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Home My WebLink About20192021.tiff/D'17c7.02-s/ PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: March 30, 2021 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Protection Agreement Amendments for 2019- 20 Core/Non-Core Contracted Services Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Child Protection Agreement Amendments for 2019- 20 Core/Non-Core Contracted Services. The Department entered into Agreements with various Child Welfare service providers through the 2019-2020 Request for Proposal (RFP), Bid Number: B1900025, identified as Tyler ID 2019-0707. These Agreements were issued for a period of three (3) years with the option to renew annually. The Department is requesting to renew the current Agreements with no changes for 34 providers reflected in the attached list. Agreements will be renewed for the third and final year for the period of June 1, 2021 through May 31, 2022. 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. Approve Recommendation Perry L. Buck Mike Freeman Scott K. James, Pro-Tem Steve Moreno, Chair Lori Saine Schedule Work Session Pass -Around Memorandum; March 30, 2021 , CMS ID (i (5 o� � f AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement Amendment, made and entered intoCi'f9 day of 2021 by and between the Board of Weld County Commissioners, on behalf of the Weld County Depa t of Human Services, hereinafter referred to as the "Department", and North Range Behavioral Health, h einafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Foster Care/Adoption Services, Functional Family Therapy, Monitored Sobriety Services, and Multisystemic Therapy, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2021, approved on May 29, 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: December 9, 2019 to amend the Scope of Services and Rate Schedule. June 1, 2020 to extend the term date through May 31, 2021 and 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 2019-2021. • 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. • All other terms and conditions of the Original Agreement remain unchanged. c2o/ 9- ,.Z.oa/ IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld C% n Clerk to the Bo. d _��_ WELD COUNTY, COLORADO By: .4.frAvoO••� Deputy Clerk BOARD OF COUNTY COMMISSIONERS B and /// a,, Steve Moreno, Char MAY 0 3 2021 North Range Behavioral Health 1300 North 17t' Avenue Greeley41%31 By: Date: Polfal f 4R9AQAAQ1Q40475 Larry Pottorff Executive Director April 21, )021 12:58 PM MDT Contract Form Entity Information New Contract Request Entity Name* Entity ID* NORTH RANGE BEHAVIORAL HEALTH P00008661 Contract Name* NORTH RANGE BEHAVIORAL HEALTH (AGREEMENT AMENDMENT) Contract Status CTB REVIEW Contract Description* BID #B2000037. TERM: 6,'1/21-5/31 /22. Contract Description 2 CONSENT. PA WAS SENT TO Contract Type AMENDMENT Amount* 30.00 Renewable* NO Automatic Renewal Grant IGA CTB ON 3 / 31 `21 . Department HUMAN SERVICES Department Email CM- HumanServicesrw,+eldgov.co m Department Head Email CM -Human Services- DeptHeadzwveldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY` WELDG OV.COM ❑ New Entity? Contract ID 4728 Contract Lead * APEGG Contract Lewd Email apeggk weldgov.com;cobbx xlk@weldgov.com Requested BOCC Agenda Date* 05126;2021 Parent Contract ID Requires Board Approval YES Department Project it Due Date 05 22;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 OnBase Contract Dates Effective Date Review Date* 04,/01 2022 Renewal Date Termination Notice Period Con ct (n€t>lrirtat"on ntact In Purchasing Purchasing Approver CONSENT Apprtnval Prcr+eess Department Head JAMIE ULRICH DH Approved Date 04,.27x"2021 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/03;2021 Originator APEGG Contact Type Committed Delivery Date Finance Approver CONSENT Expiration Date* 05'31.'2022 Contact Phone 1 Contact Phone 2 Purchasing . 04/27/2021 Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 04/2712021 04/27;2021 Tyler Ref # AG 050321 Corii-e2g$ .17P 4i 3363 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: May 26, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with North Range Behavioral Health 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 North Range Behavioral Health. The Department entered into an agreement with North Range Behavioral Health, with a term of June 1, 2019 through May 31, 2020, under Bid No. B1900025, for Foster Care/Adoption Services, Functional Family Therapy, Monitored Sobriety Services, Multisystemic Therapy, and Mental Health/Diagnostic Testing Services. This agreement is identified as 2019-2021, approved on May 29, 2019. When the Department drafted the original Scope of Services and Rate Schedule, the information pertaining to Mental Health/Diagnostic Testing Services was inadvertently left out of the documents. The Department has not referred clients to the vendor for these services since the agreement was approved on May 29, 2019. In addition, the vendor has informed the Department that they are no longer going to be providing the Monitored Sobriety Services. The Department would like to add the Mental Health Services/Diagnostic Testing and delete the Monitored Sobriety Services as outlined on the attached matrix. I do not recommend a Work Session. I recommend approval of this Amendment. Mike Freeman Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; May 26,2020 - CMS 3565 Page I �. lk) (PlibaAte,) lam- -ao o�/orl,-o goo�a 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 A__ Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Page VENDOR RENEWALS Vendor Program Area Service Name Neurosequential Model of Therapeutics (NMT) Evaluation, Brain Map, and Presentation with Recommendation Funding Core Rate $ 1,000.00" Unit Type Episode Updated NMT Evaluation Core $ 600.00 Episode Mower, Curt Foster Care/Adoption Support Training and Consultation _ Core $ 150.00' Hour Travel Core $ 50.00 Hour Nathan Swisher, PsyD, PLLC Mental Health Services Clinical Diagnostic Interview and Report Core $ 300.00 Episode Cognitive Ability and Achievement Testing Core $ 360.00 Hour Comprehensive Battery Testing Core $ 360.00 = Hour General Diagnostic/Personality Testing Core $ 360.00 Hour Psychotherapy'' Core $" 125.00 Hour North Range Behavioral Health Community Based Family Support Services Foster Care - Parents as Teachers Group Core $ 33.00 Hour Kinship - Parents as Teachers Group Core $ 33.00`_ , Hour Foster Care/Adoption Support Foster Care - Advanced Incredible Years Parent Group Core $ 8.30 Hour Foster Care - Conscientious Discipline Training Core $'` 25.00 Hour Foster Care - Dina School Group Core $ 20.00 Hour Foster Care -Home Instruction for Parents of Preschool Youngsters (HIPPY) Core $ 25.00 Hour Foster Care -Incredible Babies Group Core $ 8.30 Hour Foster Care -Incredible Years Parent Group Core $ 8.32< Hour Foster Care - Positive Solutions Group Core $ 15.00 Hour Foster Care - The Growing Brain Group Core $ 6.88 Hour Foster Care - Whole Brain Child Group Core $ 25.00 Hour Kinship - Advanced Incredible Years Parent Group Core $ 8.30 Hour Kinship - Conscientious Discipline Training Core $ 25.00 Hour Kinship - Dina School Group Core $ '; 20.00 Hour Kinship - Home Instruction for Parents of Preschool Youngsters (HIPPY) Core $ 25.00 Hour Kinship -Incredible Babies Group Core $ 8.30 Hour Kinship - Incredible Years Parent Group Core $ 8.32 Hour Kinship - Positive Solutions Group Core $ 15.00: Hour Kinship - The Growing Brain Group Core $ 6.88 Hour Kinship - Whole Brain Child Group Core $` 25.00 Hour Functional Family Therapy Child Welfare Functional Family Therapy Core $ 1,200.00 Month Functional Family Therapy Core $ 700.00 Month Mental Health Services MH Psych Testing Hourly Rate (partial test) Core $ 120.00 Hour MH Psych Testing Level 1 Core $ ' 250.00; Episode MH Psych Testing Level 2 Core $ 800.00 Episode MH Psych Testing Level 3' Core $'" 1,200.00" Episode MH Psych Testing Level 4 Core $ 1,800.00 Episode MH Psych Testing Level 5 Core $ 2,500.00 Episode Monitored Sobriety Services 5 Panel Urinalysis CW Block/Child Welfare Services $ 20.00 Test 7 Panel Urinalysis CW Block/Child Welfare Services $;,: 20.00' Test Breathalyzer CW Block/Child Welfare Services $ 5.00 Test Confirmation of Positive Result CW Block/Child Welfare Services $ ` 35.00 Drug Ethyl Glucuronide/EtG Test CW Block/Child Welfare Services $ 35.00 Test WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 82000037 9 VENDOR RENEWALS Vendor Program Area Service Name Hair Testing Funding CW Block/Child Welfare Services Rate $ 100.00 Unit Type Test Instant Swab CW Block/Child Welfare Services $ 20.00 Test Multi -Panel Instant UA CW Block/Child Welfare Services $ 20:00 Test Oral Swab - 6 Panel CW Block/Child Welfare Services $ 20.00 Test Oral Swab - Synthetic'Cannabinoids "Spice" CW Block/Child Welfare Services $ 35.00 Test Oxycodone or Buprenorphine Add-on Test to 5 or 7 Panel CW Block/Child Welfare Services $ 2.00 Test Patch Monitoring CW Block/Child Welfare Services $ 65.00 Test Single Panel EtG Add-on Test, Added to 5 or 7 Panel UA CW Block/Child Welfare Services $ 2.00 Test UA-Synthetic Cannabinoids "Spice" CW Block/Child Welfare 5er/ices $ 35.00 Test Multisystemic Therapy Multisystemic Therapy Core $ 1,800.00 Month Oval Options for Conflict Management, LLC Mediation Intake Call Core $ 200.00 Hour Mediation Services Core $ 200.00 Hour Referral Fee Core $ 50.00 Episode Paid In Full Child Mentoring and Family Support Best Day Ever Event -Last Session Core $ 250.00 Episode Level 1 - Intro to Best Effort Core $ 95.00 Episode Level 1 - Intro to Camaraderie Core $ 195.00 Episode Level 1 - Intro to Work as a Team Core $ 195.00 Episode Level 1 - Prep and Test for Level 2 Core $ 195.00 Episode Level 2 - R.M.M. Family Club Core $ 100.00 Class Level 3 - Pass On R.M.M. 12 Core Values Core $ 100.00 Class Recovery Abuse Program Monitored Sobriety Services 8 Panel UA with ETG, Color Line CW Block/Child Welfare Services $ 25.00 Test 8 Panel UA with ETG, Walk -In CW Block/Child Welfare Services $ 30.00 Test BAC, One -Time Walk -In CW Block/Child Welfare Services $ 10.00 Test BAC, Random CW Block/Child Welfare Services $ 5.00 Test ETG Only CW Block/Child Welfare Services $ 25.00 Test ETG Only, Quick Test CW Block/Child Welfare Services $ 30.00 Test Extra Adulteration Panels CW Block/Child Welfare Services $ 5.00 Test Intake Fee, One -Time CW Block/Child Welfare Services $ 25.00 Episode UA Confirmation CW Block/Child Welfare Services $ 25.00 Test Savio House Functional Family Therapy FFT-Inside Catchment Core $ 1,300.00 Month FFT-Outside Catchment Core $ 1,800.00 Month Home Based Services Community Based Services Adolescent -Inside Catchment Area Core $ 1,814.00 Month Community Based Services Adolescent -Outside Catchment Area Core $ 2,314.00 Month Community Based Services Child Protection -Inside Catchment Core $ 1,814.00 Month Community Based Services Child Protection -Outside Catchment Core $ 2,314.00 Month Kinship Services -Inside Catchment Core $ 1,600.00 Month Kinship Services -Outside Catchment Core $ 2,100.00 Month Life Skills Life Skills Mentoring High Level (10hrs/wk), Inside Catchment Core $ 2,537.00 Month Life Skills Mentoring High Level (10hrs/wk), Outside Catchment Core $ 3,037.00 Month WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: B2000037 10 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement Amendment, made and entered into _ ( S+ day of _. To rte. , 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 North Range Behavioral Health, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services, Functional Family Therapy, Foster Care/Adoption Services and Monitored Sobriety Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2021, approved on May 29, 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 December 9, 2019. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2021. • 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 second full year term, for the period of June 1, 2020 through May 31, 2021. 2. Exhibit C, Scope of Services, is hereby amended as attached. 3. 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 above written. ATTEST: Weld ounty Clerk to the $oard B :\ c Qty Lam_ Y Deputy Clerk to the Board COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO �1.e1L. Mike Freeman, Chair CONTRACTOR;, JUN 0 12020 North Range Behavioral Health 1300 North 17t' Avenue Greeley, CO 80631 By: Larry Pottorff Date: Larry Pottorff, Executive Director 5/11/2020 PQ 19 - aoD I EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Foster Care/Adoption Services, Functional Family Therapy, Mental Health Services, Diagnostic/Testing Services and Multisystemic Therapy, as referred by the Department. 2. Foster Care/Adoption Services: Contractor will provide a variety of groups to support foster and kinship parents to be better equipped to facilitate positive relationships with the children in their care. These groups will be trauma -informed, strengths -focused and evidence -based for families with children birth to eight (8) years of age. a. Groups available under this agreement include: i. Incredible Years Parent Groups ii. Incredible Babies iii. Incredible Toddlers iv. Positive Solutions Groups v. The Whole Brain Child Training vi. The Growing Brain (0-5) Training vii. Dina School (for children while adult caregivers are in session) viii. Parents as Teachers b. Capacity for Services: i. Incredible Years Parent Groups — 2 hours/week = 14 weeks 1. Dina School (2 hours —14 weeks) ii. Incredible Years Parent Groups — Extended — 2 hours/week = 6 to 8 weeks 1. Dina School (2 hours -8 weeks) iii. Incredible Babies (4-12 months) —1-1/2 hours = 8 sessions 1. This is an adult -child in vivo group iv. Incredible Toddlers (13 -24 months) —1-1/2 hours = 12 sessions 1. This is an adult -child in vivo group v. Positive Solutions Groups —1 hour/week = 6 weeks 1. PSG Child Groups (1 hour/week = 6 weeks) vi. The Whole Brain Child Training -1 hour/week= 4 weeks 1. Social -Emotional Skills Group (1 hour = 4 weeks) vii. The Growing Brain (0-5) Training — 2 hours/week = 8 weeks 1. Dina School (2 hours — 8 weeks) viii. Parents as Teachers —1 hour/every other week = 1 year in home c. Goals of Service: i. Foster parents will have skills, strategies and abilities to promote positive relationships and address the trauma and challenging behaviors that are present with children in their care under the age of eight (8) years. ii. Adult caregivers will promote social and emotional development. iii. Adult groups will be based on Cognitive Behavioral Theories and incorporate effective adult learning strategies to strengthen relationships and give a deeper understanding of trauma and early brain development iv. Child groups are abased experiential and behavioral learning appropriate for young children and focus on increasing regulation and problem -solving skills while building a sense of trust and safety for children that may have experienced ruptures and trauma. d. Outcomes of Service: 1 i. Foster parents will feel more capable of supporting the needs of the young children in their care that have experienced loss, trauma or ruptures in their early years. ii. Adult caregivers will have specific strategies that assist them in having consistent, predictable and nurturing interaction that promotes response relationships and attachment in the adult/child relationship. iii. Children will be assessed in group and supported to the appropriate level of care that their presenting needs require. e. Target Population: i. Foster parents of infants, toddlers and preschool age children, ages birth to six (6) years of age. ii. Dina School and The Whole Brain Child can serve children up to age eight (8). f. Service Access: i. Littler Prevention Campus, 2350 West 3rd Street Road, Greeley, CO. ii. South County services will vary based on need and numbers to impact. Groups will occur at the Contractor's office or High Plains Library District locations in Frederick or Erie. g. Language: English and Spanish. The Positive Solutions Group is also available in Somali, Swahili, Burmese and Rahinga. 3. Functional Family Therapy: Contractor will provide services in accordance with Function Family Therapy licensing agreements consultant directives. Services will include pre, post and intermittent assessments and trauma focused training. All services are overseen/supervised by a licensed professional and Functional Family Therapy National Consultant. a. Capacity for Services: i. Maximum: 40-45 youth ii. Length of Treatment: 2-6 months, 1-2 hours per week b. Goals of Service: i. Empower families with the skills and resources needed to independently address the difficulties they have raising their children. ii. Empower youth to cope with family, peer, school and neighborhood problems. iii. Build community and natural support systems. iv. Decrease negatively and blame among family members. v. Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues. c. Outcomes of Services: i. Youth will be living in the home ii. Youth will be in school or working iii. Youth will have no new arrest or legal involvement d. Target Population: i. Ten (10) to 17 years of ages, male or female 1. Child must be at risk of out -of -home placement or transitioning back from placement within 30 days 2. Child is displaying moderate to severe behavioral problems in the home/school/community 3. Child demonstrates verbal and/or physical aggression at home/school/community 4. Child is engaged with deviant peer group 5. Child is struggling with school behaviors to include failing grades, truancy anti- social behaviors 2 ii. Family has persistent conflict and negative child -parent relationship iii. Caregiver is abusing substances iv. Family has limited resources and would benefit from psychoeducation and parenting skill development e. Service Access: i. Family interventions, cognitive/behavioral, family therapy, school and community -based interventions, and substance abuse intervention in -person throughout Weld County, as clinically appropriate ii. Bi-lingual therapist, case management, school interventions, advocacy, court/staffing participation, sustainability planning, booster services after discharge may be provided via phone, video conferencing or in person as needed. f. Language: English. Video translation available. 