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Home My WebLink About20192575.tiffCon%en-i- o(-1 ag/ ai PRIVILEGED AND CONFIDENTIAL MEMORANDUM n+ -cot c+ =tJ #(-1(095 DATE: April 20, 2021 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with Tennyson Center for Children Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Agreement Amendment with Tennyson Center for Children. The Department entered into a Child Protection Agreement for Services with Tennyson Center for Children, identified as Tyler ID 2019-2575 on July 3, 2019, The Agreement was amended on June 1, 2020 to extend the term date through May 31, 2021 and on July 1, 2020 to amend the Scope of Services and Rate Schedule. The Agreement is now being amended to renew for a third and final year, for the period of June 1, 2021 through May 31, 2022, and to make changes to the Rate Schedule as noted below. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Day Treatment Services $161.29183.82/Day (Special Education—,AdraRtive Skills ie with Emotional Needs (ASPEN) Excess Costs) $2,$24900.00/Month (Special Education — ASPEN Therapy) $6,016,00 apy and Excess Costs) $1,820-7441.00/Month (Special Education — Therapy) $3,700.00iMonth-(Spec ' Costs) $17.059G:4-7/Day (Special Education Exceeds Costs) I do not recommend a Work Session. I recommend approval of this Agreement Amendment. Perry L. Buck Mike Freeman Scott K. James, Pro-Tem Steve Moreno, Chair Lori Saine IMEMEENNEEEMEME _ Pass -Around Memorandum; April 20, 2021— ID 095 Page 1 a644-0-10) Approve Recommendation Schedule Work Session Other/Comments: QOicl-a5-15 f-IRoo90 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TENNYSON CENTER FOR CHILDREN This Agreement Amendment, made and entered into a day of Ap r � i 2021 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 Tennyson Center for Children, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Day Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019- 2575, approved on July 3, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement was set to end on May 31, 2020. • The Original Agreement was amended on: June 1,2020 to extend the term date through May 31, 2021. July 1, 2020 to amend the Scope of Services and Rate Schedule. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2575. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Term This agreement is being renewed for a third and final year, for the period of June 1, 2021 through May 31, 2022. 2. Exhibit D, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. 020!9- 57�, IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST. Kdf4;GL BOARD OF COUNTY COMMISSIONERS Weld ' ou ty Clerk to the B • ar% WELD COUNTY, COLORADO By Deputy Cler,>to the oard Steve Moreno, Chair APR 2 8 2021 Tennyson Center for Children 2950 Tennyson Street Denver, Colorado 80212 By: Date: ,fafCh�ah Karl Chap/Man (� �z.zo.� �. «Mori Kathryn Arbour, Chief Operating Officer Apr 12, 2021 020/ 9- �575- EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. 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 Day Treatment Services Rate Unit Type Service Name $183.82 Day Special Education — ASPEN Excess Costs $2,900.00 Month Special Education — ASPEN Therapy $1,820.00 Month Special Education — Therapy $97.05 Day Special Education Exceeds Costs Aftercare Services Rate Unit Type Service Name $125.00 Hour Out -of -Office $125.00 Hour Family Team Meeting, Team Decision Making, Professional Staffing $125.00 Hour No Show Home -Based Intervention Rate Unit Type Service Name $125.00 Hour Out -of -Office $125.00 Hour Family Team Meeting, Team Decision Meeting, Professional Staffing $125.00 Hour No Show Kinship Services — Therapeutic Rate Unit Type Service Name $125.00 Hour Out -of -Office $125.00 Hour Family Team Meeting, Team Decision Meeting, Professional Staffing $125.00 Hour No Show Mental Health Services Rate Unit Type Service Name $125.00 Hour Out -of -Office $125.00 Hour Family Team Meeting, Team Decision Meeting, Professional Staffing $125.00 Hour No Show 3. 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 7th 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 Contract Request Entity Information Entity Name* Entity ID* TENsNYSON CENTER FOR CHILDREN :L7;00030337 ❑ New Entity? Contract Name* Contract !D TENN.4SON CENTER FOR CHILDREN (AGREEMENT 4095 AMENDMENT) Contract Status CT6 REVIEW Contract Description* BID 481900025 TERM: 0 1 s 21 - 5' 31 2 2 Contract Lead .k APEGG Contract Lead Email apegg )weldgov.com:cobbx xlk aweldgov.corn Contract Description 2 CONSENT. PA IS BEING SENT THROUGH THE NORMAL PROCESS, ETA. TO CT6 4; 22 2.1. Contract Type* AMENDMENT Amount* MOO Renewable * NO Automatic Renewal Grant !GA Department HUMAN SERVICES Department Email CM- HumanServicesgws+eldgov.co m Department Head Email CM-HurnanServices- DeptHead 'weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY:gWELDG OV.C:OM Requested BQCC Agenda Date* 05:26 2021 Parent Contract ID 20192575 Requires Board Approval YES Department Project Due Date 05122:2021 Will a work session with BOCC be required?'* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On6ase Contract €3ates Effective Date Review Date* 04(01.2022 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Purchasing Approver CONSENT Approval Process Department Head JAMIE ULRICH DH Approved Date 04,19,2021 Final Approval ROCC Approved ROCC Signed Date ROCC Agenda Date 04:`28;'2021 Originator APEGG Committed Delivery Date Contact Type Contact Email Finance Approver CONSENT Expiration Date* 0S{31'2022 Contact Phone Y Purchasing Approved Date 04,119;2021 Finance Approved Date 04 19 2021 Tyler Ref AG 042 821 Legal Counsel CONSENT Contact Phone 2 Legal Counsel Approved Date 04{"19,; 2021 Cam.)-e1R-e;/- 3717 PR1V111,;(11�l) AND CONHDFNTIAL MEMORANDUM DATE: June 23, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with Tennyson Center for Children Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Agreement Amendment with Tennyson Center for Children. The Department entered into a Child Protection Agreement for Services, identified as Tyler ID 2019-2575, on July 3, 2019 for the term June 1, 2019 through May 31, 2020. The agreement was amended on June 1, 2020 to extend the term from June 1, 2020 through fVfay 31, 2021. The vendor has requested to add Aftercare Services, Home -Based Intervention, Kinship Services, and Mental f lealth Services. The associated rates are as follows: Aftercare Services $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Home -Based Intervention $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Kinship Services (Therapeutic) $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Mental Health Services $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Pass -Around Memorandum; June 23, 2020 -- CMS 3741 Bid No. B 1900025 osir-oe•ff 43.a.ioe„ at,g)sfAtiO 5-0 o7/01/2.0 Page 1 „.C14t — 2 5 75 PRIVILEGED AND CONFIDENTIAL Day Treatment Services $161.29/Day (Special Education — ASPEN Excess Costs) $2,820.00/Month (Special Education — ASPEN Therapy) $6,046.00/Month (Special Education — ASPEN Therapy and Excess Costs) $1,770.00/Month (Special Education — Therapy) $3,700.00/Month (Special Education — Therapy and Excess Costs) $96.47/Day (Special Education .Exceeds Costs) I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair to sign. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro -Tem Kevin Ross Approve Schedule Recommendation Work Session rf• Other/Comments: Pass -Around Memorandum; June 23, 2020 — CMS 3741 Bid No. B 1900025 Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TENNYSON CENTER FOR CHILDREN S/ This Agreement Amendment, made and entered into / day of , 2020 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Hum Se s, hereinafter referred to as the "Department", and Tennyson Center for Children, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Day Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2575, approved on July 3, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: ▪ The Original Agreement will end on May 31, 2020. ▪ The Original Agreement was amended on June 1, 2020. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2575. ▪ These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Exhibit C, Scope of Services, is hereby amended as attached. 2. Exhibit D, Rate Schedule, is hereby amended as attached. . All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first written. above ATTEST' ditift/i) Weld ou , Clerk to the : o . rd By: COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO 1ti4/L¢z Deputy Cle to t e Boar. j r �; ��'� s �tMike Freeman, Chair f_QFACTOR: Tennyson Center for Children 2950 Tennyson Street Denver, CO 80212 By: Date: 'JUL 012020 / atitve /L%/Om- Kathryn M. A our (Jun 15, 202021:16 MOT) Kathryn Arbour, Chief Operating Officer Jun 15, 2020 020/9-a7. %5 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Day Treatment, Aftercare, Kinship, and Mental Health Services, along with Home - Based Intervention, as referred by the Department. 2. Contractor will provide Day Treatment Services as outlined by the Department. 3. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: a. Individual and family therapy b. Group therapy (psychoeducation and skill building groups) c. Milieu interventions d. Multidisciplinary meetings/communications e. Crisis support f. Education services (including Individualized Educational Plan (IEP) meetings) 4. Capacity for Services: a. Contractor retains 10 classroom -based, Master's level clinicians who are assigned an average of eight (8) students each. b. Each student will receive a minimum of two (2) face-to-face hours of individual and/or family therapy per week. c. Clinicians will be available for support during the school day. d. Each classroom will be supported by a certified teacher and two (2) direct care staff members. 