Interventions — Moderate a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Can include life skills coaching, Applied Behavior Analysis, parenting skills, child development psychoeducation, and mentoring provided in the individual's home. 13 b. Anticipated Frequency of Services: iii. Two (2) to six (6) hours per week, based on individual needs and goals. c. Anticipated Duration of Services: i. Eight (8) to twelve (12) weeks, based on individual needs and goals. d. Goals of Services: i. Individuals will engage in skill acquisition opportunity to demonstrate and maintain skills in their home environment. ii. Individuals will develop and maintain self -care and coping practices. iii. Individuals will demonstrate an increased knowledge of safe parenting practices, awareness of child development, and the impact of trauma / abuse and neglect. e. Ou.comes of Services: i. Increased ability to generalize and maintain learned skills over time in their home environments. ii. Reduced likelihood of out of home placement and court involvement for child protection concerns. iii. Reduced recidivism for child welfare contact and involvement. f. Target Population: i. Clients with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). ii. Individuals, dyads, or families. g. Language: English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Program Area: Kinship Services (Therapeutic) 1. Kinship Services (Therapeutic) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intensive Family Therapy, Applied Behavior Analysis (ABA), Caregiver Consultation, and Caregiver Training. b. Anticipated Frequency of Services: i. Two (2) hours per week minimum. c. Anticipated Duration of Services: i. Twelve (12) weeks minimum. Duration is highly dependent on case specifics, children's needs, and engagement of involved parties. d. Goals of Services: i. Provide supportive and comprehensive services to kinship placement providers. ii. Provide psychoeducation, therapy, skill acquisition, and prevention strategies to mediate challenges presented in kinship care. 14 iii. Provide Kinship caregivers with resources, community connections, and skills to develop coping practices. e. Outcomes of Services: i. Preservation of Kinship placement. ii. Improve quality and stability of relationships within kinship placement. iii. Prevent kinship provider burnout and reduce risk of harm in placement. f. Target Population: i. Clients with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). ii. Individuals, dyads, or families. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Pro¢ram Area: Life Skills 1. Therapeutic Life Skills a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. May include but are not limited to role play practice of skills, direct support, prompting and prompt fading strategies, and naturalistic in -situation instruction. b. Anticipated Frequency of Services: i. Two (2) hours per week at a minimum, taking place over one (1) to three (3) sessions, depending on the client's needs. c. Anticipated Duration of Services: i. Duration will be case specific. d. Goals of Services: i. Provide skill acquisition training to individuals. ii. Provide safe therapeutic support in which clients social/emotional needs are respected and addressed in ways that will allow learning of skills and processing the emotions related to their challenges. iii. Individuals will increase their independence to the maximum potential possible for their abilities. iv. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. v. Individuals will improve the quality of their relationships, develop leisure skills that are healthy and sustainable. vi. Successful mental health management during stressful or triggering life skill activities. e. Outcomes of Services: i. Successful reunification or other successful case closure. 15 ii. Increased ability to access home and community resources. iii. Increased independence and ability to establish and maintain meaningful healthy relationships. iv. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. f. Target Population: i. Clients with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). ii. Individuals, dyads, or families. g. Language: i. English and Spanish (proficient) — no interpreter services are available h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 2. Life Skills a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Approaches are highly individualized and dependent on the specific skill deficits and goals of the individual. May include but are not limited to role play practice of skills, direct support, prompting and prompt fading strategies, and naturalistic in -situation instruction. b. Anticipated Frequency of Services: i. Two (2) hours per week minimum, one (1) to three (3) sessions depending on the client's needs. c. Anticipated Duration of Services: i. Duration will be case specific. d. Goals of Services: i. Provide skill acquisition training to individuals. ii. Individuals will increase their independence to the maximum potential possible for their abilities. iii. Individuals will secure and maintain resources that will allow them to meet their court ordered treatment goals. e. Outcomes of Services: i. Successful reunification or other successful case closure. ii. Increased ability to access home and community resources. iii. Increased independence and ability to establish and maintain meaningful healthy relationships. iv. Increased ability to identify and maintain healthy supports and leisure skills that contribute to stable and predictable parenting. f. Target Population: i. Clients with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). 