4. Multisystemic Therapy: Contractor will provide services in accordance with Multisystemic Therapy licensing agreements consultant directives. Services will include pre, post and intermittent assessments and trauma focused training. All services are overseen/supervised by a licensed professional and Multisystemic Therapy National Consultant. a. Capacity for Services: i. Maximum: 50-70 youth ii. Length of Treatment: 2-5 months iii. Intensity of Service: 3-5 hours per week b. Goals of Service: i. Empower families with the skills and resources needed to independently address the difficulties they have managing their children. ii. Empower youth to cope with family, peer, school and neighborhood problems. iii. Build community and natural support systems. iv. Decrease anti -social behavior. c. Outcomes of Services: i. Youth will be living in the home ii. Youth will be in school or working iii. Youth will have no new arrests iv. Caregivers will have the parenting skills necessary to handle future problems v. Improved family relations vi. Improved family network of supports vii. Youth will have increased success in educational/vocational setting viii. Youth will be involved with prosocial peers and activities ix. Changes will be sustained d. Target Population: i. Twelve (12) to 17 years of ages, male or female 1. Child must be at risk of out -of -home placement or returning from placement 2. Child is involved in criminal behavior 3. Child is abusing substances 4. Behavior is chronic 5. Child engaged with deviant peers 6. Child is struggling in school 7. Child is displaying moderate to severe behavior problems ii. Family has persistent conflict and negative child -parent relationship iii. Caregiver is abusing substances 3 iv. Family has limited resources and would benefit from psychoeducation and parenting skill development e. Service Access: i. In -home caregiver interventions, cognitive/behavioral, family therapy, individual therapy, and school and community -based interventions, in -person throughout Weld County, as clinically appropriate ii. 24/7 on -call services, case management, school interventions, advocacy, court/staffing participation, and sustainability planning may be provided via phone, video conferencing or in person as needed. f. Language: English. Video translation available. 5. Diagnostic/Testing Services a. Capacity for Services: Four (4) to eight (8) hours per month. b. Goals of service: Provide medically necessary standards for determining children and adult cognitive and intellectual functioning, personality profiles that lead to recommendations for treatment. c. Outcomes of Service: i. Establish data points based on standardized testing and assessment tools that aid in the appropriate development of treatment planning for clients. d. Target Population: Age five (5) years and up who require extensive psychological testing to determine treatment needs. e. Service Access: i. In practitioner's office located at Island Grove Center, 1260 H Street, Greeley, CO 80631. ii. Video conferencing, and phone conferencing services are available. iii. In person only. f. Language: English. Video translation available. 6. 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. 7. 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). 8. 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). 9. 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 4 (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. 10. 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. 11. 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. 12. 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. 13. 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. 14. 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. 15. 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. 5 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 Foster Care/Adoption Services $8.30/Hour (Foster Care -Advanced Incredible Years Parent Group) $20.00/Hour (Foster Care -Dina School Group) $8.30/Hour (Foster Care -Incredible Babies Group) $8.32/Hour (Foster Care -Incredible Years Parent Group) $33.00/Hour (Foster Care -Parents as Teachers Group) $15.00/Hour (Foster Care -Positive Solutions Group) $6.88/Hour (Foster Care -The Growing Brain Group) $25.00/Hour (Foster Care -Whole Brain Child Group) $25.00/Hour (Foster Care -Conscientious Discipline Training) $25.00/Hour (Foster Care -Home Instruction for Parents of Preschool Youngsters) $25.00/Hour (Kinship -Conscientious Discipline Training) $8.30/Hour (Kindship-Advanced Incredible Years Parent Group) $20.00/Hour (Kinship -Dina School Group) $8.30/Hour (Kinship -Incredible Babies Group) $8.32/Hour (Kinship -Incredible Years Parents Group) $33.00/Hour (Kinship -Parents as Teachers Group) $15.00/Hour (Kinship -Positive Solutions Group) $6.88/Hour (Kinship -The Growing Brain Group) $25.00/Hour (Kinship -Whole Brain Child Group) Functional Family Therapy $700.00/Month (Functional Family Therapy) $1,200.00/Month (Child Welfare Functional Family Therapy) Diagnostic/Testing Services $250.00/Episode (MH Psych Testing Level 1) $800.00/Episode (MH Psych Testing Level 2) $1,200.00/Episode (MH Psych Testing Level 3) $1,800.00/Episode (MH Psych Testing Level 4) $2,500.00/Episode (MH Psych Testing Level 5) $120.00/Hour (MH Psych Testing Hourly Rate Partial Test) Multisystemic Therapy $1,800.00/Month (Multisystemic Therapy) 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 Farm New Contract Request Entity information Entity Name* Entity ID' NORTH RANGE BEHAVIORAL HEALTH @00008661 ❑ New Entity? Contract Name* Contract ID NORTH RANGE BEHAVIORAL HEALTH (AGREEMENT 3565 AMENDMENT) Contract Status CTB REVIEW Contract Lead* CULLINTA Contract Lead Email cullinta@co weld.co.us.cobbxxl k@co.weld.co.us Parent Contract ID Requires Board Approval YES Department Project # Contract Description " CONSENT. BID NO. B2000037. BOCC APPROVAL 04/1520. CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06/01/20 THROUGH 05/31/21. FUNDING. CORE/OTHER. Contract Description 2 Contract Type* AGREEMENT Amou nt * $0 00 Renewable* NO Automatic Renewal Grant ICA Department HUMAN SERVICES Department Email CM- Huma nServices@weldgov.com Department Head Email CM-HumsnServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@ V MELD GOV.COM Requested BOCC Agenda Date* 04' 15 2020 Due Date 04/11;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 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 Termination Notice Period Review Date* 04/01/2021 Renewal Date Committed Delivery Date Expiration Date* 0513112021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 05.+12 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 05/1312020 Tyler Ref # AG 060120 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 05/13/2020 Submit Contract xiD # 30(371 PRIVILEGED AND CONFIDENTIAL /z - 9- /9 MEMORANDUM DATE: November 20, 2019 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Agreement Amendment with North Range Behavioral Health 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 North Range Behavioral Health. The Department entered into an agreement with North Range Behavioral Health, with a term of June 1, 2019 through May 31, 2020, for Foster Care/Adoption Services, Functional Family Therapy, Monitored Sobriety Services and Multisystemic Therapy. This agreement is identified as 2019-2021, approved on May 29, 2019. The provider is now offering a specialized Child Welfare -Functional Family Therapy (CW-FFT) and the Department would like to add this service as an option under the existing agreement. The associated rate is $1,200.00 per month. I do not recommend a Work Session. I recommend approval of this Amendment. Sean P. Conway Mike Freeman, Pro-Tem Scott James Barbara Kirkmeyer, Chair Steve Moreno Approve Recommendation Work Session Schedule Other/Comments: Pass -Around Memorandum; November 20, 2019 — CMS 3061 Page 1 C)7( 66"19 0-460 €Z0/9.-' 0Z04,/ /� -�% /‘ i'&po 9e' AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement Amendment made and entered into 914 day of 019 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 North Range Behavioral Health hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Foster Care/Adoption Services, Functional Family Therapy, Monitored Sobriety Services and Multisystemic Therapy ("Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2021, approved on May 29, 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. 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 above written. ATTEST: ddrA44) JC40 K• Weld C.0 ty Cler the B•ar By: Deputy Cler / o the : • and COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLA RADO c Barbara Kirkmeyer, hair D 0 9 2019 CONTRACTOR: North Range Behavioral Health 1300 North 17th Avenue Greeley, Colorado 80631 (970) 347--2n1'2/,0/�� 1 tOfLarry Po orff (Sep 10, 201 ) By: Date: Larry Pottorff, Executive Director Sep 10, 2019 olo/ 9-024,021 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Foster Care/Adoption Services, Functional Family Therapy, Mental Health Services, Monitored Sobriety Services and Multisystemic Therapy, as referred by the Department. 2. Foster Care/Adoption Services: Contractor will provide a variety of groups to support foster and kinship parents to be better equipped to facilitate positive relationships with the children in their care. These groups will be trauma -informed, strengths -focused and evidence -based for families with children birth to eight (8) years of age. a. Groups available under this agreement include: i. Incredible Years Parent Groups ii. Incredible Babies iii. Incredible Toddlers iv. Positive Solutions Groups v. The Whole Brain Child Training vi. The Growing Brain (0-5) Training vii. Dina School (for children while adult caregivers are in session) viii. Parents as Teachers b. Capacity for Services: i. Incredible Years Parent Groups — 2 hours/week = 14 weeks 1. Dina School (2 hours — 14 weeks) ii. Incredible Years Parent Groups — Extended — 2 hours/week = 6 to 8 weeks 1. Dina School (2 hours — 8 weeks) iii. Incredible Babies (4-12 months) — 1-1/2 hours = 8 sessions 1. This is an adult -child in vivo group iv. Incredible Toddlers (13 -24 months) — 1-1/2 hours = 12 sessions 1. This is an adult -child in vivo group v. Positive Solutions Groups — 1 hour/week = 6 weeks 1. PSG Child Groups (1 hour/week = 6 weeks) vi. The Whole Brain Child Training — 1 hour/week= 4 weeks 1. Social -Emotional Skills Group (1 hour = 4 weeks) vii. The Growing Brain (0-5) Training — 2 hours/week = 8 weeks 1. Dina School (2 hours — 8 weeks) viii. Parents as Teachers — 1 hour/every other week = 1 year in home c. Goals of Service: i. Foster parents will have skills, strategies and abilities to promote positive relationships and address the trauma and challenging behaviors that are present with children in their care under the age of eight (8) years. ii. Adult caregivers will promote social and emotional development. iii. Adult groups will be based on Cognitive Behavioral Theories and incorporate effective adult learning strategies to strengthen relationships and give a deeper understanding of trauma and early brain development iv. Child groups are abased experiential and behavioral learning appropriate for young children and focus on increasing regulation and problem -solving skills while building a sense of trust and safety for children that may have experienced ruptures and trauma. d. Outcomes of Service: i. Foster parents will feel more capable of supporting the needs of the young children in their care that have experienced loss, trauma or ruptures in their early years. 1 g• ii. Adult caregivers will have specific strategies that assist them in having consistent, predictable and nurturing interaction that promotes response relationships and attachment in the adult/child relationship. iii. Children will be assessed in group and supported to the appropriate level of care that their presenting needs require. e. Target Population: i. Foster parents of infants, toddlers and preschool age children, ages birth to six (6) years of age. ii. Dina School and The Whole Brain Child can serve children up to age eight (8). f. Service Access: i. Littler Prevention Campus, 2350 West 3`d Street Road, Greeley, CO. ii. South County services will vary based on need and numbers to impact. Groups will occur at the Contractor's office or High Plains Library District locations in Frederick or Erie. Language: English and Spanish. The Positive Solutions Group is also available in Somali, Swahili, Burmese and Rahinga. 3. Functional Family Therapy: Contractor will provide services in accordance with Function Family Therapy licensing agreements consultant directives. Services will include pre, post and intermittent assessments and trauma focused training. All services are overseen/supervised by a licensed professional and Functional Family Therapy National Consultant. a. Capacity for Services: i. Maximum: 40-45 youth ii. Length of Treatment: 2-6 months, 1-2 hours per week b. Goals of Service: i. Empower families with the skills and resources needed to independently address the difficulties they have raising their children. ii. Empower youth to cope with family, peer, school and neighborhood problems. iii. Build community and natural support systems. iv. Decrease negatively and blame among family members. v. Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues. c. Outcomes of Services: i. Youth will be living in the home ii. Youth will be in school or working iii. Youth will have no new arrest or legal involvement d. Target Population: i. Ten (10) to 17 years of ages, male or female 1. Child must be at risk of out -of -home placement or transitioning back from placement within 30 days 2. Child is displaying moderate to severe behavioral problems in the home/school/community 3. Child demonstrates verbal and/or physical aggression at home/school/community 4. Child is engaged with deviant peer group 5. Child is struggling with school behaviors to include failing grades, truancy anti- social behaviors ii. Family has persistent conflict and negative child -parent relationship iii. Caregiver is abusing substances iv. Family has limited resources and would benefit from psychoeducation and parenting skill development e. Service Access: 2 i. Family interventions, cognitive/behavioral, family therapy, school and community -based interventions, and substance abuse intervention in -person throughout Weld County, as clinically appropriate ii. Bi-lingual therapist, case management, school interventions, advocacy, court/staffing participation, sustainability planning, booster services after discharge may be provided via phone, video conferencing or in person as needed. I Language: English. Video translation available. 4. Functional Family Therapy — Child Welfare: Contractor will provide services in accordance with the evidence -based practice of Functional Family Therapy -Child Welfare. a. Capacity for Services: i. Very intensive services in the beginning, tapering off as family gains skills and confidence. ii. Average of one (1) to three (3) hours per week. b. Goals of Service: Services are divided into four phases, each with a different goal. Contractor will offer booster sessions when needed to support the family. i. Engagement: Engage family quickly in services. ii. Motivation: Reduce negativity and blame, increase hope, build a relational focus, balance alliances and create a motivational context for change for each family member. iii. Behavior Change: Eliminate the referral behaviors and increase protective factors and decrease risk factors. iv. Generalization: Ensure families are linked to the appropriate services to continue to manage risk factors, develop specific and individualized relapse plans and ensure families can use the skills learned in new areas. c. Outcomes of Services: i. Retain children and youth in their existing homes or placements. ii. Prevent future abuse and/or neglect. iii. Reduce individual, family and community risk factors to increase family members' ability to function effectively in their lives. d. Target Population: i. Birth to 18 years of ages who are involved in the Child Welfare system or at risk of being involved in the Child Welfare system. e. Service Access: i. Office: 928 12th Street, Greeley, Colorado or 145 151 Street, Fort Lupton, Colorado ii. In the home or community throughout Weld County f. Language: English. Interpretation services available. 