5. Goals of Service: a. Preparing students to return to public school b. Increased family and interpersonal relationships c. Decreased risk behaviors d. Increased affect regulation and skill building e. Symptom reduction (such as traumatic stress) f. Increased academic performance and abilities 6. Outcomes of Service: Increased ability of the family to develop and sustain safety and stability in their community/home environments, which in turn will reduce system involvement. a. Contractor will provide data regarding the following: i. Educational support/achievement ii. Placements iii. Community supports iv. Crisis service utilization v. Symptom reduction vi. Utilization of services 7. Target Population: a. Children, and their families, age five (5) to 18 years of age, with multisystem involvement, varied placement and custodial agreements, trauma history, presenting mental health diagnosis, and family involvement (or could be fostered). b. Excluded populations include those requiring treatment for sex offenders, treatment for substance use/abuse, and those with intellectual functioning less than 60. 1 c. Contractor does not exclude service for cultural reason including race, religion, sexual preference, gender presentation, or documentation status. 8. Service Access: As referred by the Department. Educational costs are paid by the student's respective school district. 9. Language: English only. 10. Contractor will provide Aftercare Services as referred by the Department. 11. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: a. Psychoeducation b. Parent coaching c. Individual and family therapy d. Family systems e. Behavior management f. Systems of care navigation and case management g. Therapeutic Crisis Intervention (TCI) h. Trauma Focused Cognitive Behavioral Therapy (TF-CBT) _ i. ARC framework j. Pressley Ridge curriculum k. Dialectical Behavior Therapy (DBT) 12. Anticipated Frequency of Services: Four (4) to twelve (12) hours per week. 13. Anticipated Duration of Services: Six (6) to twelve (12) months 14. Goals of Services: a. Reunification of child with family b. Permanency of the family unit c. Preventing future out of home placement 15. Outcomes of Services: a. Child and family will increase bonding and attachment. b. Child with remain in home with caregivers. c. Caregivers will understand and be able to implement a large array of skills related to crisis intervention, trauma informed attachment, and behavioral management. 16. Target Population: Children and youth, age four (4) to 18 years of age, all genders, regardless of race, traits or characteristics and their caregivers. 17. Language: English 18. Service Access and Transportation: Practitioner will provide community -based services within a twenty (20) mile radius of Interstate 25 and Highway 36, in Denver, CO. 19. Contractor will provide Home -Based Intervention as referred by the Department. 2 20. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: a. Psychoeducation b. Parent coaching c. Individual and family therapy d. Family systems e. Behavior management f. Systems of care navigation and case management g. Therapeutic Crisis Intervention (TCI) h. Trauma Focused Cognitive Behavioral Therapy (TF-CBT) _ i. ARC framework j. Dialectical Behavior Therapy (DBT) 21. Anticipated Frequency of Services: Four (4) to twelve (12) hours per week. 22. Anticipated Duration of Services: Six (6) to twelve (12) months 23. Goals of Services: a. Develop a community support system b. Improve family function c. Prevent future out of home placement 24. Outcomes of Services: a. Child will remain in home with caregivers b. Increase attachment and bonding of client and caregiving unit c. Client and caregivers will have community support network to maintain stability 25. Target Population: Children and youth, age four (4) to 18 years of age, all genders, regardless of race, traits or characteristics and their caregivers. 26. Language: English 27. Service Access and Transportation: Practitioner will provide community -based services within a twenty (20) mile radius of Interstate 25 and Highway 36, in Denver, CO. 28. Contractor will provide Kinship Services (Therapeutic) as referred by the Department. 29. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: a. Psychoeducation b. Parent coaching c. Individual and family therapy d. Family systems e. Behavior management f. Systems of care navigation and case management g. Therapeutic Crisis Intervention (TCI) h. Trauma Focused Cognitive Behavioral Therapy (TF-CBT) _ i. ARC framework j. Pressley Ridge curriculum 3 k. Dialectical Behavior Therapy (DBT) 30. Anticipated Frequency of Services: Four (4) to twelve (12) hours per week. 31. Anticipated Duration of Services: Six (6) to twelve (12) months 32. Goals of Services: a. Improve quality of care being provided by kinship caregiver b. Increased kinship caregiver knowledge surrounding trauma, abuse, and neglect c. Decrease conflict in the home and increase kinship provider resiliency 33. Outcomes of Services: a. Child and family will increase bonding and attachment b. Kinship caregiver will have knowledge and be able to implement multiple trauma focused interventions c. Avoid need for higher level of care or multiple kinship placements by maintaining placement 34. Target Population: Children and youth, ages four (4) to 18 years of age, all genders, regardless of race, traits or characteristics and their caregivers. 35. Language: English 36. Service Access and Transportation: Practitioner will provide community -based services within a twenty (20) mile radius of Interstate 25 and Highway 36, in Denver, CO. 37. Contractor will provide Mental Health Services as referred by the Department. 38. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: a. Psychoeducation b. Parent coaching c. Individual and family therapy d. Family systems e. Behavior management f. Systems of care navigation and case management g. Therapeutic Crisis Intervention (TCI) h. Trauma Focused Cognitive Behavioral Therapy (TF-CBT) _ i. ARC framework j. Pressley Ridge curriculum k. Dialectical Behavior Therapy (DBT) 39. Anticipated Frequency of Services: Four (4) to twelve (12) hours per week 40. Anticipated Duration of Services: Six (6) to twelve (12) months 41. Goals of Services: a. Improve client's mental health b. Client will learn triggers and stressors and healthy responses to these situations 42. Outcomes of Services: 4 a. Family unit will be maintained with increasing bonding and attachment b. Client with have strategies to manage triggers and stressors c. Client and family will have a community support system to help maintain mental health stabilization 43. Target Population: Children and youth, ages four (4) to 18 years of age, all genders, regardless of race, traits or characteristics and their caregivers. 44. Language: English 45. Service Access and Transportation: Practitioner will provide community -based services within a twenty (20) mile radius of Interstate 25 and Highway 36, in Denver, CO. 5 1. Contractor will respond to the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400- 6210) 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 3. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 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 Supervisor (hainleid@weldgov.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 to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 7. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 6 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. Contractor may participate by phone, if approved by the Department. 10. Contractor will notify the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400-6210) 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. 7 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2021. 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 Day Treatment Services $161.29/Day (Special Education —ASPEN Excess Costs) $2,820.00/Month (Special Education —ASPEN Therapy) $6,046.00/Month (Special Education — ASPEN Therapy and Excess Costs) $1,770.00/Month (Special Education —Therapy) $3,700.00/Month (Special Education —Therapy and Excess Costs) $96.47/Day (Special Education Exceeds Costs) Aftercare Services $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Home -Based Intervention $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Kinship Services (Therapeutic) $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) Mental Health Services $125.00/Hour (Out -of -Office) $125.00/Hour (FTM, TDM, Prof. Staffing) $125.00/Hour (No show) 3. 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 7th 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. Contract Form New Contract Request Entity Information Entity Name* Entity ID* TENNYSON CENTER FOR CHILDREN @00030337 Contract Name* TENNYSON CENTER FOR CHILDREN Contract Status CTB REVIEW Contract Description* AGREEMENT AMENDMENT TO (THERAPEUTIC) AND MENTAL CHILD WELFARE 2019-20 RFP, FUNDING: CFORE/OTHER New Entity? Contract ID 3741 Contract Lead* CULLINTA Contract Lead Email cullinta@comeld.co.us;cobbrxl k@co_weld.co.us Parent Contract ID 20190707 Requires Board Approval YES Department Project # ADD AFTERCARE SERVICES, HOME -BASED INTERVENTION, KINSHIP SERVICES HEALTH SERVICES BID NO B1900025. Contract Description 2 TERM: 06O1/20 THROUGH 05/31/21 Contract Type* AGREEMENT Amount $0.00 Renewable* NO Automatic Renewal ICA Department HUMAN SERVICES Department Email C M- HumanServices@weldgov.com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email C M- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 07/01/2020 Due Date 06127/2020 Will a work session with MCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date* 04/01/2021 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 06/23/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06/2912020 Originator SNYDERKL Contact Type Committed Delivery Date Contact Email Finance Approver BARB CONNOLLY Expiration Date r 95'3112021 Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 06/25/2020 Tyler Ref # AG 062920 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 05/25/2029 Submit PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: April 2, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Welfare 2020-21 Service Provider Agreement Amendments 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 Welfare 2020-21 Service Provider Agreement Amendments. The Department entered into agreements with various Child Welfare service providers through the 2019-20 Request for Proposal (RFP), identified as Tyler ID 2019-0707). These agreements were issued for a period of three years with the option to renew annually. The attached list reflects the providers, services and rates, including minor rate changes, the Department wishes to enter into for the period of June 1, 2020 through May 31, 2021. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed agreement amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; April 2, 2020 - Not in CMS Page 1 Ccorte.-eit- /970, oGici/zo zolq-237,5 14,g©ogo VENDOR RENEWALS Vendor Program Area Service Name Supervised Visitation -In Office Funding Core Rate $ 116.00 Unit Type Hour Supervised Visitation-Larimer County Core $ 140.00 Hour Supervised Visitation -Outside Larimer County Core $ 206.00 Hour Visit Cancellation Core $ 50.00-- Hour . The Tennyson Center for Children Day Treatment Services Mileage Core $ 0.50 Mile Special Education - ASPEN Excess Costs Core $ 161.29 Day Special Education - ASPEN Therapy Core $ 2,820.00 Month Special Education - ASPEN Therapy Ft Excess Costs Core $ 6,046.00 Month Special Education - Excess Costs Core $ 96.47 Day Special Education - Therapy Core $ 1,770.00 Month Special Education - Therapy & Excess Costs Core $ 3,700.00 Month Third Way Center Home Based Services Next Steps Aftercare Program, Community Based Core $ 76.00 Day Next Steps Aftercare Program, Home Based Core $ 55.00 Day Transitions Psychology Group Home Studies Additional Adult(s), After 2 CW Block/Child Welfare Services $ 250.00 Each Full SAFE Home study, Up to 2 Adults CW Block/Child Welfare Services $ 1,200.00 Episode Mileage CW Block/Child Welfare Services $ 0.56 Mile Partial Home Study CW Block/Child Welfare Services $ 250.00 Episode Updated SAFE Home Study, Up to 2 Adults CW Block/Child Welfare Services $ 600.00 Episode Life Skills Mileage Core $ 0.56 Mile Parent Coaching, In Office or Video Conferencing Core $ 118.00 Hour Parent Coaching, In -Home Core $ 177.00 Hour Staffing, FTM, TDM, etc. Core $ 138.00 Hour Therapeutic Visitation, In Office or Video Conferencing Core $ 118.00 Hour Therapeutic Visitation, In -Home Core $ 177.00 Hour Mental Health Services Co -Parent Consultation, In Office or Video Conferencing Core $ 118.00 Hour Co -Parent Consultation, In -Home Core $ 177.00 Hour .- Co -Therapy Counseling, In Office Core $ 236.00 Hour Couples Therapy, In Office or Video Conferencing Core $ 118.00 Hour Couples Therapy, In -Home Core $ 177.00 Hour Family Therapy, In Office or Video Conferencing Core $ 118.00 Hour Family Therapy, In -Home Core $ 177.00 Hour Individual Therapy, In Office or Video Conferencing Core $ 118.00 Hour Individual Therapy, In -Home Core $ 177.00 Hour Mileage Core $ 0.56 Mile Staffing, FTM, TDM, etc. Core $ 138.00 Hour Treatment and Evaluation Services Domestic Violence Intervention DVOMB Evaluation CW Block/Child Welfare Services $ 800.00 Episode Mental Health Services Psychological Evaluation Core $ 1,200.00 Episode Sexual Abuse Treatment Offense Specific Evaluation Core $ 900.00 Episode UABACO, LLC Monitored Sobriety Services 10 Panel Quick Test CW Block/Child Welfare Services $ 13.00 Test 11 Drug Panel (Panel 1709) CW Block/Child Welfare Services $ 25.00 Test 5 Panel Quick Test CW Block/Child Welfare Services $ 10.00 Test 6 Drug Panel (Panel 33) CW Block/Child Welfare Services $ 35.00 Test 6AM Testing CW Block/Child Welfare Services $ 40.00 Drug WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 82000037 13 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TENNYSON CENTER FOR CHILDREN This Agreement Amendment, made and entered into j , day of UV ng, , 2020 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 'I etmyson Center for Children, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Day Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019- 2575, approved on July 3, 2019. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2020. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement: 1. Tenn This agreement is being renewed for a second full year term, for the period June 1, 2020 through May 31, 2021. • All other terns and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. dizAeov COUNTY: ATTEST: BOARD OF COUNTY COMMISSIONERS W el utny : Clerk to the Board B �� .CI.�w�.� Y Deputy Clerk to the Board WELD COUNTY, COLORADO Mike Freeman, Chair JUN 0 12020 CONTRACTOR: Tennyson Center for Children 2950 Tennyson Stre Denver, CO 80211 Kathryn 1 Date: Operating Officer OOO0 - Ds -7s Contract Form New Contract Request Entity Information Entity Name* Entity ID* TENNYSON CENTER FOR CHILDREN @00030337 Contract Name* TENNYSON CENTER FOR CHILDREN (AGREEMENT AMENDMENT) Contract Status CTB REVIEW ❑ New Entity? Contract ID 3575 Contract Lead* CULLINTA Contract Lead Email cullinta@co;weld.co.us;cobbod k@co_weld.co.us Parent Contract ID Requires Board Approval YES Department Project # Contract Description* CONSENT. BID NO. 2000037. BOCC APPROVAL 04/15/20 CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06/01/20 THROUGH 05/31/21 FUNDING: CORE/OTHER. Contract Desorption 2 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV. COM Requested BOCC Agenda Date* 04/15/2020 Due Date 04111/2020 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a WA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date* Renewal Date 04/01/2021 Termination Notice Period Committed Delivery Date Expiration Date* 05/31/2021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 05/27/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06/01/2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 05/2,/2020 Tyler Ref # AG 060120 Legal Counsel GABE KALOUSEK Legal Counsel Approved Daze 05/20/2020 Submit 6-2e/tA-Je-t-e #a16.? CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND THE TENNYSON CENTER FOR CHILDREN This Agreement, made and entered into thday of 2019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departmen f H an Services, hereinafter referred to as the "Department' and The Tennyson Center for Children, 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 B1900025, 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 Day Treatment Services. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2019, upon proper execution of this Agreement and shall expire May 31, 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 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 Proposal and Exhibit C, Scope of Services. 3. Referrals, Billing and Tracking a. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. b. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team Supervisor (hainleidPweldgov.com, 970-400-6210). 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 7th of the month, following the month of service, utilizing billing forms required by the 1- 3 9 2019-2575 %' 3-/ % ilkp090 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 7th 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. 2 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 OMG 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 an, 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. seq. 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. seq. and its implementation regulations, 45 C.F.R. Part 91; and Title VII of the Civil Rights Act of 1964; and 3 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 4 contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR) and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 5 9. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect 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, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. 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 0110/93 or equivalent, covering premises operations, fire damage, independent Contractors, 6 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 as follows 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 970-400-6503 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 8 program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Kathryn Arbour, Chief Operating Officer 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: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970)400-6510 9 For Contractor: Kathryn Arbour, Chief Operating Officer 2950 Tennyson Street Denver, CO 80212 (720) 855-3310 18. Litigation 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. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall 10 not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, 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. 11 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit 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 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. 12 31. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, 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. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 34. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 13 36. Attorney's Fees/Legal Costs In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 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. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: �.J �/• aidtO; K BOARD OF COUNTY COMMISSIONERS Weld ty Clerk to the Boar. WELD COUNTY, COLORADO e :oard 15 Barbara Kirkmeyer, Chair JUL 0 3 2019 CONTRACTOR: The Tennyson Center for Children 2950 Tennyson Street Denver, CO 80212 (720)855-3310 ICathle tiI,4`bov- Kathryn M Ar our (May 14, 2019) By: Date: Kathryn Arbour, Chief Operating Officer May 14, 2019 00ca- as15 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 REQUEST FOR PROPOSAL CrTennyson Center 29So Tennyson St. j' ], iDenver, CO 80212 or Children Main: 303.433.2541 Fax: 303.433.9701 January 28, 2019 Weld County Department of Human Services, We thank you for the opportunity to continue providing various Child Welfare services to Weld County Department of Human Services within Bid No. B1900025. The Tennyson Center for Children has an established satellite office in Weld County at 2230 13th St, Greeley, CO 80631. Our target area would be to serve Weld County residents by providing focused, evidence -based services in the areas of day treatment, life skills, home based intervention, and mental health services as described in the Bid No. B1900025. Tennyson Center for Children is qualified to offer these services as evidenced by having operated an existing community based services team in the Weld County area since October 2016. Our team consists of four staff, master and bachefor fever, when fully staffed. Tennyson Center for Children requires all eligible staff to be registered with the Colorado Department of Regulatory Agencies. Tennyson Center implements a trauma informed care practice model throughout all services we provide to our clients. Our agency measures success based on accomplishment of treatment plan goals focused around safety, stability, and improvement in family functioning. If awarded the bid for each of these services, Tennyson Center would comply with service delivery standards as outlined in the RFP and in Exhibit A (sample agreement) and commit to being responsive to any referrals. Tennyson Center for Children accepts referrals for the Weld County CORE mental health services program Monday — Friday 8 am to 5 pm excluding observed holidays through a centralized admission system to assure referrals are responded to within 24 to 48 working hours of receipt. A basic referral screen is completed to assure needed information and authorization is received to commence services. Tennyson Center for Children believes that with the proper support, children and families possess the capacity to heal. It is our role to help children and families identify what strengths they possess and aid them in leveraging these skills and resources to overcome obstacles and live empowered lives. We appreciate the opportunity to collaborate with Weld County in providing mental health services for the residents of Weld County. Respectfully, Kari Chapman, CFO TENNYSONCENTER.ORG Fallow Us! �. F'] O EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services The Tennyson Center for Children AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) gathrvn Arbour Chief Operating Officer PRIMARY CONTACT -FULL NAME PRIMARY CONTACT - TITLE t 720 ! 855-3310 PHONE NUMBER Kathryn.arbour@tennvsoncenter.org L_303 ! 433-9701 EXT. FAX NUMBER PRIMARY CONTACT -E-MAIL ADDRESS AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) 2950 Tennyson St AGENCY MAILING ADDRESS Denver _ CITY 80212 ZIP REFERRAL CONTACT CBS referrals are handled by CBS Admissions Team REFFERAL CONTACT- FULL NAME REFERRAL CONTACT- TITLE (303 } 731.4845 REFERRAL CONTACT -PHONE NUMBER 05Admissions@tennysoncenter.org EXT. REFERRAL CONTACT -E-MAIL ADDRESS BILLING CONTACT Kari Chapman CFO BILLING CONTACT -FULL NAME BILLING CONTACT - TITLE .(720 } 855-3304 BILLING CONTACT- PHONE NUMBER EXT. karl.chapman@tennysoncenter.org BILLING CONTACT -,E-MAIL ADDRESS 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. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept 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 sit I a',Z: preference to resident Weld County bidders in all cases where the bidsrrcompetiprice and qu Signature of Authorized Represent Date of Signature: / • � S` -A Bid No.: 81900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: The Tennyson Center for Children Life Skills 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. The CBS program utilizes the following modalities for treatment: Trauma Focused Cognitive Behavioral Therapy; Family Systems; Solution Focused Therapy, Play Therapy, Therapeutic Crisis Intervention, and the ARC model (attachment, regulation and competency). The CBS program values strength based, evidenced based practices. The CBS team has training in Trauma informed practices, attachment methods, household management, Love and Logic models, behavioral management techniques and Cognitive Behavioral Therapy. The CBS program uses the following methods for treatment: individual and family therapy, school support, multidisciplinary meetings/communications, and crisis support. The CBS program has significant training and expertise related to Life Skills services in the following ways: programming around household support, psychoeducation on child development and parental responses, behavioral modification techniques, healthy communication skill development (problem - solving, conflict resolution, fair fighting, active listening, etc.), and resources for community supports. 4. Capacity to Provide Services (ex. 4 hours/week). The CBS team will provide services between 4 and 12 hours of service per week; between 1-2 staff assigned to each case. The CBS program model assures a team that has staff assigned to both ends of the week (Sunday —Thursday schedule — or —Tuesday — Saturday schedule). The team is currently structured at (1) Lead Clinician, (2) Mental Health Clinicians, and (1) Family Support Specialist (74 hour per week capacity); hiring for the 2nd clinician position. S. Goals of the service. The goals of the service include: increased functioning in the home, school, and community related to increased access to education services, increased access to sustainable community services, increased family functioning and an increase of safety in the home. Additionally, it is expected that the client will have a reduced symptomology related to their diagnosis, decreased utilization of crisis and high levels of care services. It is also expected that the family will have a positive experience in treatment to foster readiness for outpatient services or future, low level services for support. 6. Outcomes of service. TCC will provide data around the following outcomes: educational support/achievement, placements, community supports, crisis service utilization, symptom reduction, and utilization of services. The expectation is to increase the family's abilities to develop and sustain safety and stability in their community/home environments, which in turn reduces system involvement. 7. Target population for service. The CBS program provides service to the following children and families: children 0-18, multisystem involvement, varied placement and custodial agreements, experienced trauma history, presenting Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE mental health diagnosis, and family involvement (or could be fostered). Exclusions to the program include: treatment for sex offenders, treatment for substance use/abuse, and intellectual functioning less than 60. The CBS program does not exclude service for cultural reasons; including race, religion, sexual preference, gender presentation, documentation status, etc. Translation services would be considered if English/Spanish were not a primary language. 8. Service access. CBS services are offered solely in the community, home or school. The CBS office is located at 223013th St, Greeley CO; referrals will be considered within a 25 -mile radius. 9. Languages service is available in. CBS services will be offered in English primarily. The Tennyson Center is always looking to diversify staffing; and will make all attempts to provide services to meet the needs of clients referred. The Tennyson Center will communicate with Weld CO DHS at any time that Spanish services are available. 10. Rates of service. Note: Bidder should include fee for service, staffing, mileage, and any other applicable costs bidder would like considered. Rates must be an exact amount and must include the unit of cost (Le., hour, day, month, episode). Approximate rates or a range of rates for a service will not be accepted. Life Skills Provider Life Skills Services Monolingual Bachelor level Life Skills Services Bilingual Bachelor level Life Skills Services Monolingual Master's level Life Skills Services Bilingual Master's level Any staff attending sessions or Mileage exceeding 25 miles from Greeley, CO office appointments Bid No.: 1900025 Rate/Type $75/Hour $85/Hour $85/Hour $95/Hour .50 cents/mile EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: The Tennyson Center for Children Mental Health Services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. The CBS program utilizes the following modalities for treatment: Trauma Focused Cognitive Behavioral Therapy; Family Systems; Solution Focused Therapy, Play Therapy, Therapeutic Crisis Intervention, and the ARC model (attachment, regulation and competency). The CBS program values strength based, evidenced based practices. The CBS team has training in Trauma informed practices, attachment methods, household management, Love and Logic models, behavioral management techniques and Cognitive Behavioral Therapy. The CBS program uses the following methods for treatment: individual and family therapy, school support, multidisciplinary meetings/communications, and crisis support. The CBS program has significant training and expertise related to Mental Health services in the following ways: assessing and diagnosing skills by clinicians, treatment plan development, psycho - social considerations of planning/implementing treatment plans, ability to provide psycho -education to children and families around the benefits and risks of diagnosing, connecting the treatment plan with outcomes related to improve client/family Functioning, assessing for and utilizing appropriate models of treatment that match the cultural and health needs of the client/family, resourcing the family to outpatient services to support progress made during treatment. 4. Capacity to Provide Services (ex. 4 hours/week). The CBS team will provide services between 4 and 12 hours of service per week; between 1-2 staff assigned to each case. The CBS program model assures a team that has staff assigned to both ends of the week (Sunday — Thursday schedule — or — Tuesday — Saturday schedule). The team is currently structured at (1) Lead Clinician, (2) Mental Health Clinicians, and (1) Family Support Specialist (74 hour per week capacity); hiring for the 2nd clinician position. S. Goals of the service. The goals of the service include: increased functioning in the home, school, and community related to increased access to education services, increased access to sustainable community services, increased family functioning and an increase of safety in the home. Additionally, it is expected that the client will have a reduced symptomology related to their diagnosis, decreased utilization of crisis and high levels of care services. It is also expected that the family will have a positive experience in treatment to foster readiness for outpatient services or future, low level services for support. 