16 ii. Individuals, dyads, or families. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Specialized Mentorship a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Based on the intake assessment, modalities or curriculum may include but are not limited to adventure based activities, participation and engagement in community activities, modeling, skill acquisition, role playing, and development of hobbies and interests. b. Anticipated Frequency of Services: i. Two (2) hours per week minimum, typically up to three (3) sessions per week. c. Anticipated Duration of Services: i. Six (6) to twelve (12) months. d. Goals of Services: i. Provide a safe, stable, consistent connection to individuals. ii. Individuals will develop and maintain skills that promote stability, independence, and physical/mental wellbeing. iii. Individuals will develop and maintain healthy leisure skills and increase self-worth and self-confidence by reducing risk taking behavior, acting out, substance use, and negative self -statements. e. Outcomes of Services: i. Reduce future police contact or juvenile justice system involvement. ii. Maintain placement in home or current stable living situation. iii. Increase school attendance and completion. iv. Increase awareness of mental health and resources to secure supports necessary to maintain wellbeing. v. Increase social/emotional skills and self -management. vi. Increase ability to advocate for self. vii. Increased communication skills. viii. Reduce symptoms of anxiety and depression. ix. Reduce self -harm. f. Target Population: i. Youth ages eight (8) to twenty-one (21) with or without suspected or diagnosed disability, criminal involvement, or child welfare involvement. g. Language: English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. 17 i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider may transport clients. Program Area: Mental Health Services 1. Mental Health Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Abstinence -Based Treatment (ABT), Animal Assisted Therapy (AAT), Marriage and Family Therapy (MFT), Motivational Interviewing (MI), Parent -Child Interaction Therapy (PCIT). b. Anticipated Frequency of Services: i. Frequency will be case specific depending on the severity of need/trauma/crisis. c. Anticipated Duration of Services: i. Duration will be case specific with recommendations based on assessment, client goals, and abilities, in addition to level of engagement. d. Goals of Services: i. Reduce and manage mental health triggers. ii. Reduce skill deficits within emotional regulation and coping practices. iii. Increase self-awareness and self -management skills. iv. Process traumatic experiences and develop understanding of their impact on current functioning and relationships. v. Increase the ability of the client to identify emotional, mental, and physical needs and advocate for themselves. e. Outcomes of Services: i. Successful use of coping skills during day-to-day interactions, conflict, or crisis. ii. Increased independence in accessing community activities, resources, and services. iii. Increased ability to demonstrate independent engagement in pro -social and safe leisure skills. iv. Ability to establish and maintain healthy and safe relationships. v. Successful achievement of court recommended goals. vi. Successful reunification or other successful case outcome. f. Target Population: i. Ages four (4) to one hundred (100), with various diagnosed or suspected disabilities/developmental disabilities. ii. Individuals, dyads, or families, staff/professionals in need of training. g. Language: i. English and Spanish (proficient) — no interpreter services available. h. Medicaid Eligibility: i. This service is not currently Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. 18 ii. The provider will be able to transport clients for Adventure Based Therapy (ABT) services, only. 2. Psychological Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Diagnostic tools, screeners, and assessments as determined by the psychologist. b. Anticipated Frequency of Services: i. Ten (10) to twelve (12) hours total including report preparation and feedback session. c. Anticipated Duration of Services: i. One (1) to three (3) appointments. d. Goals of Services: i. Generate accurate assessment of clients' diagnosis, strengths, needs, and areas of skill deficits. ii. Generate a complete report of specialized recommendations for treatment and services tailored to the social/emotional, mental health, and learning needs of the individual. iii. Identify and determine course of treatment, treatment goals, and modality that is best suited for the individual. e. Outcomes of Services: i. Evaluation will provide data, summary, and outcome suggestions for client's learning, developmental, and mental health needs. f. Target Population: i. Client's age four (4) to one hundred (100). g. Language: i. English and Spanish (proficient) — no interpreter services available. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Neuropsychological Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Diagnostic tools, testing, screeners, and assessments as determined by the psychologist. b. Anticipated Frequency of Services: i. Ten (10) to fifteen (15) hours total. c. Anticipated Duration of Services: i. One (1) to three (3) appointments for testing and interview. d. Goals of Services: i. Assess clients' strengths and areas of skill deficits. ii. Conduct neuropsychological testing as prescribed. iii. Accurately test clients' current functioning and gather full history of the whole person. 