5. Multisystemic Therapy: Contractor will provide services in accordance with Multisystemic Therapy licensing agreements consultant directives. Services will include pre, post and intermittent assessments and trauma focused training. All services are overseen/supervised by a licensed professional and Multisystemic Therapy National Consultant. a. Capacity for Services: i. Maximum: 50-70 youth ii. Length of Treatment: 2-5 months iii. Intensity of Service: 3-5 hours per week b. Goals of Service: i. Empower families with the skills and resources needed to independently address the difficulties they have managing their children. ii. Empower youth to cope with family, peer, school and neighborhood problems. iii. Build community and natural support systems. iv. Decrease anti -social behavior. c. Outcomes of Services: 3 i. Youth will be living in the home ii. Youth will be in school or working iii. Youth will have no new arrests iv. Caregivers will have the parenting skills necessary to handle future problems v. Improved family relations vi. Improved family network of supports vii. Youth will have increased success in educational/vocational setting viii. Youth will be involved with prosocial peers and activities ix. Changes will be sustained d. Target Population: i. Twelve (12) to 17 years of ages, male or female 1. Child must be at risk of out -of -home placement or returning from placement 2. Child is involved in criminal behavior 3. Child is abusing substances 4. Behavior is chronic 5. Child engaged with deviant peers 6. Child is struggling in school 7. Child is displaying moderate to severe behavior problems ii. Family has persistent conflict and negative child -parent relationship iii. Caregiver is abusing substances iv. Family has limited resources and would benefit from psychoeducation and parenting skill development e. Service Access: i. In -home caregiver interventions, cognitive/behavioral, family therapy, individual therapy, and school and community -based interventions, in -person throughout Weld County, as clinically appropriate ii. 24/7 on -call services, case management, school interventions, advocacy, court/staffing participation, and sustainability planning may be provided via phone, video conferencing or in person as needed. f. Language: English. Video translation available. 6. Monitored Sobriety Services: Various urinalysis, breathalyzer, oral swab, patch, and hair testing. a. Capacity for Services: 24/7 access b. Goals of service: Contractor will provide observed monitored sobriety testing and communicate results in a timely fashion c. Outcomes of Service: i. Confirmation of all positive and negative monitored sobriety results for a Breathalyzer within in 24 hours through a phone call, test results, email, and/or fax to the referring caseworker. ii. Confirmation of all positive and negative monitored sobriety results for Urinalysis once lab processing has been completed, typically within five (5) business days. iii. Instant Urinalysis results will be reported within 24 hours. If the result is positive, the results will be to the lab for final confirmation. d. Target Population: Any individual the Department identifies as needing monitored sobriety services. e. Service Access: i. Crisis Stabilization Services, 1140 M Street, Greeley, CO. ii. 24 hours a day/seven (7) day per week. iii. In person only. iv. Contractor will contact DHS to confirm referral of the client for monitoring services. f. Language: English. Video translation available. 4 7. Contractor will respond to the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 8. 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 (hainlejdAweldgov.com, 970-400-6210). 9. 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 (hainlejd(a,,weldgov.com, 970-400-6210). 10. 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 (hainlejd(aweldgov.com) immediately via email, to discuss service continuation. 11. 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. 12. 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. 13. 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. 14. 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. 15. 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. 16. Contractor will notify the Quality Assurance Team Supervisor (hainlejd(aweldgov.com, 970-400-6210) of new staff who will manage and/or administer the services with the following information: 5 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. 6 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 Foster Care/Adoption Services $8.30/Hour (Foster Care -Advanced Incredible Years Parent Group) $20.00/Hour (Foster Care -Dina School Group) $8.30/Hour (Foster Care -Incredible Babies Group) $8.32/Hour (Foster Care -Incredible Years Parent Group) $33.00/Hour (Foster Care -Parents as Teachers Group) $15.00/Hour (Foster Care -Positive Solutions Group) $6.88/Hour (Foster Care -The Growing Brain Group) $25.00/Hour (Foster Care -Whole Brain Child Group) $8.30/Hour (Kindship-Advanced Incredible Years Parent Group) $20.00/Hour (Kinship -Dina School Group) $8.30/Hour (Kinship -Incredible Babies Group) $8.32/Hour (Kinship -Incredible Years Parents Group) $33.00/Hour (Kinship -Parents as Teachers Group) $15.00/Hour (Kinship -Positive Solutions Group) $6.88/Hour (Kinship -The Growing Brain Group) $25.00/Hour (Kinship -Whole Brain Child Group) Functional Family Therapy/Functional Family Therapy -Child Welfare $700.00/Month (Functional Family Therapy) $1,200.00/Month (Functional Family Therapy -Child Welfare) Monitored Sobriety Services $20.00/Test (5 -Panel Urinalysis) $20.00/Test (7 -Panel Urinalysis) $5.00/Test (Breathalyzer) $35.00/Drug (Confirmation of Positive Result per substance confirmed/retested) $35.00/Test (Ethyl Glucuronide/EtG Test) $100.00/Test (Hair Testing) $20.00/Test (Instant Swab) $20.00/Test (Multi -Panel Instant UA) $20.00/Test (Oral Swab -6 Panel) $35.00/Test (Oral Swab -Synthetic Cannabinoids "Spice") $2.00/Test (Oxycodone or Buprenorphine Add-on Test to 5 or 7 Panel) $65.00/Test (Patch Monitoring) $2.00/Test (Single Panel EtG Add-on Test, added to 5 or 7 Panel UA) $35.00/Test (UA-Synthetic Cannabinoids "Spice") Multisystemic Therapy $1,800.00/Month (Multisystemic Therapy) 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* NORTH GE BEHAVIORAL HEALTH @00008661 Entity ID* Contract Name* NORTH RANGE BEHAVIORAL HEALTH (AGREEMENT AMENDMENT) Contract Status CTB REVIEW tract Description* AMENDMENT TO ADD FFT-C'u"J. Contract Description 2 Contract Type * AGREEMENT Amount* $x}.00 Renewable NO Automatic Renewal Gant IGA If this is a ren Department HUMAN SERVICES De pa nt Email CM- HumanServices@weidgov corn Department Head Email Chat-HumanServices- DeptHeadPweldgov. corn Coum[y Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email C hrt- COUNTYA l I ORNEY@WELD GOO COM nter previous Contract ID If this is part of a PuiSA enter MSA Contract ID ❑ New Entity? Contract ID 3061 Contract Lead* CULLINTA Contract Lean Email r_ullinta(dtco.voeld co.us Requested BOCC Agenda Date' 08/07/2019 Parent Contract ID 20192021 Requires Board Approv, YES Department Project # Due Date O01012019 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effie "ve Date Termination Notice Period Review Date* 04/01/2020 Committed Delive Renewal [late Date Expiration Date 05'31;2020 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JUDY GR.IEGO DH Approved Date 11/1312019 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 11/25/2019 Originator CULLINTA Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Fnance Approved Date 11'13/2019 Tyler Ref # AG 112519 Legal Counsel KARIN MCDOUGAL Legal Counsel Approved Date 11'19+2019 Submit epti:ieet- °.024. CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH Agreement, made and entered into t p'� This Ag hg� / day of / 2019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department Human Services, hereinafter referred to as the "Department' and North Range Behavioral Health, hereinafter refe red 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 Foster Care/Adoption Services, Functional Family Therapy, Monitored Sobriety Services, and Multisystemic Therapy. 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 Response to Request for 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 (hainleid@weldgov.com, 970-400-6210). No other Department staff or other party to the case may authorize services or modifications to services. olg-/9 626464-e, 045-0 2019-2021 �o9v c. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7a' of the month, following the month of service, utilizing billing forms required by the Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the.exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in termination of the Agreement. d. Contractor agrees to submit a monthly report by the 7a' 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; 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 3 - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 CF.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 govem 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. 4 e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant 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 6 or equivalent, covering premises operations, fire damage, independent Contractors, . products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $50,000 any one fire; and $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of, this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; A provision that coverage is primary; and - A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a daims-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 Larry Pottorff, Executive Director 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below: Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley. CO 80632 (970) 400-6510 9 For Contractor: Larry Pottorff, Executive Director 1300 North 17th Avenue Greeley, CO 80631 (970) 347=2120 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 (S) 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 leaming 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 dient 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 withlunds under this Agreement, to ensure compliance with the terms of this Agreement. Contractingparties 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 govemment 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. ATTEST: t ..fdd.o;,,k, BOARD OF COUNTY COMMISSIONERS Weld ty Clerk to the Board WELD COUNTY, COLORADO By: Deputy Clerk tot S Bo. /�` ''� �� : rbara Kirkmeyer, Ch ONTRACTOR: MAY 2 2019 North Range Behavioral Health 1300 North 17th Avenue Greeley, CO 80631 (970) 347-2120 By: Date: 15 Retvt, Larry Po off (May 7, 2019 Larry Pottorff, Executive Director May 7, 2019 020!9 -ova-/ 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. flit NORTHORANGE BEHA To Whom it May Concern, EXHIBIT B CONTRACTOR'S RESPONSE TO REQUEST FOR PROPOSAL Attached you will find a proposal from the Family Connects Early Childhood and Family Services team of North Range Behavioral Health. This team provides prevention, education and therapeutic services to families and caregivers throughout Weld County. The evidence -based services provided are traumainformed and focused on two -generation work with families who have younger children (prenatal to 8 years). The team has worked collaboratively with Weld County. Department of Human Services on a variety of projects and efforts for a number of years. The therapists and educators with the team all have experience, education and skills that work to address children that have challenging behaviors, trauma or other emotional based issues that put them at risk for ruptures in relationships with caregivers, child care and teachers. Currently, Family Connects NRBH has a contract with WCDHS to provide Early Childhood Mental Health Consultation to child care providers with an emphasis. of Friend, Family and Neighbor (FFN) home settings. The therapists work to reduce the expulsions and suspensions of children in these child care settings. This proposed. CORE bid will focus on kinship and foster parents of younger children with an intent to increase knowledge, skills and abilities to promote social and emotional competence, provide nurturing and responsive relationships and be able tobecome a secure and safe adult for children that have experienced trauma. In addition to impacting kinship and foster families these services can be accessed by families that may benefit from increased knowledge, skills and consistency in providing developmentally appropriate, nurturing care and consistent boundaries that help young children thrive and comply. All of the proposed activities are research informed or evidence -based and have the capacity to help address the adverse childhood experiences many of the children in kinship and foster care. The goal of the Family Connects team is to mitigate the challenging situation that young children have experienced and work during the critical early brain growth time frame to heal and repair ruptures and build new skills for both children and adults that will help children grow and thrive in relationships as they age. Often children that have early trauma need specialized supports through the adults that care for them. However, children with challenging behaviors can be taxing for kinship and foster families to help maintain calm, predictable and nurturing environments and experiences. anis Pottorff LCSW, IMH-E® III Program Director of Family Connects 1300 North 17th Avenue • Greeley, CO 80631 970.347.2120 • WWWAortiillangeorg• EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services North Range Behavioral Health AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) Larry Pottorff PRIMARY CONTACT- FULL NAME j 970 )347-2120 PHONE NUMBER Jerry. pottorffanorth ra nae.ora PRIMARY CONTACT— E-MAIL ADDRESS 1300 N 17th Ave AGENCY MAIUNG ADDRESS Executive Director PRIMARY CONTACT - TITLE EM. FAX NUMBER Greeley CITY northranRe.ora AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) 80631 ZIP REFERRAL CONTACT REFFERAL CONTACT — FULLNAME REFERRAL CONTACT— PHONE NUMBER REFERRAL CONTACT - TITLE REFERRAL CONTACT — E-MAIL ADDRESS BILUNG CONTACT Cherihin Barriniter - BILLINGCONTACT— FULL NAME BILUNGCONTAC-,-PHONE.NUMBER Chief Financial Officer BILLING CONTACT - TITLE cherilyn.6a rri nRerganorth ranee. ora • BILLING CONTACT= E-MAIL ADDRESS., I certify that the services' proposed for intended use by the- Weld County Department of Humari Services=will meet all the specifications it has so: indicated in this:bid-form. l further affirm intenfion.to enter Tnte an agreement with Werd County; oiL'behalf ofthe .Weld County.,Depainnent of Human Services, and comply with all-requirementa of the contract; ifawarded..; 'the Board ,C)f Weld County Comnlissioners.reserve.the right.to reject any or all bids; to waive any informality in the. • bids,;(and to: accept the Sid;: 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:.pie Board -of Weld County Commissioners shallg ve.preference to:. resident Weld County bidders inn all cases where the bids any competitive in price arid.lity.. • Signature of'Authofiied Representative: Date: of Signature; Bid No::$19;00025 ACoRE) CERTIFICATE OF LIABILITY INSURANCE -- MI DATE(MDDIrrrn 6/28/2018 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Professional Risk LLC 8213 W.20th St Greeley CO 80634 "WI ACT Jennifer Hunter NAME: PHONE Exu: (970)356-8030 11r i.). (970)356-8032 Awns,: jennifer.hunter@proriskllc.coM INSURER(S) AFFORDING COVERAGE NAIC 0 mummeA:Philadelphia Insurance Co 18058 INSURED North Range Behavioral Health 1300 N 17th Avenue Greeley CO 80631 INSURER B: Pinnacol Assurance mummer:Lloyds of London INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 All (30) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY �� POLICY EFF (110900lYYYY) POLICY EXP (MWDDIYYYYI LIMITS A A X COMMERCIAL GENERAL LIABILITY X - Y - PBp¢1839283 PBSD1358O91 7/1/2018 7/1/2018 7/1/2019 7/1/2019 EACH OCCURRENCE S 1,000,000 TO RENTED $ 1,000,000 I CLAIMS -MADE X OCCUR PDAMAGE S Rte) ma, Exp(Anyonepp,,,,,) $ 20,000 X Professional Liability PERSONAL d ADV INJURY $ 1,000,000 X HIPAA - GENERAL AGGREGATE S - 3,000,000 GENL 7 AGGREGATE UAW APPLIES PER: POLICY ERCTT R LOC OTHER: PRODUCTS-COMP/OP AGG $ 3,000,000 HIPAA Limit S, 50,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED '--- �- SCHEDULED AUTOS NON -OWNED AUTOS PaPB1839283 - 7/1/2018 - 7/1/2019 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S Ma rral paymnts - S 5,000 A X UMBRELLAWUAB EXCESSLB H OCCUR CLAIMS -MADE PIOB634797 7/1/2018 7/1/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE S 2,000,000 S DED I X I RETENTION S 10,000 B - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y IN ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? ❑ (Mandatary In NH) I yes. desaae under DESCRIPTION OF OPERATIONS below NI A y 4044331 7/1/2018 7/1/2019 OTH- X I STATUTE I I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -FA EMPLOYEE S 1,000,000 E.L DISEASE - POLICY. LIMIT $ 1,000,000 C Privacy BSH02610560 7/1/2010 7/1/2019 Aayps(pte 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Admtlonnal Remarks Scbedub. may be attadud U more space lsrmWrm ) 30 day notice of cancellation; 10 day notice for non -pay applies. Weld County Department of Human Services Child Welfare Division is listed as additional insured as pertains to the General Liability policy; per written contract. This coverage is primary and non-contributory. Waiver of subrogation applies on the General Liability and Workers' Compensation policies. . CERTIFICATE HOLDER CANCELLATION Weld County Department of Human Services Child Welfare Division Attn: Tobi Vegter PO Box A Greeley, CO 80632 I SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE Dionne Perez/DP ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks" of ACORD 9744N0RTHORANGE BFRA January 28, 2019 Tobi Cullins Child Welfare Contract and Services Coordinator Weld County Department of Human Services Division of Child Welfare Financial Unit 822 7"' Street, Suite 150 Greeley, CO 80631 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Functional Family Therapy services program area. We propose to provide these services to male and female youth ages 11-17 at North Ranges youth and family site, 92812"' Street, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. In addition, three FFT staff are bilingual with professional proficiency, and agree to proficiency testing. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Jennifer Wallace Program Director — Intensive Youth and Family Services 92812"' Street Greeley, CO 80631 970-397-5331 Jennifer.wallace@northrange.org Enclosures 1300 North 17th Avenue Greeley; CO 80631 • 970-347-212O • w,w;w_NnrthRa tge:org: EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: North Range Behavioral Health Functional Family Therapy. 