6. Outcomes of service. TCC will provide data around the following outcomes: educational support/achievement, placements, community supports, crisis service utilization, symptom reduction, and utilization of services. The expectation is to increase the families abilities to develop and sustain safety and stability in their community/home environments, which in turn reduces system involvement. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 7. Target population for service. The CBS program provides service to the following children and families: children 0-18, multisystem involvement, varied placement and custodial agreements, experienced trauma history, presenting mental health diagnosis, and family involvement (or could be fostered). Exclusions to the program include: treatment for sex offenders, treatment for substance use/abuse, and intellectual functioning less than 60. The CBS program does not exclude service for cultural reasons; including race, religion, sexual preference, gender presentation, documentation status, etc. Translation services would be considered if English were not a primary language. 8. Service access. CBS services are offered solely in the community, home or school. The CBS office is located at 223O13th St, Greeley CO; referrals will be considered within a 25 -mile radius. 9. Languages service is available in. CBS services will be offered in English primarily. The Tennyson Center is always looking to diversify staffing; and will make all attempts to provide services to meet the needs of clients referred. The Tennyson Center will communicate with Weld CO DHS at any time that Spanish services are available. 10. Rates of service. Note: Bidder should include fee for service, staffing, mileage, and any other applicable costs bidder would like considered. Rates must be an exact amount and must include the unit of cost (i.e., hour, day, month, episode). Approximate rates or a range of rates for a service will not be accepted. Mental Health Services Assessment Therapy services Therapy services External meeting by request of Weld County (TDM, etc} Mileage exceeding 25 miles from Greeley, CO office Provider Master's level staff Bachelor level staff Master's level staff Bilingual Master's level Any staff attending sessions or appointments Rate/Type $125/Hour $115/Hour $125/Hour $115/Hour .50 cents/mile Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: The Tennyson Center for Children Home -Based Intervention 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. The CBS program utilizes the following modalities for treatment: Trauma Focused Cognitive Behavioral Therapy; Family Systems; Solution Focused Therapy, Play Therapy, Therapeutic Crisis Intervention, and the ARC model (attachment, regulation and competency). The CBS program values strength based, evidenced based practices. The CBS team has training in Trauma informed practices, attachment methods, household management, Love and Logic models, behavioral management techniques and Cognitive Behavioral Therapy. The CBS program uses the following methods for treatment: individual and family therapy, school support, multidisciplinary meetings/communications, and crisis support. The CBS program has significant training and expertise related to Home -Based Intervention services in the following ways: therapeutic crisis intervention tailored to in -home work, safety planning and community resourcing throughout treatment planning, community outreach and partnering, flexible schedules, company sponsored mobile offices (car/laptop/wifi), in addition to mental health and life skills services. 4. Capacity to Provide Services (ex. 4 hours/week). The CBS team will provide services between 4 and 12 hours of service per week; between 1-2 staff assigned to each case. The CBS program model assures a team that has staff assigned to both ends of the week (Sunday — Thursday schedule — or — Tuesday — Saturday schedule). The team is currently structured at (1) Lead Clinician, (2) Mental Health Clinicians, and (1) Family Support Specialist (74 hour per week capacity); hiring for the 2nd clinician position. 5. Goals of the service. The goals of the service include: increased functioning in the home, school, and community related to increased access to education services, increased access to sustainable community services, increased family functioning and an increase of safety in the home. Additionally, it is expected that the client will have a reduced symptomology related to their diagnosis, decreased utilization of crisis and high levels of care services. It is also expected that the family will have a positive experience in treatment to foster readiness for outpatient services or future, low level services for support. 6. Outcomes of service. TCC will provide data around the following outcomes: educational support/achievement, placements, community supports, crisis service utilization, symptom reduction, and utilization of services. The expectation is to increase the families abilities to develop and sustain safety and stability in their community/home environments, which in turn reduces system involvement. 7. Target population for service. The CBS program provides service to the following children and families: children 0-18, multisystem Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE involvement, varied placement and custodial agreements, experienced trauma history, presenting mental health diagnosis, and family involvement (or could be fostered). Exclusions to the program include: treatment for sex offenders, treatment for substance use/abuse, and intellectual functioning less than 60. The CBS program does not exclude service for cultural reasons; including race, religion, sexual preference, gender presentation, documentation status, etc. Translation services would be considered if English/Spanish were not a primary language. 8. Service access. CBS services are offered solely in the community, home or school. The CBS office is located at 223013th St, Greeley CO; referrals will be considered within a 25 -mile radius. 9. Languages service is available in. CBS services will be offered in English primarily. The Tennyson Center is always looking to diversify staffing; and will make all attempts to provide services to meet the needs of clients referred. The Tennyson Center will communicate with Weld CO DHS at any time that Spanish services are available. 10. Rates of service. Note: Bidder should include fee for service, staffing, mileage, and any other applicable costs bidder would like considered. Rates must be an exact amount and must include the unit of cost (i.e., hour, day, month, episode). Approximate rates or a range of rates for a service will not be accepted. Home -Based Intervention Assessment Therapy services Therapy services External meeting by request of Weld County (TDM, etc) Mileage exceeding 25 miles from Greeley, CO office Bid No.: 1900025 Provider Master's level staff Bachelor level staff Master's level staff Bilingual Master's level Any staff attending sessions or appointments Rate/Type $125/Hour $115/Hour $125/Hour $115/Hour .50 cents/mile EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: The Tennyson Center for Children Day Treatment and Educational Services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Day Treatment Program is an educational program with clinical mental health services, serving students from Kindergarten through 12th grade. Tennyson Center's school is fully accredited by AdvancED, a nationally recognized organization that focuses on school improvement. We are monitored by the Colorado Department of Education and employ licensed Special Education teachers. The Day treatment program employs Master level clinicians and utilizes the following modalities for treatment: Trauma Focused Cognitive Behavioral Therapy; Family Systems; EMDR, DBT, Play Therapy, Therapeutic Crisis Intervention, Restorative Practices and the ARC model (Attachment, Regulation and Competency). The program uses the following methods for treatment: individual and family therapy, group therapy (psychoeducation and skill building groups), milieu interventions, multidisciplinary meetings/communications, crisis support and educational services, including IEP meetings and monthly staffing meeting with internal and external teams. 4. Capacity to Provide Services (ex. 4 hours/week). Tennyson's Day Treatment Program is clinically served by 10 classroom -based, master level clinicians who are assigned an average of 8 clients each. Each client receives a minimum of two, face-to-face hours of individual and family therapy each week. Additionally, clinicians are available to support students during mental health crises that occur during the school day. Each classroom is supported by a certified teacher and two direct care staff members. 5. Goals of the service. The goals of the service include: preparing students to return to public school, increased family and interpersonal relationships, decreased risk behaviors, increased affect regulation and skill building, symptom reduction (traumatic stress in particular), and increased academic performance and abilities. The strength of our Day Treatment program is that clinical services can be provided wherever the client will benefit most, including our play therapy room, sand -tray room, family therapy rooms, or inside the classroom. 6. Outcomes of service. TCC will provide data around the following outcomes: educational support/achievement, placements, community supports, crisis service utilization, symptom reduction, and utilization of services. The expectation is to increase the family's abilities to develop and sustain safety and stability in their community/home environments, which in turn reduces system involvement. 7. Target population for service. The Day Treatment program provides service to the following children and families: children 5-18 years old, multisystem involvement, varied placement and custodial agreements, experienced trauma Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE history, presenting mental health diagnosis, and family involvement (or could be fostered). Exclusions to the program include: treatment for sex offenders, treatment for substance use/abuse, and intellectual functioning less than 60. Our ASPEN program, provides educational and clinical services to clients ages 5-18, who are dually diagnosed with an Austism Spectrum Disorder (mild or moderate), Intellectual Disability or a Developmental Disability. The Day Treatment program does not exclude service for cultural reasons; including race, religion, sexual preference, gender presentation, documentation status, etc. Translation services would be considered if English/Spanish were not a primary language. 