19 iv. Generate tailored recommendations for specialized services and modalities that will best support the client. e. Outcomes of Services: i. Accurate holistic understanding of client needs, diagnosis, and abilities. ii. Recommendations for specialized services. iii. Individualized and thorough report. f. Target Population: i. Client's age four (4) to one hundred (100). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 4. Pediatric Diagnostic Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. The pediatric diagnostic evaluation consists of systematic observations, assessments, collateral documentation review, and testing that will yield evidence to support a diagnosis of an Autism Spectrum diagnose or another disorder. b. Anticipated Frequency of Services: i. Ten (10) to fifteen (15) hours of observation, interviewing, testing and collateral review. c. Anticipated Duration of Services: i. One (1) to three (3) appointments. d. Goals of Services: i. Obtain or rule out a diagnosis of a developmental disorder. ii. Procure a thorough assessment of where a child falls along the Autism Spectrum. iii. Gain an understanding of a child's intellectual potential. e. Outcomes of Services: i. Provide a treatment and education plan specifically geared towards the child's needs. ii. Provide education and resources to those providing care for the child. iii. Identify and connect the family with specialized support services and treatment options. f. Target Population: i. Children up to age eighteen (18) with suspected developmental disabilities or Autism Spectrum Disorder. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. 20 i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Parent Child Interaction Assessment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Parent child interaction assessment utilizes prescribed evidence -based tools, observation techniques, and structured play scenarios based on the assessors training and current research. b. Anticipated Frequency of Services: i. Two (2) to three (3) hours of direct observation plus interviews and collateral documentation review. c. Anticipated Duration of Services: i. Ten (10) to twelve (12) hours including report preparation and feedback session. d. Goals of Services: i. Gather data about parental attunement, attachment, relationship dynamics between parent and child. ii. Identify harmful or dysfunctional parenting attributes. iii. Present a thorough representation of the parent child relationship. e. Outcomes of Services: i. Generate specialized recommendations for therapeutic supports to improve the quality of the parent/child relationship. ii. Reduce the likelihood of future child welfare contact. iii. Predict likelihood of potential for future abuse and neglect. f. Target Population: i. All individuals including those with various diagnosed or suspected intellectual/developmental disabilities, dyads, and families. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. Mental Health Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Clinical Interview, Adverse Childhood Experience (ACE) Questionnaire, Behavioral Rehabilitation Services (BRS), Ohio State University Traumatic Brain Injury (OSU-TBI), Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Minnesota Multiphasic Personality Inventory (MMPI), Texas Success Initiative program (TSI), mental status exam, or others as determined during the interview. 21 b. Anticipated Frequency of Services: i. Two (2) hours to four (4) hours. c. Anticipated Duration of Services: i. One (1) to two (2) appointments. d. Goals of Services: i. Conduct a thorough assessment of individuals' mental status, social/emotional skills and deficits, and adaptive functioning. ii. Identify individuals' current mental functioning and mental health diagnosis if indicated. iii. Assist individual in identifying areas of strength and need regarding their mental/emotional health. e. Outcomes of Services: i. Provide client and authorized Department service providers with a comprehensive assessment summary. ii. Provide client and authorized Department service providers with specialized treatment recommendations for modalities and treatment options that are most effective for client's abilities and needs. iii. Provide psychoeducation to the client and/or guardian regarding client's mental status, symptomology, and diagnosis. iv. Connect client with resources which can meet their needs. f. Target Population: i. Individuals with various diagnosed or suspected intellectual/developmental disabilities, ages six (6) to one hundred (100), exhibiting challenges. g. Language: i. English and Spanish (proficient) — no interpreter services available. h. Medicaid Eligibility: i. This service may be Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 7. Treatment Groups a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Seeking Safety, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), High Conflict Co -Parenting, Caring Dads, Strategies for Self -Improvement and Change (SSC/SSIC), Affective Education and Health Relationships, Veteran Group, Social Skills, Trauma -Processing, Domestic Violence, and others. b. Anticipated Frequency of Services: i. One (1) to two (2) groups per week. c. Anticipated Duration of Services: i. Sixteen (16) to fifty-two (52) weeks, depending on client progress and needs. d. Goals of Services: i. Complete treatment group assigned. 