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Special Assessments/Practices: Use of FFT approved assessments as indicated by licensing agreements and FFT consultant directives including pre, post, and intermittent assessments (provided upon request). Trauma Focused Training: Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)-February 2014 Trauma -Focused Cognitive Behavioral Therapy (TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents (DBT)-March 2014 The Impact of Trauma on the Developing Child; Dr. Perry -April 2017 All services are overseen/supervised by a licensed professional and FFT National Consultant 4. Capacity to Provide Services (ex. 4 hours/week). Maximum Program Capacity: 40 - 45 youth Length of Treatment: 2 — 6 months, 1- 2 hours per week 5. Goals of the service. Goals: Empower families with the skills and resources needed to independently address the difficulties they have raising their children; Empower youth to cope with family, peer, school, and neighborhood problems; Build community and natural support systems; Decrease negativity and blame among family members; Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues. 6. Outcomes of service. FFT Outcomes in Weld County Impact to the County Prior to Treatment • All youth receiving FFT services had at least one risk factor of: At risk of out of home placement, returning from out of home placement, legal involvement, and/or school problems prior to admission FFT in Weld County (1/1/18-1/1/19) Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE Outcomes after completing FFT Treatment (N=49 cases completed) • 100% of youth living in the home • 99% in school or working • 99% with no new arrest or legal involvement FFT in Weld County (1/1/2009 —1/1/2019) Outcomes after completing FFT Treatment (N=639) • 87% of youth living in the home (3% not living in home; 10°x6 unknown) • 88% in school or working (3% not in school or working; 9% unknown) • 79% with no new arrest or legal involvement (11% with new charges, 10% unknown) 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Age Range: . Gender Criteria: Inclusionary Criteria: -10 —17 years Both Male and Female clients served Child must be at risk of out of home placement or transitioning back from placement within 30 days; Child is displaying moderate to severe behavioral problems in the home/school/community; Child is involved in criminal behaviors to include substance abuse; Child demonstrates verbal and/or physical aggression at home/school/community; Child is engaged with deviant peer group; Child is struggling with school behaviors to include failing grades, truancy and anti -social behaviors; Family has persist conflict and negative child -parent relationship; Caregiver is abusing substances; Family has limited resources and would benefit from psychoeducation and parenting skill development. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. Primary Intervention Type: Special Services: As clinically appropriate: Family Interventions, Cognitive/Behavioral, Family Therapy, School and Community based interventions, and substance abuse intervention in person throughout Weld county. Bi-lingual therapist; Case Management, School Interventions, Advocacy, Court/Staffing Participation; Sustainability Planning; Booster services after discharge may be provided via phone, video conferencing or in person as needed. 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE English is primary language spoken for members of the team. Video translation services are available at any time through a service North Range utilizes called In Demand. 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. Monthly Cost: $700.00 per month/per family, pro -rated for partial month Medicaid Eligibility: FFT is a Medicaid covered service at North Range Behavioral Health Bid No.: 1900025 STAFF DATA SHEET (Bidder must list an appikabla staff who win manage and/or administer the proposed service- One Staff Data Shoat per pmpowed sondes. Bidder should not combine services-( PROPOSED SERVICE OR SERVICE TYPE: FT BIDDER LEGAL ENTITY NAME: orth Range Behavioral Health ' APPUCABIE STAFF MEMBER OR CONTRACTOR INFORPAATION ,- '.. . _ SUPERVISOR INFORMATION - ► o.: - - last Name .' � First Name. ' �• . _' - Worbit .. •. Work Email .. Edra:ation Laval -- „ - Degiea Focus. Lioassae/ Crude:HMIs DORA tl .. (If appnadda( Last Name First Name .. Wok 8 Wok Email - 1 Santy Samantha 970-347-2120 Samantha .santy Masters behavioral health LPC Wallace Jenny 970347-2406 jennifer.wallace @northrange.org @northrange.org 2 Steele Ani 970-347-2120 ani.steele@north Masters behavioral health LPC Wallace Jenny 970347-2406 jennifw allace ranse.org @northrange.org 3 Crookston Bradley 970-347-2120 bradlev.crooksto Masters behavioral health LPC Wallace Jenny 970347-2406 iennifer.wallace NOnorthranRe.or g (Onorthranee.org 5 6 7 8 9 10 11 12 13 14 15 16 17 la 19 20 21 22 23 24 EXHIBIT D Bid No.: 81900025 STAFF DATA SHEET MINT (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Raft Data Sheet par proposed service. Bidder should not combine services.) 25 26 27 28 Bid No.: 81900025 6,NORTH RANGE BEHAVIORAL HEALTH January 28, 2019 Tobi Cullins Child Welfare Contract and Services Coordinator Weld County Department of Human Services Division of Child Welfare Resource Unit 822 7th Street, Suite 150 Greeley, CO 80631 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Substance Use Disorder Monitoring service program area. We propose to provide these services to male and females at North Range's Crisis Stabilization site, 1140 M St., Greeley. All services will be provided by academically qualified and thoroughly trained staff as evidenced by the attached resumes and certification information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Gail White, LPC, LAC Program Director — Crisis Stabilization Services 970-313-1117 Gail.White@northrange.org. Enclosures Where hope begins. 1300 North 17th Avenue • Greeley; CO 80631 • 970-347-212O • www.NnrthRange:org EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Various urinalysis, breathalyzer, oral swab, patch, and hair testing. 4. Capacity to Provide Services (ex. 4 hours/week). 24/7 access S. Goals of the service. North Range Behavioral Health Monitored Sobriety NRBH staff will provide,observed monitored sobriety testing and communicate results in a timely fashion. 6. Outcomes of service. Contractor will confirm all positive and negative monitored sobriety results for a BA within 24 hours through a phone call, test result, e-mail, and/or fax to the referring caseworker. Contractor will confirm all positive and negative monitored sobriety results for lab UA's once processing has been completed through Redwood, typically within 5 business days. Instant UA results will be reported within 24 hours. If the result is positive, the result will be sent to Redwood for final confirmation. 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Any individual WCDHS determines is in need of monitored sobriety services. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. Services will be provided at the North Range Behavioral Health - Crisis Stabilization Services facility at 1140 M Street in Greeley, Colorado. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven days a week in person only. Contractor will accept referrals via email, phone, Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE fax, or by verbal report from dient. Upon arrival, contractor will contact DHS staff to confirm the referral of the client for monitoring services. 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. English is primary language spoken for members of the team. Video translation services are available at any time through a service North Range utilizes called In Demand. 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. $20.00/Episode (Urinalysis Test — 5 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates) $20.00/Episode (Urinalysis Test — 7 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates, Barbiturates, Alcohol) $20/Episode (Oral Swab — 6 Panel: THS, Cocaine, Amphetamines, Methamphetamines, Benzodiazepines, Opiates) $20.00/Episode (Multi -panel Instant UA) $20.00/Episode (Instant Swab) $35.00/Episode (GCMS — Confirmation of Positive Result per substance confirmed/retested) $5.00/Episode (Breathalyzer) $100.00/Episode (Hair Testing) $65.00/Episode (Patch Monitoring) $35.00/Episode (Ethyl Glucuronide/EtG Test) $35.00/Episode (UA — Synthetic Cannabinoids — "Spice's $35.00/Episode (Oral Swab — Synthetic Cannabinoids — "Spice") $2.00/Episode (UA - Single Panel EtG Add-on Test — Only When Added to a 5 or 7 Panel UA) $2.00/Episode (UA - Optional Add-on Panel (Oxycodone or Buprenorphine) — Only When Added to a 5 or 7 Panel UA) Monitoring services are at times eligible for Medicaid funding. Contractor is a Medicaid approved provider. Upon referral, contractor will contact the identified case worker to determine funding. When eligible, contractor will utilize Medicaid resources. Bid No.: 1900025 STAFF DATA SHEET MIBTTD Bidder must list all applicable staff who wiU manage and/or adminrstar the proposed service. One Raft Data Shoat per proposed service. Bidder should not comber sandals.) PROPOSED SERVICE OR SERVICE TYPE: jMonitored Sobriety IDDER LEGAL ENTITY NAME: North Range Behavioral Health ,.. - APPUCABIE STAFF MEMBER -OR CONTRACTOR INFORMATION - ' a SUPERVISOR INFORMATION IYo: Iast Name ' �; FasttName,.- WerkB .' Work. Email .' • Largay -' " Degree Foan- Credentials. (If applicidde) : last Name' . Fast Name Work 0 Work Email . ,* 1 White Gal 970-313-1117 gail.white@north Masters behavioral health IPC, LAC Collins burr 970-347-1303 klmberly.colllnsO range.org northrange.org 2 Watson Rachel 970-347-2120 rachel.watsonPn Bachelor's behavioral health CACIII White Gal 970-313-1117 Rail.white@north orthrange.org range.org 3 McKenna Belinda 970-347-2120 bellnda.mckenna Masters behavioral health LPC White Gal 970-313-1117 gail.white@north @northrange.org range.org 4 LeRoy Brittney 970-347-2120 brittney.lerov@n baMeloes behavioral health White Gail 970313-1117 gail.white@north orthrange.org range.org 5 Middlebrook Mackenzie 970347-2120 mackenzie.mlddl bachelor's behavioral health White Gal 970-313-1117 Rail.white@north ebrook@northra nge.org range.org UacheLaustin@no behavioral Rail.whitePnorth 6 Austin Rachel 970-347-2120 rthrange.org bachelor's health White Gal 970-313-1117 range.org 7 8 9 10 11 12 13 14 15 16 17 18 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT O (Bidder must list all applicable staff who will manage and/or administer the proposed servke. One Staff Data Shoat per proposed service Bidder should not cwnb6re services.) 19 20 21 22 23 24 25 26 27 28 Bid No.: 81900025 ifbNORTHORANGE BEHA January 28, 2019 Tobi Cullins Child Welfare Contract and Services Coordinator Weld County Department of Human Services Division of Child Welfare Resource Unit 822 7"' Street, Suite 150 Greeley, CO 80631 Dear Tobi: Attached is North Range Behavioral Health's Core and Contracted Services Bid proposal for the Multi -Systemic Therapy services program area. We propose to provide these services to male and female youth ages 12-17 at North Range's youth and family site, 1300 N. 17"' Avenue, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Rebecca Wyperd, LPC Program Director —Outpatient Youth and Family Services 1300 North 17"' Avenue Greeley, CO. 80631 970-381-3578 rebecca.wyperd@northrange.org Enclosures 1300 North 17th Avenue • Greeley, CO80631 • 970-347-2120 • wwW.NnrthRan9e org. EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: North Range Behavioral Health Multisystemic Therapy 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Special Assessments/Practices: Use of MST approved assessments as indicated by licensing agreements and MST consultant directives (provided upon request). Trauma Focused. Training: Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)-February 2014 Trauma -Focused Cognitive Behavioral Therapy (TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents (DBT)-March 2014 Multisystemic Therapy Contingency Management (MST -CM) -August 2016 Neurosequential Model of Therapeutics (NMT)-September 2016 -February 2017 The Impact of Trauma on the Developing Child; Dr. Perry -April 2017 All services are overseen/supervised by a licensed professional and MST National Consultant. 4. Capacity to Provide Services (ex. 4 hours/week). Maximum Program Capacity: Length of Treatment: Intensity of service: 5. Goals of the service. Goals: 6. Outcomes of service. 50 - 70 youth 2 — 5 months 3 — 5 hours per week Empower caregivers with the skills and resources needed to independently address the difficulties they are having managing their children; Empower youth to cope with family, peer, school, and neighborhood problems; Build community and natural support systems; Decrease anti -social behavior. NRBH MST Program Implementation Data Report (Report Period: 1/1/2018 -12/31/2018) Ultimate Outcomes after receiving MST Treatment (N=45) • 86.67% of youth living at home • 97.78% of youth in school/working • 93.33% of youth with no new arrests Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE Instrumental Outcomes after receiving MST Treatment (N=45) • 95.56% of caregivers with parenting skills necessary to handle future problems • 95.56% of families with improved family relations • 97.78% of families with improved network of supports • 84.44% of youth with success in educational/vocational setting • 86.67% of youth involved with prosocial peers/activities • 77.78% of cases where changes have been sustained The North Range Behavioral Health MST Team was a finalist for the MST International Team of the Year in 2015, and received the designation of The Green Team in March of 2017 for exceeding all fidelity outcome measures. 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Age Range: Gender Criteria: Inclusionary Criteria: —12 —17 years Both Male and Female clients served Child must be at risk of out of home placement; Child returning from placement; Child involved in criminal behavior; Persistent family conflict; Child and or Caregiver is abusing substances; Behavior is chronic; Child is engaged with deviant peers; Child is struggling at school; Family has few resources; Parents would benefit from psycho -education and skill development; Child is displaying moderate — severe behavior problems. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. Primary Intervention Type: Special Services: As clinically appropriate: In -home Caregiver Interventions, Cognitive/Behavioral, Family Therapy, Individual therapy, School and Community based interventions provided in person throughout Weld County. 24/7 on -call services, Case Management, School Interventions, Advocacy, Court/Staffing Participation, Sustainability Planning may be provided in person, via phone or video conferencing as needed. 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE English is primary language spoken for members of the team. Video translation services are available at any time through a service North Range utilizes called In Demand. 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. Monthly Cost: $1800.00 per month/per family, pro -rated for partial month Medicaid Eligibility: MST is a Medicaid covered service at North Range Behavioral Health Bid No.: 1900025 STAFF DATA SHEET EXHIBIT 0 Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sleet per proposed service. Bidder shotdd not combine services.) ROPOSED SERVICE OR SERVICE TYPE: IDDER LEGAL ENTITY NAME: orth Range Behavioral Health . APPIICABLF5TAFF MEMBER OR CONTRACTOR IPffORMATION -'� .. • SUPERVISOR INFORMATION -_ No: - . . Last Name ' .. . .-- Fast Name : , � . _.- WorkR, �. - .: - - ,' ,' Work Email 4,. Education, . _:- Laval ' .,' _ .. Degree -.Focus; Licansure/ Credentials DOAA O . - (ff apple) ,' .. ... Last Name � .. First Name ' � . .. Work I' ' • . , Work Ema0 . 1 Perez Rachel 970-313-1145 rachel.perez@no Masters behavioral health Wyperd Becky _ 970313-1164 rebecca.wyperd rthranpe.ort @northranse.onl 2 Kron Tonya 970-347-2120 tonya.kron@nort Masters behavioral health LPC Perez Rachel 970-313-1145 Rachel.perez@no hrange.org rthrange.org 3 Poulson Kayla 970-347-2120 kavla.poulson@n Masters behavioral hearth Perez Rachel 970-313-1145 Rachel.perez@no orthranize.org rthranxe.org 4 Coleman Demonica 970-347-2120 demonica.colema Masters behavioral health Perez Rachel 970-313-1145 Rachel.perez@no n@northranze.or g rthrange.org edward.bover@n behavioral - jlachel.perez@no 5 Boyer Eddie 970-347-2120 orthranKe.org Masters health Perez Rachel. 970-313-1145 rthrante.org 6 Peters MaeLee 970-347-2120 maelee.peters@ Masters behavioral health Perez Rachel 970-313-1145 Rachel.perez@no northranRe.org rthrange.org 7 8 9 10 11 12 13 14 15 16 17 18 Bid No.: 81900025 STAFF DATA SHEET EXHIBff D (Bidder must fist all appaKaWe staff who will manage and/or administer the proposed service. One Stan Data sheet per proposed service. Bidder should not combine services.) 19 20 21 22 23 24 25 26 27 28 Bid No.: 81900025 NORTHORANGE - January 28, 2019 Tobi Cullins Child Welfare Contract and Services Coordinator Division of Child Welfare Resource Unit 822 7"' Street, Suite 150 Greeley, CO 80631 North Range Behavioral Health (NRBH) is the community behavioral health center serving Weld County, Colorado. We are a private, non-profit corporation dedicated to providing professional, culturally competent behavioral health services to the residents of our area. NRBH is submitting this contract proposal for the mental health services option, specifically for psychological evaluations, to provide diagnostic/therapeutic services to assist the Department of Human Services, Child Welfare, in developing the family services plan, and to assist the families that are serviced to improve family communication, functioning, and relationships. NRBH is proposing to provide psychological/behavioral health evaluations that involve an integrated assessment of mental health and substance abuse issues. Services to be provided under .the terms of this contract will be provided, at a minimum, by an academically qualified, doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and supervised by a CAC III or LAC supervisor, and trained in Trauma Informed Care. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and service time frames. If desired, NRBH is also available to meet with the Department of Human Services staff to explain the program, time lines of response to referrals, and answer questions to enhance the program. If you have any questions, please do not hesitate to contact us. We look forward to hearing from you regarding the status of this proposal. Sincerely, Michael McCormick, Ph.D., LCSW, CAC III Administrative Director michael.mccormick@northrange.org 1300 North 17th Avenue Greeley, CO 80631 970-347-2405 (OFFICE) 130O North 17th Avenue • Greeley, CO 80631 • 970-347-2120 • wwvwa\torthR*Ige:org, EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: NORTH RANGE BEHAVIORAL HEALTH DIAGNOSTIC/TESTING SERVICES 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. American Psychology Association standards for industry met. All psychological testing batteries and instruments meet the standards of practice. 4. Capacity to Provide Services (ex. 4 hours/week). 4-8 hours a month 5. Goals of the service. To provide medically necessary standards for determining children and adult cognitive and intellectual functioning, personality profiles that lead to recommendations for treatment. 6. Outcomes of service. Outcomes are to establish data points based on standardized testing and assessment tools that helps to assist in the appropriate development of treatment planning for clients referred. 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Client from age five and up who require extensive psychological testing to determine treatment needs. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. This service has the capacity for video conferencing, phone conferencing and in person work. The office base services are available at the Island Grove Center: 1260 H Street, Greeley, CO 8631. 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. Translation services are available in multiple languages. 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. Psychological Evaluation/Testing Codes • Description of Use MH Psych testing Level 1 (96101L1) $250.00 capped fee MH Psych testing Level 2 (96101L2) $800.00 capped fee MH Psych testing Level 3 (96101L3) $1200.00 capped fee MH Psych testing Level 4 (96101L4) $1800.00 capped fee MH Psych testing Level 5 (96101L5) $2500.00 capped fee Bid No.: 1900025 STAFF DATA SHEET EXHIBT D (Bidder must fist all applicable staff who will manage and/or administer the proposed swam One Staff Data Sheet per proposed service_ Bidder should not combine services.) ROPOSED SERVICE OR SERVICE TYPE: {D IAGNOSfIC/TESTING _ DDER LEGAL ENTITY NAME: - Worth Range Behavioral Health . _ .. ,. APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _ .. SUPERVISOR INFORMATION No:. ' Last Name : `:; First Name ' - Wa'IiC - .' Work EmaO : - -' Edtcatlon level; - - Degree Poan. Licanssue/ Credentials Kama (If appGobla) : _. - last Name First Name • Work B Work Email • 1 Swisher Nathan 970-347-2397 nathan.swisher all PhD Psychology LP/LPC Laura Hays 970-347-2357 Iaura.hays@nort northrange.org hrange.orR 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 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 Shat par proposed service. Bidder should not combGre services.) 28 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D Bidder must list all appGcbhi staff who weal manage and/or aamirdster the proposed service. One Staff Data slyest per proposed service. Bidder shordd not combine services.) PROPOSED SERVICE OR SERVICE TYPE: _ BIDDER LEGAL ENTITY NAME: orth Range Behavioral Health . APPUCABLE STAFF MEMBER OR CONTRACTOR INFORMATION - .. - -, _ SUPERVISOR INFORMATION No.: Lasi Name .'.' . First.Name , . WorkC. '. - ; Work Email Laval - . Degiiaef !Octal licensers/ _: Credentials (pima . - Of appfiwWe) Last Name ,:: Fist Name �' Work II Work Email . 1 Santy Samantha 970-347-2120 Samantha.santy Masters behavioral health LPC CSW.09925478 CSW.09925349 0014335 Wallace Jenny 970347-2406 lennifer.wallace @northrange.org @northrange.org 2 Steele Ani 970-347-2120 anLsteele@north Masters behavioral health LPC Wallace Jenny 970347-2406 lennifer.wallace' range.org @northrange.org 3 Crookston Bradley 970-347-2120 bradlev.crooksto Masters behavioral health LPC Wallace Jenny 970347-2406 jennifer.wallace n@northranze.or g @northranae.org 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list an applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.( 25 26 27 28 Bid No.: 81900025 EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services North Ranee Behavioral Health AGENCY OR PRIVATE PRACTICE TRAILS PROVIDER ID (If Known) tarn Pottorff PRIMARY CONTACT- FULL NAME 1970 . 1347-2120 PHONE NUMBER larry.00ttoriV north ra nee.ont PRIMARY CONTACT- E-MAILADDRESS 1300 N 17th Ave AGENCY MAIUNG ADDRESS ExecutiveDirector _. PRIMARY CONTACT - TITLE EXT. FAX NUMBER northranae.ore AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE) Greeley CITY 80633 UP lacki Kennedy REFFERAL CONTACT —,FULL NAME 1970 1347-2120 REFERRAL CONTACT— PHONE NUMBER REFERRAL CONTACT EXT. Deputy Director REFERRAL CONTACT - TITLE lacki.Kennedy@NorthRanee.out . REFERRAL CONTACT — E-MAIL ADDRESS BILLING CONTACT: CherRyn Barringer . _ • BILUNG:CONTACT— FULL NAME 1970 )347-2345 BRING CONTACT- PHONE NUMBER Chief Financial officer. BILLING CONTACT = TITLE cherihrn, barri neer@ north ra n Re:ont 'BILLINGCONTACi E-MAiLADDRESS I:.certify that the services proposed for intended. use by the. Weld County Departineni-of Human Services. will .. . Meet - WI the�specificati'ons'ithas 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 wit}i all=iequiremenfs of • the contract; if awarded. _ - the Board of Weld County Commissioners reserve the right to reject any or all bids; to.waive any.tnfortriality in the: - bids,and to accept,the bid,. or part:of a'bid, that; ,in -the .opinion of.t a Be: Board; is in'the_best interests of the -Board and: ofthe Cotintyof Weld; State of Colorado..The Board of Weld County Commissioners shall give.preference,to . ' resident Weld.C,ounty bidders in all cases where the bids Are competitive in.price and�qual ty• Signature of Authoriied Representative: 1 1_71 1, Date of Signature:. Bid No. B 1:900025 STAFF DATA SHEET EXHIBIT D Bidder must list an applicable staff who win manage and/or administer the proposed service. Ono Staff Data street per proposed service. Bidder should not combine swam.) SERVICE OR SERVICE TYPE: jMonitored Sobriety DDER LEGAL ENTITY NAME: orth RarrKe Behavioral Health - - . .. --.: • - .APPl1CABLE STAFF MEMBER OR CONTRACTOR INFORMATION ^ ". •.- ..: -.. SUPERVISOR INFORMATION No -. ... last Narrre' ' fast Name ' Workfl. .. Work Eman -- Eduction l aval .• Degree Fora. lios>.ntrm/ Oreilantiah DORA 0 - - (if amicable)' Last Name . " First Name Work 0 Work Email • 1 White Gail 970-313-1117 gail.white@north Masters behavioral health LPC, LAC ACD.0000266 1PC-0011122 ACC0006837 3559 Collins Kim 970-347-1303 kimberly.collins@ range.org northranKe.org 2 Watson Radial 970-347-2120 rachel.watson@n Bachelors behavioral health CAan White Gal 970-313-1117 gail.white@north orthrange.org range.org 3 McKenna Belinda 970-347-2120 belinda.mckennd Masters behavioral health LPC White Gail 970-313-1117 Bail.white@north @northranKe.org ranee.org 4 LeRoy Brittney 970-347-2120 brittnev.lerov@b bachelors behavioral health White Gal 970-313-1117 gail.white@north orthrange.org range.org 5 Middlebrook Mackenzie 970-347-2120 mackenzie.middl bachelors behavioral health White Gal 970-313-1117 gail.white@north ebrook@northra nKe.org range.org 6 Austin Rachel 970-347-2120 rachel.austin@no bachelors behavioral health White Gail 970-313-1117 gail.white@north rthranee.ore ranze.org 7 8 9 10 11 12 13 14 15 16 17 18 Bid No.: 83900025 STAFF DATA SHEET EMIR= D (Bidder must list an applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 19 20 21 22 23 24 25 26 27 28 Bid No.: 81900025 STAFF DATA SHEET (Bidder must list an applicable staff who win manage and/or administer the proposed service. One Staff Data Shoat par proposed service. Bidder should not combine services.) - PROPOSED SERVICE OR SERVICE TYPE: ST BIDDER LEGAL ENTITY NAME: Plorth Range Behavioral Health .'APPLICABLE STAFF MEMBER OR CONTRACTOR INFOR MATION - - SUPERVISOR INFORMATION . . No last *We' ". - ' - .. Fast NanW . Whxi k - War( Errhail .- .- Education Level -' Degree Fortis.. LiowhshneJ : D6RA i _- (If apptireble) last Name First Name - work i work Email 1 Perez Rachel 970-313-1145 rachel.perez@no Masters behavioral health Wyperd Becky 970-313-1164 rebecca.wyperd rthrange.ort @northrange.org 2 Kron Tanya 970-347-2120 tonya.kron@nort Masters behavioral health LPC LPC.0015136 Perez Rachel 970-313-1145 RacheLperez@no hrange.org rthrange.org • 3 Poulson Kayla 970-347-2120 kayla.poulson@n Masters behavioral health Perez Rachel 970-313-1145 RacheLperez@no orthrange.ong rthrange.org 4 Coleman Demonic 970-347-2120 demonica.colema Masters behavioral health - Perez Rachel 970-313-1145 RacheLperez@no n@northrange.or g rthrange.org 5 Boyer Eddie 970-347-2120 edward.boyer@n Masters behavioral health Perez Rachel 970-313-1145 RacheLperez@no orthrange.org rthrange.org 6 Peters MaeLee 970-347-2120 maelee.peters@ Masters behavioral health Perez Rachel 970-313-1145 RacheLperez@no northrange.org rthrange.org 7 8 9 10 11 1z 13 14 15 16 17 18 EXHIBIT D Bid No.: B1900025 STAFF DATA SHEET UMW D (Bidder must list all applicable staff who will manage and/or administer the proposed servioa. One Staff Dam Sheet par proposed service. Bidder should not combine services.) 19 20 21 22 23 24 25 26 27 28 Bid No.: 81900025 The following tests available at NRBH are normed for English -Speaking American adults and adolescents. Adults: Minnesota Multiphasic Personality Inventory -2 (MMPI-2): Relevant to a range of contemporary applications, the MMPI-2 instrument is the most widely used and widely researched test of adult psychopathology. Used by clinicians to assist with the diagnosis of mental disorders and the selection of appropriate treatment methods, the MMPI-2 test continues to help meet the assessment needs of mental health professionals in an ever-changing environment. Milton Clinical Multiaxial Inventory -IV (MCMI-IV): This instrument provides helpful clinical insights into a patient's personality that allow clinicians to make reliable diagnostic and treatment decisions. The MCMI-IV offers updated norms that are based on a clinical adult population, a new scale, DSM-5 and ICD-10-CM alignment, updated narrative content and a new and deeper therapeutic focus. Parenting Stress Index - Third Edition (PSI -3): The PSI addresses the early identification and assessment needs recognized by the Report of the Surgeon General's Conference on Children's Mental Health (January 2001). It is well -suited for use in primary health care and pediatric practices, as well as in other settings and programs that serve at -risk children and families or provide early childhood educational and developmental experiences. The PSI is designed for the early identification of parenting and family characteristics that fail to promote normal development and functioning in children, children with behavioral and emotional problems, and parents who are at risk for dysfunctional parenting. It can be used with parents of children as young as one month. Personality Assessment Inventory (PAI): An objective inventory of adult personality, the PAI assesses psychopathological syndromes and provides information relevant for clinical diagnosis, treatment planning, and screening for psychopathology. Administration time is up to 40 minutes shorter than that for similar instruments. Trauma Symptom Inventory -2 (TSI-2): A broadband measure, the TSI-2 is designed to evaluate posttraumatic stress and other psychological sequelae of traumatic events, including the effects of sexual and physical assault, intimate partner violence, combat, torture, motor vehicle accidents, mass casualty events, medical trauma, traumatic losses, and childhood abuse or neglect. Vineland Adaptive Behavior Scales - Second Edition (Vineland -II): The leading instrument for supporting the diagnosis of intellectual and developmental disabilities. All Vineland -II forms aid in diagnosing and classifying intellectual and developmental disabilities and other disorders, such as autism, Asperger Syndrome, and developmental delays. The scales of the Vineland II were organized within a three domain structure: Communication, Daily Living, and Socialization. This structure corresponds to the three broad domains of adaptive functioning by the American Association of Intellectual and Developmental Disabilities: Conceptual, Practical, and Social. In addition, Vineland -II offers a Motor Skills Domain and an optional Maladaptive Behavior Index to provide more in-depth information about your clients. Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV): The WAIS-IV is an individually administered clinical instrument designed to assess the cognitive ability of adolescents and adults ages 16 years 0 months through 90 years 11 months. This instrument provides subtest and composite scores that represent intellectual functioning in specific cognitive domains, as well as a composite score that represents general intellectual ability. The WAIS-IV has a mean of 100 and a standard deviation of 15. Adolescents: Milton Adolescent Clinical Inventory (MACI): Unlike many other instruments developed for adults and adapted for adolescents, the MACI assessment was specifically created to address the unique concerns, pressures and situations facing teens. This dedicated tool, recently enhanced by the addition of Grossman Facet Scales, helps assess personality patterns as well as self -reported concerns and clinical symptoms. Brief and easy to administer, the MACI can assist practitioners in constructing treatment plans customized to individual needs and help them guide troubled youth toward healthier, more authentic lives. Minnesota Multipihasic Personality Inventory -Adolescent (MMPI-A): An empirically based measure of adolescentpsychopathology, the MMPI-A test contains adolescent -specific scales, and other unique features designed to make the instrument especially appropriate for today's youth. Offering reports tailored to particular settings, the MMPI-A test helps provide relevant information to aid in problem identification, diagnosis, and treatment planning for youth (ages 1418). Personality Assessment Inventory —Adolescent (PAI-A): Designed to complement its parent instrument, the Personality Assessment Inventory (PAI), the PAI-A is an objective personality assessment for use with adolescents. Items are written at a fourth -grade reading level. Clinical constructs were selected on the basis of their importance within the nosology of mental disorder and their significance in contemporary diagnostic practice and assess experiences (e.g., suicidal ideation, depression, anxiety) that are expressed with reasonable consistency across the life span. Trauma Symptom Checklist for Children (TSCC): The TSCC allows you to measure posttraumatic stress and related psychological symptomatology in children ages 8-16 years who have experienced traumatic events, such as physical or sexual,abuse, major loss, or natural disasters, or who have been a witness to violence. STAFF DATA SHEET EXHIBIT D (Bidder must list a0 applicable staff vrho wi0 manage and/or admirdster the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: SeDDER LEGAL ENTRY NAME: rAGNOSTIC/TESIING ort h Range Behavioral Health -. :APPLICABLE STAFF MEIV03ER OR CONTRACTOR INFORMATION - ... _ ' SUPERVISOR INFORMATION No:• last Mama, . •• _ Fbst Name ' Work" . . - - Work Enrol Education Lairel : Degree Fodor, tioanstceJ :. t]rada - . ' ; oow► e ' _ (ff app!'icabie) Last Name First Name ' Work A . Work Email 1 Swisher Nathan 970-347-2397 nathan.swisherP PhD Psychology LP PSY0003840 Laura Hays 970-347-2357 laura.hays@nort northranRe.orp hranRe.orp, 2 CAC AC80003840 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Bid No.: 81900025 STAFF DATA SHEET OCHIBR )Bidder must list all applicable staff who will made and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 28 Bid No.: 81900025 PSYCHOLOGICAL TESTING UPDATE NORTH RANGE BEHAVIORAL HEALTH RATES: k sychologicai Evaluatiori/Test ft Codes* Description of`Use MH Psych testing Level 1(96101L1) $250.00 capped fee MH Psych testing Level 2 (96101L2) $800.00 capped fee MH Psych testing Level 3 (96101L3) $1200.00 capped fee MH Psych testing Level 4 (96101L4) $1800.00 capped fee MH Psych testing Level 5 (96101L5) $2500.00 capped fee *Partial Testing is $120 per hour or the cost of the next lowest level of testing. FIVE TIER FLAT RATE PSYCHOLOGICAL EVALUATION OPTIONS Level 1: Behavioral Health Evaluation Cost: $25O.00 Est. Time: 3-6 hours Example: 1. Review of DSS case records, and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Possible administration of brief screening inventories (e.g., Beck Inventories, State - Trait Inventories, Personality Assessment Screener). 4. Feedback given to the client. 5. Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. The Behavioral Health Evaluation can be useful for ruling in/out basic mental health and substance abuse issues, advising on provisional diagnoses, and making recommendations for treatment when appropriate. Level 2: Partial Psychological Evaluation Cost: $800.00 Est. Time: 8-14 hours Example: 1. Review of DSS case records, and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Administration of a partial test battery, such as administration of just cognitive or just personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc.). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, test results, diagnostic formulation, and treatment recommendations. This evaluation can be useful for ruling in/out mental health_, substance abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment recommendation's. Level 3: Full Psychological Evaluation Cost: $1200.00 Est. Time: 16-20 hours Example: 1. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 2. Extensive integrated dinical evaluation (multiple sessions): 3. Administration of a formal battery of tests (multiple tests) to assess personality,, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). 4. Consultation with collateral sources. 5. Feedback given to the client. 6.,. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant behavioral health issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Level 4: Extended Psychological Evaluation Cost: $1800.00 Est. Time: 20 - hours Example: 1. This level is intended to be :utilized when impairment in cognitive functioning is suspected/known, when the client is unable to read or write, when there are major memory deficits, when resistance leads to invalid measures and instruments need to be re -administered, and/or when other significant barriers to testing are present. 2. Preauthorization is required by WC DSS Administrative Directors prior to requesting or proceeding with this level of evaluation. 3. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 4. Extensive integrated clinical evaluation (multiple sessions). 5. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). 6. Consultation with collateral sources. 7. Feedback given to the client. 8. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Level 5: Psychological/Psychiatric Evaluation Cost: $2500.00 Est. Time: 25- hours Example: 1. This level is intended to be utilized when impairment is significant (cognitive functioning, memory deficits, organicity, medical issues and/or other significant barriers to testing are present). 2. Preauthorization is required by WC DSS Administrative Directors prior to requesting or proceeding with this level of evaluation. 3. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 4. Extensive integrated clinical evaluation (multiple sessions). 5. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.). 6. Psychiatric interview and consult with a psychiatrist (MD). 7. Consultation with collateral sources. 8. Feedback given to the client. 9. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Instant UA procedures: *Client will Wash hands with soap. *Take of Jacket, roll sleeves up. *Collect urine specimen in cup: Ladies- Start the flow of the urine, then stop and hold it, deep cough, then place cup in flow of urine using one hand only. Gentlemen- the mirror in bathroom is there to insure that the urine specimen is clients' own. *Fill the iCup collection cup at least 1/3 full. *Write name of client on top of lid. *Secure the lid on cup. Making sure the lid is properly on threads so to prevent leakage. *Place on a flat surface for approximately30 seconds. *Read results within 5 Minutes, once Control lines are visible on the test Do not interpret results after 60 minutes as false results may occur. Instant Oral Devices (Swabs) *Client should not eat or drink anything 10 minutes prior to taking the test. *Remove the collection stick from package and have client put sponge end into mouth. *Swab the inside of mouth and tongue until the sponge becomes fully saturated with the oral fluid. *Flip the cap from the collection chamber open. It should have a "strainer" inside and visible. *Place the sponge of the collection stick into the chamber and press sponge fully against•strainer to collect oral fluid. *Twist open the chamber to allow the oral fluid to enter the testing device. *Test device should be on flat surface. *Wait for colored lines to appear. Results should be read in 10 minutes. Do not read results after 1 hour. *If results are positive, place the cap back on the collection chamber. Collection chamber and testing device may be sent out for confirmation. Lab oral devices *Client should not eat or drink anything 10 minutes prior to taking the test. *Remove the collection stick from package and have client put sponge end into mouth. *Swab the inside of mouth and tongue until the sponge becomes fully saturated with the oral fluid. May rest it under the tongue where the oral fluid collects. *Top of collection stick will turn blue. Test is complete. *Client will put stick, sponge side down, into the collection tube. *Snap lid on tight and put chain of custody labels on collection tube. * Put finished sample in white redwood bag and send off to lab. Lab UA procedures: *Client will Wash hands with soap. *Clients will take off Jackets, roll sleeves up. *Staff, take the foil top off of the collection cup and remove the sample bag and sample vial from the collection cup. Collect urine specimen in cup: Ladies- Start the flow of the ,urine, then stop and hold it, deep cough, then place cup in flow of urine using one hand only. Gentlemen- the mirror in bathroom is there to insure that the urine specimen is clients' own. *Fill collection cup at least 1/3 full, past the temperature marker. *After staff check the temperature marker on the collection cup to make sure the specimen temperature is within the normal range (90°F to 100°F), the client should pour urine from the collection cup into the sample vial up to the indicated fill line. Secure the vial lid and close the safety tab on the urine sample vial. Making sure the lid is on properly to prevent leakage. *Tip the vial upside down over the toilet to assure the lid is sealed. *Do not flush until staff has a chance to look in. *Place the chain of custody seal with clients' initials over the top of the lid of the vial. *Staff will give the client the tear off green strip at the bottom olthe chain of custody form as their receipt. *Put finished sample in the front pocket of the sample bag and place the chain of custody form in the back pocket of the sample bag. Seal the bag and send off to lab. EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services North Range Behavioral Health AGENCY OR PRIVATE PRACTICE Janis Pottorff LCSW, IMH-E III PRIMARY CONTACT— FULL NAME J 970 ) 347-2491 PHONE NUMBER janis.pottorff@northrange.org PRIMARY CONTACT — E-MAIL ADDRESS 1300 North 17th, Avenue; AGENCY MAILING ADDRESS TRAILS PROVIDER ID (If Known) Family Connects Program Director PRIMARY CONTACT - TITLE EXT. FAX NUMBER www:northrange. on; AGENCY/PRACTICE WEB ADDRESS (IF APPUCABLE) CITY Greeley 80631 ZIP REFERRAL CONTACT Janis Pottorff REFFERAL CONTACT — FULL NAME 19701347-2491) REFERRAL CONTACT —PHONE NUMBER EXT. Program Director REFERRAL CONTACT - TITLE janis.pottorff(anorthra nge-org REFERRAL CONTACT - E-MAIL ADDRESS BILLJNG CONTACT Emily Allen BILUNG CONTACT— FULL NAME 1970) 347-2120 BI W NG CONTACT— PHONE NUMBER EXT. Accountant BILLING CONTACT - TILE emily.allen@northrange.org BIWNG 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 shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. Signature of Authorized Representative: Date of Signature: 1/27/2019 Bid No.: B1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: NRBH — Family Connects Early Childhood & Families Team Foster Parents Training 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Family Connects Early Childhood and Family Services team of NRBH will provide a variety of groups to support foster parents to be better equipped to facilitate positive relationships with the children in their care. These groups will be trauma informed, strengths -focused and evidence based for families with children birth to eight years of age. The site -based groups and home education supports will vary in duration and provided in both English and Spanish: • Incredible Years Parent Groups • Incredible Babies • Incredible. Toddlers • Positive Solutions Groups • The Whole Brain Child Training • Conscientious Discipline Training • The Growing Brain (0-5) Training • Dina School (for children while adult caregivers are in session) • Home Instruction for Parents of Preschool Youngsters (HIPPY) • Parents as Teachers (PAT) 4. Capacity to Provide Services (ex. 4 hours/week). • Incredible Years Parent Group (2 hours a week =14 weeks) o Dina School (2 hours —14 weeks) • Incredible Years Parent Group — Extended (2 hours = 6-8 weeks) o Dina School (2 hours - 8 weeks) • Incredible Babies (4 months —12 months) (1% hours = 8 sessions) o This is an adult — child in vivo group • Incredible Toddlers (13 months — 24 months) (1% hours = 12 sessions) o This is an adult - child in vivo group • Positive Solutions Groups — (1 hour a week = 6 weeks) o PSG Child Groups (1 hour a week = 6 weeks) • The Whole Brain Child Training (1 hour a week = 4 weeks) o Social — Emotional Skills Group (1 hour = 4 weeks) • Conscientious Discipline Training (1 hour a week = 4 weeks) o Social — Emotional Skills Group (1 hour = 4 weeks) • The Growing Brain (0-5) Training (2 hours a week = 8 weeks o Dina School (2 hours — 8 weeks) • HIPPY (1 hour a week = 30 weeks — In home) • PAT (1 hour every other week = 1 year — In home) Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 5. Goals of the service. Foster parents will have skills, strategies and abilities to promote positive relationships and address the trauma and challenging behaviors that are present with children in their care under the age of eight years. In addition, adult caregivers will promote social and emotional development. The staff of Family Connects has a long history of serving families including foster and kinship with prevention, educational and therapeutic supports. The teams have specialized training and experience with Infant and Early Childhood Mental Health (IECMH) and Maternal Mental health with a strong trauma lens and two generation intervention approach. The proposed. services include groups and individualized home visiting interventions. The adult groups are based on Cognitive Behavioral Theories and incorporate effective adult learning strategies to strengthen relationships and give a deeper understanding of trauma and early brain development. The child groups are based on experiential and behavioral learning appropriate for young children and focus on increasing regulation and problem solving skills while building a sense of trust and safety for children that may have experience ruptures and trauma. 6. Outcomes of service. Foster parents will feel more capable in supporting the needs of the young children in their care that have experienced loss, trauma or ruptures in their early years. The adult caregivers will have specific strategies that assist them in have consistent, predictable and nurturing interaction that promote . responsive relationships and attachment in the adult child relationship. Children will be assessed in group and supported to the appropriate level of care that their presenting needs require. 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Foster parents of infants, toddlers and preschool age children are the focus of these services. These groups and home -based individualized services are most appropriate for families caring for young children birth to 6 years of age. A few of the group experiences (Dina School and Whole Brain Child) expand the knowledge and skills for children up to the age of 8 years. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. It is the intent to offer the groups in two locations. The bulk of groups will be offered at NRBH Littler Prevention Campus, 2350 West 3rd Street Road, Greeley, CO. The South County region will be varied based on need and numbers to impact. Family Connects has potential to conduct groups at either the NRBH office or High Plains Library District locations in Frederick and Erie. Home education supports will be available in Weld County only. Time and mileage will be based on the NRBH Littler Prevention Campus in Greeley. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. The groups and home visiting supports are available in both English and Spanish with some other languages of the Refugee populations for the Positive Solutions Groups and HIPPY. Languages include Somali, Swahili, Burmese, Rahinga. 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. Cost for groups, training and home visit vary based on the mode of services. Group and training cost are per individual attending and home visits are based on a household/kinship family. • Incredible Years Parent Groups O 14 weeks group = $233 per participant O 8 weeks expanded group = $133 per participant (must attend 14 week first) • Incredible Babies (4 months to 12 months) O 8 sessions = $133 per participant • Incredible Babies (4 months to 12 months) O 8 sessions = $133 per participant • Positive Solutions Groups O 6 sessions = $90 per participant • The Whole Brain Child Training O 4 sessions = $100 per participant • Conscientious Discipline Training O 4 sessions = $100 per participant • The Growing Brain (0-5) Training O 8 sessions — 2 hours = $110 per participant • Dina School (for children while adult caregivers are in session) o $20 per hour per child • Home Instruction for Parents of Preschool Youngsters (HIPPY) (2, 3, 4, 5 years old) home - based individualized visits by HIPPY educator. O 30 sessions = $750 per household • Parents as Teachers (PAT) — Individualized for (0-3 years) home -based individualized visits by PAT educators (includes developmental assessment and monitoring) O 30 sessions = $1,500 per household Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 1. Bidder's legal entity name: 2. Program name or service type being proposed: NRBH — Family Connects Early Childhood & Families Team Kinship Supports, Services and Education 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Family Connects Early Childhood and Family Services team of NRBH will provide a variety of groups to support kinship families to be better equipped to facilitate positive relationships with the children in their care. These groups will be trauma informed, strengths -focused and evidence based for families with children birth to eight years of age. The site -based groups and home education supports will vary in duration and provided in both English and Spanish: • Incredible Years Parent Groups • Incredible Babies • Incredible Toddlers • Positive Solutions Groups • The Whole Brain Child Training • Conscientious Discipline Training • The Growing Brain (0-5) Training • Dina School (for children while adult caregivers are in session) • Home Instruction for Parents of Preschool Youngsters (HIPPY) • Parents as Teachers (PAT) 4. Capacity to Provide Services (ex. 4 hours/week). • Incredible Years Parent Group (2 hours a week =14 weeks) o Dina School (2 hours —14 weeks) • Incredible Years Parent Group — Extended (2 hours = 6-8 weeks) o Dina School (2 hours — 8 weeks) • Incredible Babies (4 months -12 months) (1'14 hours = 8 sessions) o This is an adult — child in vivo group • Incredible Toddlers (13 months — 24 months) (1114 hours = 12 sessions) o This is an adult — child in vivo group • Positive Solutions Groups — (1 hour a week = 6 weeks) o PSG Child Groups (1 hour a week = 6 weeks) • The Whole Brain Child Training (1 hour a week = 4 weeks) o Social — Emotional Skills Group (1 hour = 4 weeks) • Conscientious Discipline Training (1 hour a week = 4 weeks) o Social — Emotional Skills Group (1 hour = 4 weeks) • The Growing Brain (0-5) Training (2 hours a week = 8 weeks o Dina School (2 hours — 8 weeks) • HIPPY (1 hour a week = 30 weeks — In home) • PAT (1 hour every other week = 1 year — In home) Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 5. Goals of the service. Kinship family systems will have skills, strategies and abilities to promote positive relationships and address the trauma and challenging behaviors that are present with children in their care under the age of eight years. In addition, adult caregivers will promote social and emotional development. The staff of Family Connects has a long history of serving families including foster and kinship with prevention, educational and therapeutic supports. The teams have specialized training and experience with Infant and Early Childhood Mental Health (IECMH) and Maternal Mental health with a strong trauma lens and two generation intervention approach. The proposed services include groups and individualized home visiting interventions. The adult groups are based on Cognitive Behavioral Theories and incorporate effective adult learning strategies to strengthen relationships and give a deeper understanding of trauma and early brain development. The child groups are based on experiential and behavioral learning appropriate for young children and focus on increasing regulation and problem - solving skills while building a sense of trust and safety for children that may have experience ruptures and trauma. 6. Outcomes of service. Kinship families will feel more capable in supporting the needs of the young children in their care that have experienced loss, trauma or ruptures in their early years. The adult caregivers will have specific strategies that assist them in have consistent, predictable and nurturing interaction that promote responsive relationships and attachment in the adult child relationship. Children will be assessed in group and supported to the appropriate level of care that their presenting needs require. 