8. Service access. Day Treatment services are provided in conjuction with clients who are enrolled in the Education program. Referrals for the Day Treatment program are directed to the Campus Admissions Department. Medicaid, School districts and the Department of Human Services can refer clients to the Day treatment program. The educational costs are paid by the client's respective School District. 9. Languages service is available in. Day treatment services will be offered in English primarily. The Tennyson Center is always looking to diversify staffing; and will make all attempts to provide services to meet the needs of clients referred. The Tennyson Center will communicate with Weld CO DHS at any time that Spanish services are available. 10. Rates of service. Note: Bidder should include fee for service, staffing, mileage, and any other applicable costs bidder would like considered. Rates must be an exact amount and must include the unit of cost (i.e., hour, day, month, episode). Approximate rates or a range of rates for a service will not be accepted. Day Treatment Provider Special Education Tennyson Education Staff Special Education - ASPEN Tennyson Education Staff Any staff attending sessions or Mileage exceeding 25 miles from Greeley, CO office appointments Rate/Type $1770/month $2820/month .50 cents/mile Bid No.: 1900025 Senn, Erin Erin 12/5/2016 Therapist 0/10%2016 Therapist CB5 • CBS 'Tennyson Center for Children Exhibit D - Life Skills, Mental Health Services, Home -Based Intervention Staff Info Barrios Tiffany f: 21/2027 Therapist 1/17/2017 Therapist CBS e "rRachel 1 �,,, ^�„ _ 76/19/2017 Therapist; Cohen Shawn 6/22/2015 Therapist CBS ,;.,'..I 13�r.. h�i yr' ��, �" i`,7p r: d: fvil.;yJ :.. I;d I �,,n •: ., , �1., ,....,., ,i q iTa tt, id 1 iF Deis x�rJ IyS5a ��ySsTW i 3. I: 8/x/2012 al to i' yl�, t CBS t, x':�$Cw�6:?.vs :tr J , f „ . rm IR:Odbli9lr�t ., .Pa ..L.;9VN'l$'. �I v.7:?'J ,� .. .. ,.fir ;�, �,�ik. x..,.,,,rF t ...tr ..v_,. Y. Y Crawley Blanco Kristina Anne 8/3/2015 Therapist CBS Elliottr 5F� lvlerga�et K, _ " .. _{ 8/31/201- gapisi _ _ C Harris Megan Allison 10/20/2014 Therapist CBS Gaikv�9ad` n;;51ir. �l;sne.(tia + ? ;rr " . 12/2/.2018 Therapist' ;h CBs Giles -Vazquez Victoria 8/201/2017 Therapist CBS •' itiiiSon ' p �,:Ci :.Emma -'S, .: a :;, i5: �',p s+��3a"J'';� C';- T era Ist.; .';CBS, 4> Krz. ....' t?� ,f M; ,,,.t-t'•,'�l1/2 -:h p. .. �. 016 -:, � .. s Hoekstra Hannah 9/17/2018 Therapist CBS Richele `.a Meridith Smith Melissa Vasquez Ronnie Post Keith br S4ve adb Squarreli Elena Su IRO Sweet Melanie 8/29/2017 Clinical Supervisor CBS 1/18/2016 10/10/2016 Therapiist. Executive sup!' Therapist CBS 9/17/2018 Therapist 8/31%2012 Therapist ;r u 5! 8/15/2016 9/24/• 2018 Therapist • CBS _:, 11/7/2018 Therapist CBS Therapist CBS Wille, Clara Clara 12/11/2017 Therapist Newvahner;;: Richele Newvahner, Richeie MSW r,LPCC LSW Cohen, Shawn MSW LCSW LPCC .001'5623 a LSW.0009921870 MFTC.0013752 / LPCC.0015282 CSW.09924903 t ?Fi0 ;t Crawley Blanco, Kristina MSW LCSW Harris, Megan Allison Newvahner, Richele :... MSW LCSW CSW.09923614 6/27/2017 8/31/2019 25a. 1443. 21 5/4/2018 @io J.'n, 8/31/2019 1/17/201$ *. 7/17/2014 8/31/2019 Newvahner, Richele LPCC NLC.010935 CPCC 00152' 1 M51A Newvahner, Richele NLC cSW 09925579, NLC.0109017 �o/2fl`z� 8/31/2019 8{31/2019 Newvahner, Richele Ne4vyahnera I2i�I�t�rCl� �'��rs9''";�i Shuman, Meridith Master of Educa' LPC -:LS11U' 0009VA LPC.0004591 3/9/2007 Master of Arts Ct LCSW:;. LPC 099253301 LPC.0012392 's1F J0o 0li& 1,28/2018 3/30/2015 8/31)201 8/31/2019 a:.hriey Richele am -0C Newvahner, Richele Thiel; Stephanie Master of Arts C, LPC LPC.0005368 CSW.09925034 8/20/2009 9/5/2017 8/31/2019 831/-2019:: Vasquez, Ronnie Wsnfrey, Sarah:-� Newvahner, Richele Master of Arts N Master of°Att"s�7 MA age LM FT LPCC / NLC MFT.0001339 .)006024 LPCC.0016121 8/22/2016 3/3/2t]1' s; 8/31/2019 8%31%201;9; a'hner,.Richrel 0015501 r—: Newvahner, Richele LPCC 9 A.4, G� LPCC.0014776 Newvahner,,.RichQle F stir;;' Newvahner, Richele Nevwahner ,F��chele:':, Newvahner, Richele sis NLC r. LPCC NLC.0107117 N LC.0106791 LSW.0c09922060 LPCC.0016391 9 �wvahr�er,.R�chele •T I� cm Newvahner, Richele �N MSW LSW LSW.0009921669 0099.21<285 Therapist +r_an�fdate/Reegistered 1730683848 Therapist - Candidate/Registered Therapist:--Candidate/Registered Therapist - Licensed �: a i , rr ivrill!�perP f,; ry,igi�4�� Ei +� F,rraitil�lf"Ibd4v a��..�Pl�ii �s'.J% Therapist - Licensed S079 1184128308 -k Lic Clinical Social Worker 1780108811 S079 Lic Clinical Social Worker 1962907378 T�peraplst licensed w; 50 rofessionaWadnselor Therapist - Licensed ',Therapist Candidate/Registerked Therapist - Candidate/Registered 1'tierapist Lrcensed _ Therapist - Candidate/Registered Therapist Ca did pApi4e Therapist - Licensed Therapist' Liceri+• ` i'; Therapist - Licensed S079 Lic Clinical Social Worker 117402206 1295045458 9/2425216 1508361908 507.9:.: ,ic Cimical 5ocfal ul/arker 1972008894 S081 4.. Lic Professional Counselor 1730658444; 1245520857 i, Yr. .0' S081 't:'Lic Clinical 5oc1aI�UVgrker , ? Lic Professional Counselor a hecaptst Cafldidafie/Registe Therapist - Licensed 5081 Lic Professional Counselor 217402$302...:: 1407299597 .185189627$ '�: 1346683612 Therapist Licensed` °, Therapist - Licensed Tker*'ptst Ltcet sed, Therapist - Candidate/Registered Therapist Cariipdatef Registered: Therapist - Candidate/Registered .Therapist Cap.clidate/Registered; 'N 5079•' S080 'sosl IpnicaPS,OeiatWbrker` '`'" Lic Marriage/Family Therapist Lic Professional Counselof�; ��,�, ��P,'F'w,t� �Fi 363 ,ar. 1497038400 3;346514569 1316411903 Therapist - Candidate/Registered 4410::40:0016044.0!t� Therapist - Candidate/Registered nkFi�� !T," �"��'4't`'`'W ar +i"I . tN t 4,�a .�° igltir !',sL�11 Lun Ci3s�.,far�� '�.1;': �{ ee3�.'. di�w: Therapist - Candidate/Registered .I. X al 7 1164927109 ip ^Iwo My'r, 1740785153'' 1952806382 14073.24718 • 1255862793 1326461161 ie a ist Candpiiateil4istf 0.1 Social Worker Clinical co yil itlitlis�tGj:ik�hb�!Ia:;sa�IgfiY'J�iflii S�:fip:751.;,,,,gA7g>.,,,, r ;rtupit.75„,,,f,,,,,,,,,,,,„,....„,,,,.„_— 'Ill litipi4,If.,I i,dl,t��w'l 1 •40'0ae:1-,Egleti ? Stephanie Thiel Aligon:Harris "4I09.i rjg Sarah-Winfrey_ `"f Meridith Shuman ax Yvor�e !�o, Ned Breslin aryTaxonomy N[)escrmtior 1041c0700X ;% 104100000X 4;Ih ply �Ml�d`I`itt� .fo'2546X 101YP2500X rs-rl4% 101YP2500X lolvp2soax Allison=Harris � .�w-�:��-. �SaFaf�;W�nfre.y`: :� , +;S� ra h��1"!�l ihfrej Allison Harris IMeritl th.ShuMan'' Yvonne Rodman rag I� I Allison Harris Social:.lfSfp.r.,ker. Co ounselorxProfessionaco Counselor Professions co Counselor Professions co Counselor Professions co lortmo80ox Counselor Mental Heal co 'b •fin ry lia iuril 106H0o000X Marriage & Family The co i�iYF�2�Q4x C-otan��1'or. Fr'ofessloi'ia Co "' 1,„,g,1226, E I91 @,(!� Jb Satfq �q 0i$; r. i`1 Tennyson Center for Children Exhibit D - Day Treatment Staff Info bso` A2/9/2016 P,atie4- ccess mat O'Brodo Elizabeth Anne 11/10/2014 Executive Admissions:. CAMPUS O'Brodo, Elizabeth ENW . Pi}Oeni Garza Stone-Reinig 5/2/2016 Assistant Program Manager Periy,1,, li oen�x=, Antonia �rvg.w4r, u 6/19/2017 herapist Therapist Shook Lozano ritett≤ Ratigan Oldham Kathleen Shannon Ellen Jessica 9i �i�'Ky"iP:31NvF*Pk�": Jesslca Ross ao'thoa` . Sprague $tAneri t White Rd' Dilorio Mica Rebecca F>i3P„ eannia r' . Vanessa ,[liana„ Lea h • Brandy uf 9,, 4; {p��M11911JliIVl�ii�S:6�h �'i a�� n r P': r:' 51201 2/15/2017 6/2.5/2018 - -. Therapist Therapist 12/6/2016 Occupational Therapist =9/24/2012 Speech Pa_ologiST 8/17/2015 Speech Pathologist 1/19/2018:' 48. 2/29/2016 10/20/2016: 10/21/2016 Nurse Ci grain)pgtctorr '. Tieraplsf; Program Director erk Tha 4*..,V;'0 ,. Therapist urbahn, Rebecca .- DTX Durbahn, Rebecca Ross, Vanessa RES self RES Courtney, Jessica RES/DTXi Ross, Variessak RES/DTX O'Brodo, Elizabeth RES/DTX RosS; Vahessa RES/DTX Ross, Vanessa Nich6 7/10/2017 heraP [- Therapist 1217 ,O011 Therapist 8/21/2017 Therapist 111:11,2018., ,' � „ ..Therapist" '.. 9/6/2016 Training Manager RES/DTX RES/DTX;; RES/DTX 551J.,y , SS 1okti,Mari;Tiana- .- Ross, Vanessa Ross; Van'esSa �ou"rthey:Jess�ca Dilorio, Dustan , �r MSW LCSW SW 09925573 CSW.09923715 r 1 -2 10/6/2014 $�31/�07;9 •, • �.Therapist`� ticerse�ck 8/31/2019 Therapist - Licensed MSW SWP SW P.0001299 ?ravisioraa(1 aL(censed�agc, Therapist - Provisionally Licensed (RCCF) Therapist Licensed' r z Therapist - Provisionally Licensed (RCCF) u ?sz Master() LPP MFT�0001544�, r LPP,0001461 i/31%20.18� 8131/2019 UPrg0i3132 OT.0004241 SLP.0000335 �•a hgrapist: o,%KG tall &ensea t4e6 j:9.I RxN / RN /APN Si_P.0001775 X�N:0�01458�.N R;;; �[?N�0;9919&7 NP RNQ1833�9 06/06/2016 12/21/2009 11/06/2014 APN.0990756-NP / RN.0193498 / RXN.0101090-N P 9/30/2019 ers Counsel'.. MSW `i �I i LPP / LPCC LCSW N1 MSW LCSW tp�bt LPP.0001474 / LPCC.0015485 SWP 0,0013�5h CSW.00001502 CSW.09925566 CSW.09924986 Aor 2/8/2010 9/19%2.18 8/11/2017 Nurse ; pdva,nce'PragMO. Practitioner/Prescri Nurse -Advance Practice - Practitioner/Prescriber 8/31/2019 T d�ipl lN'�'� Rln terap�ista,-t ice,sei Therapist - Provisionally Licensed (RCCF) herapist .provisionally:Licensed {RCCF) i Therapist - Licensed i 1 Is�ilMlli�IrdFl �,�II f o- 44iu3S /31/z01s 8/31/2019 5 Therapist - Licensed MastelA0 MSW >5tepxFW N1SV)! t''' N aa� SWP MFT 000-1558 .` SW P.0001307 N?I. YWtt!50"Y 09925,71 LPP.0001530 !V' ` 'SWP 000'110 Master of Arts IV LPC LPC.0013303 s 20 iyzo 81/2019 8/31/2019 dtaplst ice .ses Therapist - Provisionally Licensed (RCCF) .rapist 1�:je„cpAg. Therapist - Provisionally Licensed (RCCF) ," . ,-Therapist, Prou�stonaliy Licensed (RCCF)":,' 8/31/2019 Therapist - Licensed 7% Lic Clinical Social Worker S079 1:: uc:eroressionar ounseior.,: 1902298284 z....._ • r..306-�756fl° 1992202782 r�o�iss�71, 1134625544 Ned Breslin 322D00000X ebeera Durbefi Vanessa Ross 06r t000Qo, Durbahn; Rebecca Rebecca Durbahn 1306315999,.;;' s�a�Ft'gs� 1659684009 4607310 81 lic Proliessional,C.ouhselor- C s. 116491435 363LP0808X Jessica Courtney elizabeth o'firodsa „; i r *4 0'0 Jessica Courtney Vanessa Ross 5079 Lic Clinical Social Worker r: 1851798623 elizabeth o'brodo 1041C0700X Ge rnl�ca(5.oaa� UV©rker °'° 5079 Lic Clinical Social Worker 16294'50291 1023390341 464ODUfbai Rebecca Durbahn 104100000X 1041C0700X 41 ar�rage/Fa rnr;ly�Th e ra pst 1316292725 1235636390 lirai SA. a � �x �P S079 LrcoGlrnre*t orlceri,. 