22 e. Outcomes of Services: i. Complete accurate assessment of clients' treatment, strengths, needs, and areas of skill deficits. ii. Complete designated curriculum specialized for the service type. iii. Reduce and/or eliminate concerns of recidivism, relapse, and other risk factors. iv. Increase coping capacity, safety tools, safe relationships, problem -solving, communication, and decision -making. f. Target Population: i. Individuals with various diagnosed or suspected intellectual/developmental disabilities, ages six (6) to one hundred (100). g. Language: i. English and Spanish (proficient) — no interpreter services available. h. Medicaid Eligibility: i. This service is partially Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 8. Consultation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Case consult. ii. Document review. b. Anticipated Frequency of Services: i. As needed. c. Anticipated Duration of Services: i. As requested by the Department. d. Goals of Services: i. Identify correct course for client treatment, needs, and dynamics. e. Outcomes of Services: i. Achieve successful direction. f. Target Population: i. Department and Court Professionals. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 23 Program Area: Substance Abuse Treatment Services 9. Substance Abuse Treatment — Group Treatment (E.g. Relapse Prevention, SSIC/SSC, Seeking Safety) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Motivational Interviewing (MI), multimodal approaches. b. Anticipated Frequency of Services: i. One group weekly. c. Anticipated Duration of Services: i. Duration will be case specific. d. Goals of Services: i. Reduce and manage substance use or substance misuse. ii. Reach a goal of being alcohol or substance use free. iii. Maintain abstinence from all substances. e. Outcomes of Services: i. Successful daily practice of self -care and coping skills. ii. Successful establishment and maintenance of pro -social relationships. iii. Successful reunification or other successful case closure. f. Target Population: i. Ages twelve (12) to one hundred (100) with various diagnosed or suspected disabilities. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 10. Substance Abuse Treatment - Individual Treatment a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Motivational Interviewing (MI), multimodal approaches b. Anticipated Frequency of Services: i. One (1) to three (3) sessions per week depending on the client's needs. c. Anticipated Duration of Services: i. Duration will be case specific. d. Goals of Services: i. Reduce and manage substance use or substance misuse. ii. Reach a goal of being alcohol or substance use free. 24 iii. Maintain abstinence from all substances. e. Outcomes of Services: i. Successful daily practice of self -care and coping skills. ii. Successful establishment and maintenance of pro -social relationships. iii. Successful reunification or other successful case closure. f. Target Population: i. Ages twelve (12) to one hundred (100) with various diagnosed or suspected disabilities. g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually, in the client's home, or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235. ii. The provider will not be transporting clients. 11. Urinalysis and Breathalyzer a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Secure and protected drug panel screening tools. ii. Substances tested for: 1. Amphetamine (AMP) 2. Barbiturates (BAR) 3. Buprenorphine (BUP) 4. Benzodiazepines (BZO) 5. Cocaine (COC), 6. Creatine (CR), 7. Ethylglucuronide (ETG), 8. Fenfluramine/phentermine (FEN) 9. Methadone (MTD) 10. Opiates (OPI) 11. Oxycodone (OXY) 12. Tetrahydrocannabinol (THC) 13. Tramadol b. Anticipated Frequency of Services: i. As needed or as required by treatment. c. Anticipated Duration of Services: i. Length of Substance Use Disorder (SUD) treatment. d. Goals of Services: i. Complete sobriety testing successfully. e. Outcomes of Services: i. Provide negative sobriety test results when scheduled. f. Target Population: i. Clients in SUD treatment. W g. Language: i. English. h. Medicaid Eligibility: i. No. i. Service Access and Transportation: i. Services will take place in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 ii. The provider will not be transporting clients. 12. Substance Treatment Intake a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intake Assessment and Screening Tools. b. Anticipated Frequency of Services: i. One (1) to two (2) hours. c. Anticipated Duration of Services: i. Thirty (30) days. d. Goals of Services: i. Complete Substance Use Disorder (SUD) intake. e. Outcomes of Services: i. SUD intake report generated and released. f. Target Population: i. Client with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). g. Language: i. English h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 ii. The provider will not be transporting clients. 