7. Target population for service. Note: Please include age range, applicable genders, and any specific characteristics/traits/needs. Kinship families are the focus of these services. These groups and home -based individualized services are most appropriate for families caring for young children birth to 6 years of age. A few of the group experiences (Dina School and Whole Brain Child) expand the knowledge and skills for children up to the age of 8 years. 8. Service access. Note: Bidder must indicate capacity for video conferencing, phone conferencing and in person. If office -based, bidder should provide full physical addresses for all locations. If provided outside the office, bidder should note home -based and/or community -based, and geographical area(s) bidder is willing to travel to. It is the intent to offer the groups in two locations. The bulk of groups will be offered at NRBH Littler Prevention Campus, 2350 West 3rd Street Road, Greeley, CO. The South County region will be varied based on need and numbers to impact. Family Connects has potential to conduct groups at either the NRBH office or High Plains Library District locations in Frederick andErie. Home education supports will be available in Weld County only. Time and mileage will be based on the NRBH Littler Prevention Campus in Greeley. Bid No.: 1900025 EXHIBIT C PROPOSAL TEMPLATE 9. Languages service is available in. Note: Bidder should note the language and level of proficiency. The groups and home visiting supports are available in both English and Spanish with some other languages of the Refugee populations for the Positive Solutions Groups and HIPPY. Languages include Somali, Swahili, Burmese, Rahinga. 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. Cost for groups, training and home visit vary based on the mode of services. Group and training cost are per individual attending and home visits are based on a household/kinship family. • Incredible Years Parent Groups O 14 weeks group = $233 per participant O 8 weeks expanded group = $133 per participant (must attend 14 week first) • Incredible Babies (4 months to 12 months) O 8 sessions = $133 per participant • Incredible Babies (4 months to 12 months) O 8 sessions = $133 per participant • Positive Solutions Groups O 6 sessions = $90 per participant • The Whole Brain Child Training O 4 sessions = $100 per participant Conscientious Discipline Training O 4 sessions = $100 per participant • The Growing Brain (0-5) Training O 8 sessions — 2 hours = $110 per participant • Dina School (for children while adult caregivers are in session) $20 per hour per child • Home Instruction for Parents of Preschool Youngsters (HIPPY) (2, 3, 4, 5 years old) home - based individualized visits by HIPPY educator. O 30 sessions = $750 per household • Parents as Teachers (PAT) — Individualized for (0-3 years) home -based individualized visits by PAT educators (includes developmental assessment and monitoring) O 30 sessions = $1,500 per household Bid No.: 1900025 STAFF DATA SHEET EKHIBIT D (Bidder must list an applicable staff who will manage and/or administer the proposed service. One Staff Data Shoat per proposed service. Bidder shadd not comtane services.) _ PROPOSED SERVICE OR SERI:nship and Foster Family Trainingi BIDDER LEGAL ENTITY NAMorth Range Behavioral Health - Famly Connects APPLICABLE STAFF M13VJBER OR CONTRACTOR INFORMATION .- ' _ - '_ SUPERVISOR INFORMATION No. last Norma taxi ,. Fast' . , Namo :. ' : . Workg - , ..: ' Work Email ` Edhratioii Level • ' Degree Foam lioottw+ei _ _• ''OORA 11 _ e . Lass Name :. First N wort a work EmaO a ., 1 Pottorff Janis 97(-347-2491 janls.00ttortMnorthrange.org MSW Social Work LCSW, IMH-E III CS1N.09923659 Alexander Kendall 347-2120 kendall.alexander@northranee 2 Brockman Kate 970-347-2120 kate.broccmanenorthrange.org MA Pscyhobgy LPC, IMH-E II LPC-0006183 Pottorff Janis 347-2491 jann.pottorff@northrange.org 3 Kearney Amanda 970.347-2120 amanda.keamey@northrange.org MA Psychology LMFT, IMH-E III MFT.0001186 Pottortf Janis s/a s/a 4 Murray Mariana 970-347-2120 marlena.mumay@northrange.org MSW Social Work MSW 119571901 Brodanan Kate 347-2120 kate.brockman@northrange.org 5 Delgado Sarah 970-347-2120 sarah.delgadoeanorthrange.org MA MFTC.0013653 Brockman Kate s/a s/a 6 Puga Juanita 970-347-2120 juanha.puga@northrange.org BA Early Udldisood IMH-EI n/a Pottorff Janis 3/a s/a 7 Shover Brenda 970-347-2120 brenda.shover@northrange.org BA Early Childhood PAT Certified n/a Pottorff Janis s/a s/a 8 Peados Iliana 970-347-2120 iliana.palacios@northrange.org BA Human Services PAT Certified n/a Pottorff Janis s/a s/a 9 Greer Hannah 970-347-2120 hannahrrreer@northrange.org MA Psryhclogy LPC LPC.0015085 Pottorff Janis 3/a s/a 10 Castro - Frederick Lucero 970-347-2320 Jucero.certro-frederkJs@northrance,org MSW Social Work MSW IMH-E I n/a Pottorff Janis s/a s/a 11 Hurley Cara 970-347-2120 cara.hurlev@northrange.ors MA Pscyology MA LPC .0015607 Pottorff Janis s/a s/a 12 Preuss Jamie 970-347-2120 jamie.oreuss@northrange.org MSW Social Work LCSW CSW.09923493 Pottorff Janis s/a s/a 13 DeKraii .Elise 970-347-2120 elise.dekraii@northrange.org BA PscyMbgy PSP Certified n/a Preuss Jamie 347-2120 jamie.oreuss@northrange.org 14 Padlla Martha 970-347-2120 martha.eadilla@northrange.org BA Pscyhology PSP Certified_ n/a Preuss Jamie s/a s/a 15 Luna Noemi 970-347-2120 noemi.luna@northranve.ore AA Human Services PSP Certified n/a Preuss Jamie s/a s/a 16 Mercado Laura 970-347-2120 laura.mercado@northranee.org BA Pscyholagtr n/a n/a Preuss Jamie s/a s/a 17 Alvarado Astrid 970-347-2120 astrid.alvarado@northrange.org Peer Early Childhood PSP Certified n/a Preuss Jamie s/a s/a 18 Chavis Dedra 970-347-2120 dedra,ChayiSOnorthrange.ont MA Psychology LPC LPC0015151 Brockman Kate s/a s/a 19 20 21 22 23 24 25 26 27 Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list ail applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) 28 c Bid No.: 81900025 STAFF DATA SHEET EXHIBIT D (Bidder must list aU applicable staff who wiU manage and/or administer the proposed service- One Staff Data Sheet per proposed service. Bidder should not combine services-) PROPOSED SERVICE OR SERVInship and Foster Family Trainingi BIDDER LEGAL ENTITY NAME: North Range Behavioral Health - Family Connects APPUCABIE STAFF MEMBER OR CONTRACTOR. INFORMATION : - .. :. .. SUPERVISOR INFORMATION - No.. List Name : First Hama - Worlm -: ' •: . Wort• EmaO Education lauel Degree Focus- .:lioprmnre/ .• Cradantiats ' OORAO. (If appf. . , Last Name. First Name : .. Work 0 Work:Erriail 1 Pottorff Janis. 970-347-2491 janis.pottorff@northranr;e.org MSW Social Work LCSW, IMH-E III Alexander Kendall 970-347-2120 2 Brockman Kate 970-347-2120 first.last@northranae.ora MA Pscyhology LPC, INIH-E II Pottorff Janis 970-347-2491 3 Kearney Amanda 970.347-2120 first.last@northrange.ora MA Pscyhology LMFT, IMH-E III Pottorff Janis 970-347-2491 4 Murray Marten 970-347-2120 first.last@northranKe.orP. MSW Social Work MSW Brodanan Kate 970-347-2120 5 Delgado Sarah 970-347-2120 first.last@northranRe.or8 MA Brockman Kate 970-347-2120 6 Puga Juanita 970-347-2120 first.last@northranae.ora BA Early Childhood IMH-EI Pottorff Janis 970-347-2491 7 Shover Brenda 970-347-2120 first.last@northranae.org BA Early Childhood Pottorff Janis 970-347-2491 8 Palados Iliana 970-347-2120 first.lastldnorthrante.org BA Human Services Pottorff Janis 970-347-2491 9 Greer Hannah 970-347-2120 firstlast@northranKe.org MA Pscyhology LPC Pottorff Janis 970-347-2491 10 Castro - Frederick Lucero 970-347-2120 ftrst.last@northranae.orp MSW Social Work MSW IMH-E I Pottorff Janis _ 970-347-2491 11 Hurley Cara 970-347-2120 first.last@northranRe.org MA Pscyhology MA Pottorff Janis 970-347-2491 12 Preuss Jamie 970-347-2120 first.last@northranKe.orp MSW Social Work LCSW Pottorff Janis 970-347-2491 13 DeKraii Elise_ 970-347-2120 first.last@northranRe.ora BA Pscyhology BA Preuss Jamie 970-347-2120 14 Padilla Martha 970-347-2120 first.lastPnorthranae.org BA Pscyhology BA Preuss Jamie 970-347-2120 15 Luna Noemi 970-347-2120 firstaast@northrange.org AA Human Services AA Preuss Jamie 970-347-2120 16 Mercado Laura 970-347-2120 firstlast@northrange.org BA. Pscyhology BA Preuss Jamie 970-347-2120 17 Alvarado Astrid 970-347-2120 firstlast@northrange.org Peer Early Childhood Peer Preuss Jamie 970-347-2120 18 - Preuss Jamie 970-347-2120 19 20 21 22 23 24 25 26 27 28 Bid No.: 81900025 Group Descriptions Group Duration. Incredible Years Parent Groups (IY) (Able to support'' adult and English) IY Parent Preschool Basic 14 weeks The Preschool Basic parenting program strengthens parent -child interactions and attachment, reducing I emotional, and language development. Parents also learn how to build school readiness skills and are encour children's emotional regulation and social skills. In the parenting groups, trained Incredible Years® facilitato trigger parenting group discussions, problem solving, and practice exercises. Regulation and School Readiness S ■Program 2 — Using Praise and Incentives to Encourage ■Program 3 — Positive Discipline — Rules, Routines anc ■Program 4— Positive Discipline — Handling Advanced IY Parent Group 8 weeks The Advanced Program builds on the Preschool and School Age Basic Programs by focusing on parents' interp, solving skills, anger and depression management, and wa. ■Program 5 — How to Communicate Effectively with ■ Program 6 — Problem Solving for Paren ■ Program 7 — Teaching Children to Probl Incredible Babies (4 months to 12 months) 8 weeks In the Parents and Babies Program, parents learn how to: Help their babies feel loved, safe, and secure. Encc Know Your Baby (0-3 months) ■Part 2 — Babies as Intelligent Learners (3 - ■Part 3 — Providing Physical, Tactile and Visu. ■ Part 4 — Parents Learning to Read Babii ■ Part 5 — Gaining Support ■Part 6 — Babies' Emerging Sense of Self (6 - Positive Solutions Groups (Spanish and English) 6 weeks This is an evidence -based series of six sessions developed by the Center on the Social and Emotional Foundati promote their young child's social and emotional development and to better understand young children's approaches to improve their interactions with their child; help children learn appropriate behavior; and to b successful early learning experiences. 2: Making It Happen! Session 3: Why Do They Do What They Do? Session 5: Facing the Challenge, Part 1 Session 6: Facing th Whole Brain Child (Spanish and English) I 6 weeks I This is down-to-earth parenting, using every day moments and interactions — the good, the bad, and the ugl child that is beginning to use their "upstairs brain" five years of age and older. Each chapter of the book an same strategies discussed in the chapter to the adult brain. 1. Parenting with the Brain in Mind, 2. Two Br Staircase of the Mind: Integrating the Upstairs and Downstairs Brain, 4. Kill the Butterflies! Integrating Memc Parts of the Self, 6. The Me -We Connection: Integr ; q. 1 Conscientious Discipline (Spanish and English) 4 weeks Created by Dr. Becky Bailey, an internationally renowned expert in child developmental psychology, Conscic rather than applying discipline to them. 1, Understand the brain states (the base of the pyramid), 2. Learn yo family, classroom, or team, 4. Use the seven skills of discipline to respond to events in new ways. to parents, child care givers, educators, and patient caregivers. It can be pictured as a pyramid with four st parents and children to: 1. Set and achieve goals together... despite obstacles, 2. Manage emotions instea Resolve conflict in a way that creates closer The Growing Brain (W5) Training (English) 8 weeks This innovative training focuses on evidence -informed strategies with which to prepare early childhood provi niche by providing a comprehensive understanding of how the brain develops, along with ways the provider c Participants will learn skills and strategies for: 1.Teaching early childhood providers about brain developrr language, cognition, prosocial behavior, and social -en 3.Reducing toxic stress that can negatively influence brain deve The Growing Brain: From Birth to 5 Years Old is comprised of seven 3 -hour units. Unit 1: Brain Basics, Unit 2: Language Development, Unit 4: Cognition and Executive Function, Unit 5: Social —Emotional Development, L will be divided into 8 weeks for a shorter version to accommodate the time constra Dina School (for children while adult caregivers are in session) varies This is child care that will be offered during groups. The lead teachers utilize the Incredible Years classroom a- while parents and caregivers are in groups: This is a resource that is being offered to reduce barriers for adult care for children under the age of 8 years in the Dina School Classroom. It is not a drop off care classroom. School is only available for Greeley based groups. The classrom teachers and staff have capacity to support languages there will be an attempt to find staff i 1. ".ti ". .. �._ a.,. "'y��-.J «. �1 11 -,. j Wi Home Instruction for Parents of Preschool Youngsters (HIPPY) (2, 3, 4, 5 years old) home -based individualized visits by HIPPY educator. (7 Languages) 30 weeks Home Instruction for Parents of Preschool Youngsters — known as HIPPY — partners with parents to prepare poverty, limited education and English proficiency. HIPPY is an evidenced -based family support model that skills needed for them to take responsibility for preparing their children for school. Peer parent educators del directly to parents, who then work each day with their own three, four and five year old children. This evide home -based model reducing barriers for many of our isolated new immigrants and refugee families. The W different languages including: English, Spanish, Rahinga, Burmese, Somali, Swahili, French, Arabic. The pee connect families to additional resources as needed. Child screenings are a component of Parents as Teachers (PAT) — Individualized for (0-3 years) home -based individualized visits by PAT educators (includes developmental assessment and monitoring) (Spanish and English) 30 sessions The PAT home -based health and development education visits focus on families prenatal to age 3 years h, Spanish and English. There are four dynamic components to the Parents as Teachers model: *Personal Visits, these four components form a cohesive package of services with four primary goals: LIncrease parent k 2.Provide early detection of developmental delays and health issues, 3.Prevent child abuse and neg Length of Each. Group , Participant Cost per Groups' Total Cost , Per hour Cost a. - -.. 1. xy '�,. •. c.L.. h7 1 'fl� t - _ t� '1. - - .''Y 2 hours $16.64 I $233.00 I $8.32 iarsh discipline and fostering parents' ability to promote children's social, aged to partner with teachers and day care professionals so they can promote rs use video clips of real -life situational vignettes to support the training and ■Program 1— Strengthening Children's Social Skills, Emotional kills e Cooperative Behavior I Effective Limit Setting Misbehavior 2 hours 1 $16.62 I $133.00 I $8.30 ersonal issues such as effective ys to give and get support. t Adults and Children Its -Adults lem Solve communication and problem 2 hours I $16.62 I $133.00 I $8.30 )urage their babies' physical and language development. ■ Part 1— Getting to -6 months) al Stimulation as' Minds -12 months) II :.! .ts h -:.' .ex.,, x. '. r . s , ..: ,... ,,' 7 .... ii.1 hour I $15.00 I $90.00 I $15.00 ons for Early Learning (CSEFEL). It is designed to help parents and caregivers challenging behaviors. Parents and caregivers will learn how to use positive iuild their child's confidence and self-esteem: Thereby, preparing children for Session 1: Making a Connection! Session 4: Teach Me What to Do! Session le Challenge, Part 2 c'u :i^ IN ,., r .t, r _ 4iy� ca }h 1 hour i $25.00 I $150.00 $25.00 y. The content in this course if appropriate for all parents but focuses on the d session that aligns has a section for parents and other adults, applying the Arts Are Better Than One: Integrating the Left and the Right, 3. Building the )ry for Growth and Healing, 5. The United States of Me: Integrating the Many ating Self and Other 1 1 hour I $25.00 J $ioo.00 $25.00 >us Discipline® is built on the premise of developing discipline within children ur seven powers as adults , 3. Discover new ways to connect members of your The Conscious Discipline process applies equally :ages: Conscious Discipline, a research -based discipline approach, can teach d of acting out, 3. Set personal boundaries to encourage mutual respect, 4. relationships $6.88 ders for their vital role in building healthy brains. The curriculum fills a unique :an encourage healthy brain development in children from birth to 5 years old. tent (architecture and neurobiology) to inform their practice, 2.Supporting iotional development, lopment of very young children. Factors Affecting Brain Growth and Development, Unit 3: Communication and Init 6: Understanding Behavior Unit 7: The Everyday Play. The course pints for providers and caregivers or young children . varies I $20.00 I varies I $20.00 tanagement strategies to provide a social emotional rich learning environment :s that plan to attend any of the adult learning groups. The intent into provide Adults must be attending one of the groups in the NRBH Littler Campus. Dina Spanish and English dominant speaking children. If there is a need for other that can support. 1 hour $25.00 $750.00 $25.00- their children for success in school, particularly those most at risk because of works directly with parents in their homes to give them books, activities and liver 30 weeks of high quality school readiness curriculum activities and books nce-based curriculum is able to support families in multiple language and is a eld County HIPPYCorps team is able to support families and caregivers in 7-9 r mentors are from the cultures they support and act as a trusted liaison to the home visits as is basic case management to resources. 