145179$623 S081 Lic Professional Counselor `1063903045 ' ` 1073951.430 =Rebecca"D:urbahn Vanessa Ross 06H3000p Vanessa Ross , J:essca<�ouitri'ey. °` 1041C0700X 101yP2500X Social: Worker',,.„ . CQ Residential Treatment I co arr age & :Family 7i�ea co w; 'SE Nurse Practitioner Psyc co IR a ractitiorier°Fsyt 0o0nselor.Professiona co a, Social Worker Clinical co 'Soc10trOM Social Worker Clinical co $41:01, — sue... -0nseior Profess% yam, Counseiori,, (Stib ta' 01 �1 1 041C0700 Counselor Professiona co Client#: 1089099 TENNYCEN ACORDT.. CERTIFICATE OF LIABILITY INSURANCE DATE IMM10DMYY) Orr 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER US! Colorado, !LC C/L P.O. BOX 7050 Englewood, CO 80155 BOO 873-8500 ar PC1. Julie King PHONE 800 873-8500 FAX Na): 303 831-5295 Est):I INC, E•MA(AIC,IL ADDREADDRESS: den•certificate@usi.com INSURERIS) AFFORDING COVERAGE NAIC b INSURER A Hanover Amerlcan Insurance Company 36064 INSURED Tennyson Center for Children At Colorado Christian Home 2950 Tennyson Street Denver, CO 80212-3029 INSURER B: Hanover Insurance Company 22292 INSURER CAssurance pinnecoltompany 41190 INSURER D: Allmerlca Financial Benefit 41840 INSURER E: INSURER F : • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE' FOR THE POLICY PERIOD INDICATED. 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INSR LTR TYPE OF INSURANCE ADDLSUBR 1NSR WWI POLICY NUMBER POLICY EFF IMM/DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY BZZ4A43533304 10/01/2018 10/01/2019 EACH OCCURRENCE $1,000,000 1 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence] $100,000 --- -- MED EXP (Any one parson) $ 5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO - SECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ D AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY x SCHEDULED AUTOS NON -OWNED AUTOS ONLY W4A43530904 10/01/2018 10/01/2019 p °Maul WINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B x UMBRELLA LIAB EXCESS LIAR X t OCCUR CLAIMS -MADE UH4A43533403 10/01/2018 10/01/2019 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 $ DED RETENTION$ C WORKERS COMPENSATION ANb EMPLOYERS' LIABILITY OFFICERR/MEMBER EXCLUDDEED? ECUTIVEIYN I (Mandatory in NH) If yes, describe under N 1 A 4085885 loroirzola 1aov2ols x PER iOTH- ,_STATUTE :FR E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 A Professional Liab BZZ4A43533304 10/01/2018 10/01/2019 $1,000,000 Each Claim $3,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage: Cyber Liability Policy Term: 10/01/2018 to 10/01/2019 Carrier: Lloyd's of London Policy # WN163122 Network Security and Privacy Liability - $1,000,000 Limit (See Attached Descriptions) CANCELLATION For Information only 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 � A © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S24361323/M24014652 JSKBC DESCRIPTIONS (Continued from Page 1) Security Liability - $1,000,000 Limit Multimedia Liability - $1,000,000 Limit *** Full Prior Acts*** Coverage: Crime Policy Term: 10/01/2018 to 10/01/2019 Carrier: Hanover American Insurance Company Policy # BZZ4A43533304 Employee Theft - $200,000 Limit / $5,000 Deductible Forgery or Alteration - $100,000 Limit / $5,000 Deductible Coverage: Physical Abuse, Sexual Misconduct Or Sexual Molestation Liability Policy Term: 10/01/2018 to 10/01/2019 Carrier: Hanover American Insurance Company General Liability Policy # - BZZ4A43533304 Physical Abuse, Sexual Misconduct or Sexual Molestation - $1,000,000 Each Incident Limit Physical Abuse, Sexual Misconduct or Sexual Molestation - $3,000,000 Aggregate Limit SAGITTA 25.3 (2016/03) 2 of 2 #S24361323/M24014652 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: Community Based Service BIDDER LEGAL ENTITY NAME: The Tennyson Center for Children at Colorado Christian Home APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name First Name Work# Work Email Education Level Degree Focus Licensure/ Credentials DORA # (If applicable) Last Name Rrst Name Work # Work Email 1 Tapp Vivian 970.302.5018 vivian.tapp@tenn BA n/a Deis Alyssa 303.882.0460 sarah.winfrey@te 3 Smith Melissa 720.512.7683 melissa.smith@te MA LPC.0013198 Winfrey Sarah 720.301.3070 sarah.winfrey@te 4 Deis Alyssa 303.882.0460 alyssa.deis@tenor BA n/a Winfrey Sarah 720.301.3070 sarah.winfrey@te 5 Winfrey Sarah 720.301.3070 sarah.winfrey@te MA LPC.0006024 Shuman Meridlth 720.855.3241 meridith.shuman( 6 Newvahner Richele 303.433.2541 richele.newvahne MA LPC.0004591 Winfrey Sarah 720.855.3436 sarah.winfrey@ter 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 81800058 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.( lnysoncenter.org lnysoncenter.org lnysoncenter.org ptennysoncenter.org lnysoncenter.org 01800058 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: The Tennyson Center for Children Day Treatment and Educational Services 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Day Treatment Program is an educational program with clinical mental health services, serving students from Kindergarten through 12th grade. Tennyson Center's school is fully accredited by AdvancED, a nationally recognized organization that focuses on school improvement. We are monitored by the Colorado Department of Education and employ licensed Special Education teachers. The Day treatment program employs Master level clinicians and utilizes the following modalities for treatment: Trauma Focused Cognitive Behavioral Therapy; Family Systems; EMDR, DBT, Play Therapy, Therapeutic Crisis Intervention, Restorative Practices and the ARC model (Attachment, Regulation and Competency). The program uses the following methods for treatment: individual and family therapy, group therapy (psychoeducation and skill building groups), milieu interventions, multidisciplinary meetings/communications, crisis support and educational services, including IEP meetings and monthly staffing meeting with internal and external teams. 4. Capacity to Provide Services (ex. 4 hours/week). Tennyson's Day Treatment Program is clinically served by 10 classroom -based, master level clinicians who are assigned an average of 8 clients each. Each client receives a minimum of two, face-to-face hours of individual and/or family therapy each week. Additionally, clinicians are available to support students during mental health crises that occur during the school day. Each classroom is supported by a certified teacher and two direct care staff members. 5. Goals of the service. The goals of the service include: preparing students to return to public school, increased family and interpersonal relationships, decreased risk behaviors, increased affect regulation and skill building, symptom reduction (traumatic stress in particular), and increased academic performance and abilities. The strength of our Day Treatment program is that clinical services can be provided wherever the client will benefit most, including our play therapy room, sand -tray room, family therapy rooms, or inside the classroom. 6. Outcomes of service. TCC will provide data around the following outcomes: educational support/achievement, placements, community supports, crisis service utilization, symptom reduction, and utilization of services. The expectation is to increase the family's abilities to develop and sustain safety and stability in their community/home environments, which in turn reduces system involvement. 7. Target population for service. The Day Treatment program provides service to the following children and families: children 5-18 years old, multisystem involvement, varied placement and custodial agreements, experienced trauma Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE history, presenting mental health diagnosis, and family involvement (or could be fostered). Exclusions to the program include: treatment for sex offenders, treatment for substance use/abuse, and intellectual functioning less than 60. Our ASPEN program, provides educational and clinical services to clients ages 5-18, who are dually diagnosed with an Austism Spectrum Disorder (mild or moderate), Intellectual Disability or a Developmental Disability. The Day Treatment program does not exclude service for cultural reasons; including race, religion, sexual preference, gender presentation, documentation status, etc. Translation services would be considered if English/Spanish were not a primary language. 8. Service access. Day Treatment services are provided in conjuction with clients who are enrolled in the Education program. Referrals for the Day Treatment program are directed to the Campus Admissions Department. Medicaid, School districts and the Department of Human Services can refer clients to the Day treatment program. The educational costs are paid by the client's respective School District. 9. Languages service is available in. Day treatment services will be offered in English primarily. The Tennyson Center is always looking to diversify staffing; and will make all attempts to provide services to meet the needs of clients referred. The Tennyson Center will communicate with Weld CO DHS at any time that Spanish services are available. 