13. Substance Treatment Evaluation a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evaluation Assessment and Screening Tools. b. Anticipated Frequency of Services: i. One (1) to two (2) hours. c. Anticipated Duration of Services: i. Thirty (30) days. d. Goals of Services: 26 i. Complete Substance Use Disorder (SUD) evaluation. e. Outcomes of Services: i. SUD evaluation report generated and released. f. Target Population: Client with various diagnosed or suspected disabilities, ages twelve (12) to one hundred (100). g. Language: i. English h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Services will take place virtually or in the provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 ii. The provider will not be transporting clients. Terms 1. Contractor will respond to the Quality Assurance Team(HS-CWOualityAssurance(a,weldhov.com within three (3) business days regarding the ability to accept the received referral. 2. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team HS- CWOualityAssu rance(&weld2ov.com. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the part of case participants who cancel without 24 hour notice. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWOualitvAssurance(aiweld2ov.com. 4. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team HS-CWOualityAssurance(ai)weldeov.com immediately via email, to discuss service continuation. 5. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 6. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited 27 to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation referrals will be approved by the caseworker, their supervisor, or the Family Support and Visitation Center. A change is deemed as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Quality Assurance Team, and the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the Client Verification Form. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone, if approved by the Department. 10. Contractor will notify the Quality Assurance Team HS-CWQualityAssurance(aiweldgov.com of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. ON EXHIBIT D RATE SCHEDULE Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2022. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Rate I Unit Type I Service Name Applied Behavior Analysis (ABA) — Board Certified Behavior Analyst (BCBA) $125.00 Hour In-Office/Video $140.00 Hour In-Office/Video - Spanish $130.00 Hour In -Home or Community $145.00 Hour In -Home or Community — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffmg $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Applied Behavior Analysis (ABA) - Behavior Technician .1111 $85.00 Hour In-Office/Video $100 Hour In-Office/Video — Spanish $90.00 Hour In -Home or Community $105.00 Hour In -Home or Community — Spanish $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffmg $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Social Skills Group $45.00 Hour In-Office/Video $60.00 Hour In-Office/Video — Spanish $50.00 Hour In -Home or Community $65.00 Hour In -Home or Community — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, $0.56 Mile 80235 or the first appointment location of the day Trauma Processing Group $45.00 Hour In-Office/Video $60.00 Hour In-OfficeNideo — Spanish $50.00 Hour In -Home or Community $65.00 Hour In -Home or Community — Spanish Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, $100.00 Hour Professional Staffing No show — maximum of two (2) no shows or two (2) hours per month per $25.00 Each client. Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, $0.56 Mile 80235 or the first appointment location of the day Rate Unit T e I Service Name Domestic Violence Intake $275.00 Hour In-office/Video $290.00 Hour In-officeNideo — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Domestic Violence Evaluation $500.00 Hour In-officeNideo $515.00 Hour In-office/Video — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Domestic Violence Treatment Group $45.00 Hour In-office/Video $60.00 Hour In-office/Video — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Domestic Violence Individual Treatment $125.00 Hour In-officeNideo $140.00 Hour In-office/Video — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffmg $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Caring Dads $45.00 Hour In-office/Video $60.00 Hour In-office/Video — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. High Conflict Co -Parenting $45.00 Hour In-office/Video $60.00 Hour In-office/Video — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffmg $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. '1TTt1TL111FiUTh Rate Unit Type Service Name Foster Parent Consultation - Individual/Family $150.00 Hour In-Office/Video $165.00 Hour In-Office/Video - Spanish $165.00 Hour In -Home or Community $180.00 Hour In -Home or Community— Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Foster Parent Consultation - Group $45.00 Hour In-Office/Video $60.00 Hour In-Office/Video - Spanish $55.00 Hour In -Home or Community $70.00 Hour In -Home or Community — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day '171 r ITlu_ Rate Unit Type Service Name Foster Parent Trainin —Various $200.00 Hour In-Office/Video $215.00 Hour In -Home or Community $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Rate Unit T e Service Name Home Based Interventions - Intensive $125.00 Hour In-Office/Video $140.00 Hour In-Office/Video - Spanish $130.00 Hour In -Home or Community $145.00 Hour In -Home or Community - Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Home Based Interventions - High $85.00 Hour In-OfficeNideo $100.00 Hour In-Office/Video — Spanish $90.00 Hour In -Home or Community $105.00 Hour In -Home or Community — Spanish $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day home -Based Interventions. -Moderate $70.00 Hour In-Office/Video $85.00 Hour In-Office/Video — Spanish $75.00 Hour In -Home or Community $90.00 Hour In -Home or Community — Spanish $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffmg $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Rate Unit T e Service Name ship Ses-vices (Therapeutic) $125.00 Hour In-Office/Video $140.00 Hour In-Office/Video — Spanish $130.00 Hour In -Home or Community $145.00 Hour In -Home or Community — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Rate Unit Tye Service Name Thera eut Life Skills $125.00 Hour In-Office/Video $140.00 Hour In-Office/Video — Spanish $130.00 Hour In -Home or Community $145.00 Hour In -Home or Community — Spanish anish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffmg $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Life Skills $85.00 Hour In-Office/Video $100.00 Hour In-Office/Video - Spanish $90.00 Hour In -Home or Community $105.00 Hour In -Home or Community — Spanish $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Specialized Mentorship $85.00 Hour In-Office/Video $100.00 Hour In-Office/Video — Spanish $90.00 Hour In -Home or Community $105.00 Hour In -Home or Community — Spanish $75.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Rate Unit Type Service Name Mental Health Thera $125.00 Hour In-Office/Video $140.00 Hour In-Office/Video - Spanish $130.00 Hour In -Home or Community $145.00 Hour In -Home or Community — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Psychological Evaluation $175.00 Hour In-Office/Video for Partial Evaluation $190.00 Hour In-Office/Video for Partial Evaluation — Spanish $1,750.00 Each Full Evaluation $2,000.00 Each Full Evaluation — Spanish $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. $0.56 Mile Mileage — For distances exceeding 30 miles roundtrip from provider's office located at 7175 West Jefferson Avenue, Suite 4000, Lakewood, Colorado, 80235 or the first appointment location of the day Nenrops cholo ical Evaluation $200.00 Hour In-Office/Video for Partial Evaluation $2,350.00 Hour Full Evaluation $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Pediatric Diagnostic Evaluation $200.00 Hour In-Office/Video for Partial Evaluation $2,350.00 Hour Full Evaluation $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Parent Child Interaction Assessment. $150.00 Hour In-Office/Video for Partial Evaluation $1,500.00 Each Full Evaluation $150.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. MentalHealth ttoit $500.00 Each Evaluation $$550.00 Each anish Evaluation - Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Treatment Groups $45.00 Hour In-Office/Video $60.00 Hour In-Office/Video — Spanish $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. insi Ration $125.00 Hour In-Office/Video $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. fliimgi1T Rate Unit Type I Service Name Substance Abuse Treatment .—Group Treatment $45.00 Hour In-Office/Video $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffin $25.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Substance Abuse Treatment - Individual Treatment $110.00 Hour In-Office/Video $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Urinalysis and; Breathal zer $21.00 Each Urinalysis (UA) $7.00 Each Breath Alcohol (BA) $15.00 Each Confirmation Test Substance Treatment Intake $225.00 Hour Substance Treatment Intake $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $55.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Substance Treatment Evaluation $375.00 Hour Substance Treatment Intake $100.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No show — maximum of two (2) no shows or two (2) hours per month per client. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 71 day of the month following the month of service, but no later than 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. New Cofltract Request Entity Inforrnaton Entity Name* LIFELONG INC Entity ID * 40004 ❑ New Entit COntractName* Contract ID Parent Contract t ID LIFELIN , INC CHILD PROTECTIONAGREEMENT 5550 COntract Status Contract Le * RqLuIeS Board Approval CTh REVIEW APEGG YES Contract Lead Email e etProject apeggweIdgovcorn;cobbx lk ieEdgov.corr Contract Description* NEW AGREEMENT FOR A POST -BID PROVIDER. RELATED TO BID #8210 04 TERM: DECEMBER 1, 2021 THROUGH MAY 31, 2022. Contract ipti 2 PA IS BEING ROUTED THROUGH THE NORMAL PROCESS. ETA TO CTh: 2/3/22. Contract Type ent Requested a Due Date AGREEMENT HUMANSERVICESDate* 02/12/2022 Amount * Department Email _l 02/16/2022 50.00 CM- Will a work sessionwith 11OCC be sequined?* HumanServices@weIdgovco NO Remewat4e NO s Contract require Purchasing Dept. to be included? Depann ent Head ail Automatic Kerr CM-HumanServices- DeptHeadweIdgovconi Grant County Attorney GENERAL COUNTY I,IGA ATTORNEY EMAIL County Attorney Email CM_ U T EARN LDG OV COM Ii this is part f a MSA enter MSA ContractI Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On8ase Conitact. Uat Effective Date Termination Notice Period Contact Information Contact Info Gintact Na,re rchahtg Purchasing Gontact Review Date 04/0112022 Committedlivery Date Contact pail Rene al Date Expiration Date* 05/31/2022 Approval Process Department Head Finance Approver L. a.1 Counsel JA. #E ULRICH CHRIS D`O' 'ADIO CAITLIN PERRY DH Approved Date Finance e Date Legal Counsel Approved Date 02/0112022 02/07/2022 02/08/2022 Final Approval 6OCC Approved Tyler Ref # AG 021622 Signed Date Agenda 02/16/2 22 Originator APEGG Hello