90 minutes $50.00 $1,500.00 $33.00 ere in Weld County. The PAT educators have the capacity to support *Group Connections, *Resource Network, *Child Screening. Together, nowledge of early childhood development and improve parent practices, ;lect, and 4.Increase children's school readiness and success Comments • Each session will be billed for 2 hours at the hourly rate. The rate is billed for each parent attending unless a child is open to NRBH for mental health services; then the first family member is coverend under Medicaid. Any other health insurance does not cover adult psycho eduction groups Groups will close to new participants after week 3. Content builds on each session. IY is open to all adult learners and is a strong evidence -based approach that works to impact knowledge shifts in the adult that will impact parenting and relationship practices with their children. Each session will be billed for 2 hours at the hourly rate.The rate is billed for each parent attending unless a child is open to NRBH for mental health services; then the first family member is coverend under Medicaid. Any other health insurance does not cover adult psycho eduction groups Must have attended the 14 Parent Basic IY group. Those attending this group will have more complex challenges in relationships, behaviors and compliance. Each session will be billed for 2 hours at the hourly rate. The rate is billed for each parent attending unless a child is open to NRBH for mental health services; then the first family member is coverend under Medicaid. Any other health insurance does not cover adult psycho eduction groups. Only parents and infant in age category attend group. The model engages parents in teach, do and feedback loops using CBT theories and in vivo practice sessions. r I] - - 1::. N-. These sessions build upon each other as a basic introduction to parent child relationships and compliance. The session time has been reduced to 1 hour to accommodate more engagement for families. This is considered a basic introduction boot camp. Over the next year we will be able to offer PSG groups in a variety of languages utilizing our HIPPY peer mentors as facilitators. _ •. '1 This includes the book and materials as a resource for families attending. This is a universal access learning group for all families. The expectation is that they would attend all 6 sessions to gain the most from the content. k, :t I k �_ ,. . These groups are intended for child care providers as well as families (biological, kinship and foster). 1�. I E I r,i 7 - } C Each session will be billed for 2 hours at the hourly rate. This is an evidence -based curriculum that was developed by leaders from Zero to Three. It is most helpful for child care providers, staff, foster families and other professionals working with children birth to five years of age. :v Must pre -register all children that will be attending and provide basic health information on allergies, medical conditions etc. I . r0. 4'., 4 1.; _ _ .. c rlr_ .� f 4i� C; :' i•.'.:1 '. ,. �, I. Engagement expectations are to completed 26 weeks of home -based education. HIPPY USA fidelity looks at parent engagement benchmarks to shift parenting practice. Fidelity for PAT visits is that for families with risk factors they receive a minimum of 24 visits over the course of one year. The visits may last 60-90 minutes based on individualized needs and goals. ,� ` n }; ' 4 � I c a C 1 ACOR o® CERTIFICATE OF LIABILITY INSURANCE DATEMM 6/28/2018 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Professional Risk LLC 8213 W.2oth St Greeley CO 80634 CONTACT Jennifer Hunter NAME PHONE - (970) 356-8030 I rr �). (PM 336-8032 AD6ldtsy:jennifer.hunter@proriskllc.com DRE INSURER(S) AFFORDING COVERAGE NAIL Q emwmRA:Philadelphia Insurance Co 18058 MSURED North Range Behavioral Health 1300 N 17th Avenue Greeley CO 80631 INSURER e : Pinnacol Assurance eeuRERc:Lloyds of London OMWMRD: OMURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 All (30) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADM INSD SUER WYD POLICY PLUMBER POUCY EFF IMIARIMYYYY) POLICY EXP (MiUDD/YYYY) LIMITS A A X COMMERCIAL GENERAL LJABI.RY OCCUR X Y PHPR839283 PHSD1358091 7/1/2018 7/1/2018 - 7/1/2019 7/1/2019 EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE X DAMAGE PREMISETO RENTED occtarence) $ 1,000,000 X Professional Liability MED EXP (My one person) $ 20,000 X HIPAA PERSONAL dADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JECT X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER titPM UnitS 50,000 A AUTOMOBILE LlA&1.1TY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS WM1(1839283 - 7/1/2018 • 7/1/2019 COMBINED SINGLE LWIT (Ea acriderd) s 1,000,000 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments s 5,000 A X UMBRELLA UAB EXCESS U1113 / OCCUR CLARAS-MADE PH0B634797 7/1/2018 7/1/2019 EACH OCCURRENCE $ 2,000,000 _ X AGGREGATE S 2,000,000 DED 1 X IRETENTION $ 10,000 s B WORKERS COMPENSATION AND EMPLOYERS LJTY ANY PROPRIETORRARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED? (Mandatory In NH) II yes, describe under DESCRIPTION OF OPERATIONS below Y I N NIA Y 4044331 7/1/2018 7/1/2019 X I STATUTE I I ER E.L EACH ACCIDENT $ 1,000,000 ❑ El DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POUCY LIMIT $ 1,000,000 C Privacy HSH02610560 7/1/2018 7/1/2019 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS,/ LOCATIONS / VEHICLES (ACORD 101, Additional Ranks Schedule, may bo attached If more space Is required) 30 day notice of cancellation; 10 day notice for non -pay applies. Weld County Department of Human Services Child Welfare Division is listed as additional insured as pertains to the General Liability policy, per written contract. This coverage is primary and non-contributory. Waiver of subrogation applies on the General Liability and Workers' Compensation policies. CERTIFICATE HOLDER CANCELLATION Weld County Department of Human Services Child Welfare Division Attn: Tobi Vegter PO. Box A Greeley, CO 80632 I 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 Dionne Perez/DP © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Foster Care/Adoption Services, Functional Family Therapy, Mental Health Services, Monitored Sobriety Services and Multisystemic Therapy, as referred by the Department. 2. Foster Care/Adoption Services: Contractor will provide a variety of groups to support foster and kinship parents to be better equipped to facilitate positive relationships with the children in their care. These groups will be trauma -informed, strengths -focused and evidence -based for families with children birth to eight (8) years of age. a. Groups available under this agreement include: i. Incredible Years Parent Groups ii. Incredible Babies iii. Incredible Toddlers iv. Positive Solutions Groups v. The Whole Brain Child Training vi. The Growing Brain (0-5) Training vii. Dina School (for children while adult caregivers are in session) viii. Parents as Teachers b. Capacity for Services: i. Incredible Years Parent Groups — 2 hours/week = 14 weeks 1. Dina School (2 hours —14 weeks) ii. Incredible Years Parent Groups — Extended —2 hours/week = 6 to 8 weeks 1. Dina School (2 hours —8 weeks) iii. Incredible Babies (4-12 months) —1-1/2 hours = 8 sessions 1. This is an adult -child in vivo group iv. Incredible Toddlers (13 -24 months) —1-1/2 hours =12 sessions 1. This is an adult -child in vivo group v. Positive Solutions Groups —1 hour/week = 6 weeks 1. PSG Child Groups (1 hour/week = 6 weeks) vi. The Whole Brain Child Training —1 hour/week= 4 weeks 1. Social -Emotional Skills Group (1 hour = 4 weeks) vii. The Growing Brain (0-5) Training — 2 hours/week = 8 weeks . 1. Dina School (2 hours — 8 weeks) viii. Parents as Teachers — 1 hour/every other week = 1 year in home c. Goals of Service: i. Foster parents will have skills, strategies and abilities to promote positive relationships and address the trauma and challenging behaviors that are present with children in their care under the age of eight (8) years. ii. Adult caregivers will promote social and emotional development. iii. Adult groups will be based on Cognitive Behavioral Theories and incorporate effective adult learning strategies to strengthen relationships and give a deeper understanding of trauma and early brain development iv. Child groups are abased experiential and behavioral learning appropriate for young children and focus on increasing regulation and problem -solving skills while building a sense of trust and safety for children that may have experienced ruptures and trauma. d. Outcomes of Service: 1 i. Foster parents will feel more capable of supporting the needs of the young children in their care that have experienced loss, trauma or ruptures in their early years. ii. Adult caregivers will have specific strategies that assist them in having consistent, predictable and nurturing interaction that promotes response relationships and attachment in the adult/child relationship. iii. Children will be assessed in group and supported to the appropriate level of care that their presenting needs require. e. Target Population: i. Foster parents of infants, toddlers and preschool age children, ages birth to six (6) years of age. ii. Dina School and The Whole Brain Child can serve children up to age eight (8). f. Service Access: i. Littler Prevention Campus, 2350 West 3`a Street Road, Greeley, CO. ii. South County services will vary based on need and numbers to impact. Groups will occur at the Contractor's office or High Plains Library District locations in Frederick or Erie. g. Language: English and Spanish. The Positive Solutions Groupis also available in Somali, Swahili, Burmese and Rahinga. 3. Functional Family Therapy: Contractor will provide services in accordance•with Function Family Therapy licensing agreements consultant directives. Services will include pre, post and intermittent assessments and trauma focused training. All services are overseen/supervised by a licensed professional and Functional Family Therapy National Consultant. a. Capacity for Services: i. Maximum: 40-45 youth' ii. Length of Treatment: 2-6 months, 1-2 hours per week b. Goals of Service: i. Empower families with the skills and resources needed to independently address the difficulties they have raising their children. ii. Empower youth to cope with family, peer, school and neighborhood problems. iii. Build community and natural support systems. iv. Decrease negatively and blame among family members. v. Decrease anti -social behavior to include legal' contacts, truancy and substance abuse issues. c. Outcomes of Services: i. Youth will be living in the home ii. Youth will be in school or working iii. Youth will have no new arrest or legal involvement d. Target Population: i. Ten (10) to 17 years of ages, male or female 1. Child must be at risk of out -of -home placement or transitioning back from placement within 30 days 2. Child is displaying moderate to severe behavioral problems in the home/school/community 3. Child demonstrates verbal and/or physical aggression at home/school/community 4. Child is engaged with deviant peer group 5. Child is struggling with school behaviors to include failing grades, truancy anti- social behaviors 2 ii. Family has persistent conflict and negative child -parent relationship iii. Caregiver is abusing substances iv. Family has limited resources and would benefit from psychoeducation and parenting skill development e. Service Access: i. Family interventions, cognitive/behavioral, family therapy, school and community -based interventions, and substance abuse intervention in -person throughout Weld County, as clinically appropriate ii. Bi-lingual therapist, case management, school interventions, advocacy, court/staffing participation, sustainability planning, booster services after discharge may be provided via phone, video conferencing or in person as needed. f. Language: English. Video translation available. 4. Multisystemic Therapy: Contractor will provide services in accordance with Multisystemic Therapy licensing agreements consultant directives. Services will include pre, post and intermittent assessments and trauma focused training. All services are overseen/supervised by a licensed professional and Multisystemic Therapy National Consultant. a. Capacity for Services: i. Maximum: 50-70 youth ii. Length of Treatment: 2-5 months iii. Intensity of Service: 3-5 hours per week b. Goals of Service: i. Empower families with the skills and resources needed to independentlyaddress the difficulties they have managing their children. ii. Empower youth to cope with family, peer, school and neighborhood problems. iii. Build community and natural support systems. iv. Decrease anti -social behavior. c. Outcomes of Services: i. Youth will be living in the home ii. Youth will be in school or working iii. Youth will have no new arrests iv. Caregivers will have the parenting skills necessary to handle future problems v. Improved family relations vi. Improved family network of supports vii. Youth will have increased success in educational/vocational setting viii. Youth will be involved with prosocial peers and activities ix. Changes will be sustained d. Target Population: i. Twelve (12) to 17 years of ages, male or female 1. Child must be at risk of out -of -home placement or returning from placement 2. Child is involved in criminal behavior 3. Child is abusing substances 4. Behavior is chronic S. Child engaged with deviant peers 6. Child is struggling in school 7. Child is displaying moderate to severe behavior problems ii. Family has persistent conflict and negative child -parent relationship iii. Caregiver is abusing substances 3 iv. Family has limited resources and would benefit from psychoeducation and parenting skill development e'. . Service Access: i. In -home caregiver interventions, cognitive/behavioral, family therapy, individual therapy, and school and community -based interventions, in -person throughout Weld County, as clinically appropriate ii. 24/7 on -call services, case management, school interventions, advocacy, court/staffing participation, and sustainability planning may be provided via phone, video conferencing or in person as needed. f. Language: English. Video translation available. 5. Monitored Sobriety Services: Various urinalysis, breathalyzer, oral swab, patch, and hair testing. a. Capacity for Services: 24/7 access b. • Goals of service: Contractor will provide observed monitored sobriety testing and communicate results in a timely fashion c. Outcomes of Service: i. Confirmation of all positive and negative monitored sobriety results for a Breathalyzer within in 24 hours through a phone call, test results, email, and/or fax to the referring caseworker. ii. Confirmation of all positive and negative monitored sobriety results for Urinalysis once lab processing has been completed, typically within five (5) business days. iii. Instant Urinalysis results will be reported within 24 hours. If the result is positive, the results will be to the lab for final confirmation. ' d. Target Population: Any individual the Department identifies as needing monitored sobriety services. e. Service Access: i. Crisis Stabilization Services, 1140 M Street, Greeley, CO. ii. 24 hours a day/seven (7) day per week. iii: In person only. iv. Contractor will contact DHS to confirm referral of the client for monitoring services. f. Language: English. Video translation available. 6. 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. 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). 8. 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 9. 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. 10. Contractor will identify in detail areas of continued concem and make recommendations to the Department regarding continuation of services and/or the need for additional services. 11. 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. 12. 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. 13. 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. 14. 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. 15. 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. 5 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 Foster Care/Adoption Services $8.30/Hour (Foster Care -Advanced Incredible Years Parent Group) $20.00/Hour (Foster Cate -Dina School Group) $8.30/Hour (Foster Care -Incredible Babies Group) $8.32/Hour (Foster Care -Incredible Years Parent Group) $33.00/Hour (Foster Care -Parents as Teachers Group) $15.00/Hour (Foster Care -Positive Solutions Group) $6.88/Hour (Foster Care -The Growing Brain Group) $25.00/Hour (Foster Care -Whole Brain Child Group) $8.30/Hour (Kindship-Advanced Incredible Years Parent Group) $20.00/Hour (Kinship -Dina School Group) $8.30/Hour (Kinship -Incredible Babies Group) $8.32/Hour (Kinship -Incredible Years Parents Group) $33.00/Hour (Kinship -Parents as Teachers Group) $15.00/Hour (Kinship -Positive Solutions Group) $6.88/Hour (Kinship -The Growing Brain Group) $25.00/Hour (Kinship -Whole Brain Child Group) Functional Family Therapy $700.00/Month (Functional Family Therapy) Monitored Sobriety Services $20.00/Test (5 -Panel Urinalysis) $20.00/Test (7 -Panel Urinalysis) $5.00/Test(Breathalyzer) $35.00/Drug (Confirmation of Positive Result per substance confirmed/retested) $35.00/Test (Ethyl Glucuronide/EtG Test) $100.00/Test (Hair Testing) $20.00/Test (Instant Swab) $20.00/Test (Multi -Panel Instant UA) $20.00/Test (Oral Swab -6 Panel) $35.00/Test (Oral Swab -Synthetic Cannabinoids "Spice") $2.00/Test (Oxycodone or Buprenorphine Add-on Test to 5 or 7 Panel) $65.00/Test (Patch Monitoring) $2.00/Test (Single Panel EtG Add-on Test, added to 5 or 7 Panel UA) $35.00/Test (UA-Synthetic Cannabinoids "Spice") Multisystemic Therapy $1,800.00/Month (Multisystemic Therapy) 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 7"' 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. Hello