10. Rates of service. Note: Bidder should include fee for service, staffing, mileage, and any other applicable costs bidder would like considered. Rates must be an exact amount and must include the unit of cost (i.e., hour, day, month, episode). Approximate rates or a range of rates for a service will not be accepted. Our contracts with most of the Medicaid RAF's include provisions for day treatment costs. Day Treatment Special Education - Therapy Special Education —ASPEN Therapy Mileage exceeding 25 miles from Greeley, CO office Special Education - Excess Costs Special Education — ASPEN Excess Costs Special Education —Therapy & Excess Costs Special Education — ASPEN Therapy & Excess Costs Provider Tennyson Education Staff Tennyson Education Staff Any staff attending sessions or appointments Tennyson Education Staff Tennyson Education Staff Tennyson Education Staff Tennyson Education Staff Rate/Type $1770/month $2820/month .50 cents/mile $96.47/day $161.29/day $3700/month $6046/month Bid No.: 1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE Day Treatment BIDDER LEGAL ENTITY NAME: Tennyson Center for Children APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION ; ':":SUPERVISOR INFORMATION No. Last Name First Name Work# Work Email Education Level Degree Focus Ucensure/ Credentials DORA # (If applicable) Lest Name fltst Name Work # 1 Jewett Allison 303-433-2541 allison.jewett@tennysoncenter.org MSW Clinical Social N CSW.09925573 Durbahn Rebecca 303-433-2541 2 O'Brodo Elizabeth 303-433-2541 elizabeth.o'brodo@tennysoncenter.org MSW Clinical Social G\CSW.09923715 Breslin Ned 303-433-2541 3 Brown Phoenix 303-433-2541 phoenix.brown@tennysoncenter.org LPP.0001516/ LPCC.0016122 Durbahn Rebecca 303-433-2541 4 Garza Antonia 303-433-2541 antonia.Rarza@tennysoncenter.org MSW Clinical Social yI SWP.0001299 Ross Vanessa 303-433-2541 5 Perry Emily 303-433-2541 emily_perry@tennysoncenter.org MA Counselor MFT.0001544 Durbahn Rebecca 303-433-2541 6 Shook Kathleen 303-433-2541 kathleen.shook@tennysoncenter.org LPP.0001461 Durbahn Rebecca 303-433-2541 7 Wall Samantha 303-433-2541 samantha.wall@tennysoncenter.org MSW SWP.0001326 Ross Vanessa 303-433-2541 8 Lozano Shannon 303-433-2541 shannon.lozano@tennysoncenter.org O7.0004241 Parks Rebecca 303-433-2541 9 Pruett Jessica 303-433-2541 jessica.pruett@tennysoncenter.org SLP.0000335 Parks Rebecca 303-433-2541 10 Ratigan Ellen 303-433-2541 ellen.ratigan@tennysoncenter.org SLP.0001775 Parks Rebecca 303-433-2541 11 Beroske Marcie 303-433-2541 marcie.beroske@tennysoncenter.org Nurse Practitioner Psych/Mental Health RXN.0101458-NP /APN.0991987- NP /RN.0183339 Courtney Jessica 303-433-2541 12 Oldham Jessica 303-433-2541 jessica.oldham@tennysoncenter.org Nurse Practitioner Psych/Mental Health APN.0990756-NP /RN.0193498 / RXN.0101090- NP Courtney Jessica 303-433-2541 13 Courtney Jessica 303-433-2541 jessica.courtney@tennysoncenter.org MA Clinical Social N LPC.0006151 O'Brodo Elizabeth 303-433-2541 14 Stone-Reinig Mica 303-433-2541 mica.stone-reinis@tennysoncenter.org LPP.0001474/ LPCC.0015485 Courtney Jessica 303-433-2541 15 Morrow Claire 303-433-2541 claire.morrow@tennysoncenter.org MSW SWP.0001305 Ross Vanessa 303-433-2541 16 Durbahn Rebecca 303-433-2541 rebecca.durbahn@tennysoncenter.org MSW Clinical Social N CSW.00001502 O'Brodo Elizabeth 303-433-2541 17 Horton 0reeanna 303-433-2541 breeanna.horton@tennysoncenter.orp, MSW Clinical Social N CSW.09925566 Durbahn Rebecca 303-433-2541 18 Ross Vanessa 303-433-2541 yanessa.ross@tennysoncenter.org MSW Clinical Social N CSW.09924986 Durbahn Rebecca 303-433-2541 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 19 Rothman Tiana 303-433-2541 tana.rothman@tennysoncenter.org MA Marriage/Famil MFT.0001556 Durbahn Rebecca 303-433-2541 20 Sprague Leah 303-433-2541 leah.sprague@tennysoncenter.org MSW SWP.0001307 Ross Vanessa 303-433-2541 21 Shafner Caitlyn 303-433-2541 caitlyn.shafner@tennysoncenter.org MSW Clinical Social N CSW.09925575 Ross Vanessa 303-433-2541 22 White Brandy 303-433-2541 brandy.white@tennysoncenter.org LPP.0001530 Rothman Tiana 303-433-2541 23 Roddy Cadence 303-433-2541 cadence.roddy@tennysoncenter.org MSW SWP.0001303 Courtney Jessica 303-433-2541 24 Dilorio Dustan 303-433-2541 dustan.dilorio@tennysoncenter.org MA Counselor LPC.0013303 Courtney Jessica 303-433-2541 25 Papke Annika 303-433-2541 annika.papke@tennysoncenter.org Counselor ACD.0000301 / LPC.0011624 Courtney Jessica 303-433-2541 26 27 28 Bid No.: B1900025 STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) Work Email rebeccadurbahn@tennysoncenter.org ned.breslin@tennysoncenter.org rebecca.durbahn@tennysoncenter.org vanessaross@tennysoncenter.org ebeccadurbahn@tennysoncenter.org ebeccadurbahn@tennysoncenter.org vanessaross@ennysoncenter.org rebeccaparks@tennysoncenterorg rebeccaparks@tennysoncentecorg ebeccaparks@tennysoncenter.org jessicacourtney@tennysoncenter.org jessica.courtney@tennysoncenter.org elizabeth.obrodo@tennysoncenter.org jessica.courtney@tennysoncenter.org vanessa.ross@tennysoncenter.org elizabeth.o'brodo@tennysoncenter.org rebecca.durbahn@tennysoncenter.org rebecca.durbahn@tennysoncenter.org Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) rebeccadurbahn@tennysoncenteron, vanessa.oss@tennysoncenter.orF vanessa.oss@tennvsoncenter.org Liana.rothman@tennysoncenter.org jessica.courtney@tennysoncenter.org jessica.courtney@tennysoncenter.org jessica.courtney@tennysoncenter.org Bid No.: 81900025 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Day Treatment Services, as referred by the Department. 2. Contractor's Day Treatment Program is an educational program with clinical mental health services. In addition to educational services, Contractor will provide: a. Individual and family therapy b. Group therapy (psychoeducation and skill building groups) c. Milieu interventions d. Multidisciplinary meetings/communications e. Crisis support f. Education services (including Individualized Educational Plan (IEP) meetings) 3. Capacity for Services: a. Contractor retains 10 classroom -based, Master's level clinicians who are assigned an average of eight (8) students each. b. Each student will receive a minimum of two (2) face-to-face hours of individual and/or family therapy per week. c. Clinicians will be available for support during the school day. d. Each classroom will be supported by a certified teacher and two (2) direct care staff members. 4. Goals of Service: a. Preparing students to return to public school b. Increased family and interpersonal relationships c. Decreased risk behaviors d. Increased affect regulation and skill building e. Symptom reduction (such as traumatic stress) f. Increased academic performance and abilities. 5. Outcomes of Service: Increased ability of the family to develop and sustain safety and stability in their community/home environments, which in turn will reduce system involvement. a. Contractor will provide data regarding the following: i. Educational support/achievement ii. Placements iii. Community supports iv. Crisis service utilization v. Symptom reduction vi. Utilization of services 6. Target Population: a. Children, and their families, age five (5) to 18 years of age, with multisystem involvement, varied placement and custodial agreements, trauma history, presenting mental health diagnosis, and family involvement (or could be fostered). b. Excluded populations include those requiring treatment'for sex offenders, treatment for substance use/abuse, and those with intellectual functioning less than 60. c. Contractor does not exclude service for cultural reason including race, religion, sexual preference, gender presentation, or documentation status. 1 7. Service Access: As referred by the Department. Educational costs are paid by the student's respective school district. 8. Language: English only. 9. Contractor will respond to the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 10. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 11. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 12. 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 Supervisor (hainleid@weldgov.com) immediately via email, to discuss service continuation. 13. 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. 14. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 15. 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. 16. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, 2 change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 17. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. Contractor may participate by phone, if approved by the Department. 18. Contractor will notify the quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210) 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. 3 EXHIBIT D RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2020. 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 $161.29/Day (Special Education — ASPEN Excess Costs) $2,820.00/Month (Special Education —ASPEN Therapy) $6,046.00/Month (Special Education —ASPEN Therapy and Excess Costs) $1,770.00/Month (Special Education —Therapy) $3,700.00/Month (Special Education —Therapy and Excess Costs) $96.47/Day (Special Education Exceeds Costs) 3. 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 7th 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. Entity Information r Contract Request Entity Name* Entity ID* TENNYSON CENTER FOR CHILDREN @00030337 Contract Name I tNNYSON CENTER FOR CHILDREN (CHILD PROTECTION AGREEEMENT FOR SERVICES) Contract Status CTB REVIEW ❑ New Entity? Contract ID 2697 Contract Lead* CULLINTA Contract Lead Email c ullinta@co.weld.co.us Contract Description* CONSENT. NEW AGREEMENT FOR SERVICES. FUNDING: CORE/OTHER Contract Description 2 BID NO. 6190002E. Contract Type* AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal IGA Deparment HUMAN SERVICES Department Email Clvl- H uman Services@weldgov_ corn Department Heart Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY AI I ORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM Parent Contract ID 20190707 Requires Board Approval YES Department Project # I tR+l: 06/01/19-06/31/20. Requested BOCC Agenda Date 05122/2019 Due Date 0511812019 Will a work session with BOCC be required?' NCI [Does Contract require Purchasing Dept. to be included? tf this is a renewal enter previous Contract ID If this is part of a !ASA enter'ASA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Review Date* 04/0112020 Committed Delivery [Date Renewal Date* 06/01/2020 Expiration Date Contact Information Contact Info Contact Name Purchasing Purchasing Approver CONSENT Approval Process Department H JUDY GRIEGG DH Approved Date 06/2712019 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 07/03/2019 Originator CULL' NTA Contact Type Contact Email Hnance Approver CONSENT Contact Phone 1 Contact Phone 2 Purchasing Approved Date 06?27/2019 Finance Approvers Date 06/27/2019 Tyler Ref AG 070319 Legal Counsel CONSENT Legal Counsel Approved Date 0a/27/2019 Submit Hello