HomeMy WebLinkAbout20211642.tiffRESOLUTION
RE: APPROVE STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR
INDIVIDUAL PROVIDER CONTRACTS FOR PURCHASE OF FOSTER CARE
SERVICES IN A FOSTER CARE HOME AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Standard Form of Agreement, Rates,
and Provider List for Individual Provider Contracts for Purchase of Foster Care Services in a
Foster Care Home between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Human Services, and the
various providers as shown on the attached provider list, with further terms and conditions being
as stated in said standard form, and
Exhibit A to CWS-7A Individual Provider Contract for Purchase
of Foster Care Services in a Foster Care Home
WHEREAS, after review, the Board deems it advisable to approve said standard form,
rates, and provider list, copies of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Standard Form of Agreement, Rates, and Provider List for
Individual Provider Contracts for Purchase of Foster Care Services in a Foster Care Home
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and the various
providers as shown on the attached provider list, be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign any contracts consistent with said standard form.
Cc: HSO4 cA(Kmic,1 ,
AGTCsc/CD), cT6(cR)
07/07/2I
2021-1642
HR0093
STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR INDIVIDUAL
PROVIDER CONTRACTS FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER
CARE HOME
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 23rd day of June, A.D., 2021.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:
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Weld County Clerk to the Board
BY:
Deputy Clerk to the Board
APP:: !L -='""ARM:
County Attorney
Date of signature: III
ZI
Steve Moreno, C air
2021-1642
HR0093
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: June 15, 2021
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Weld County Department of Human Services' Child
Welfare Request to Approve 2021-22 SFY Out -of -
Home (OOH) Foster and Kinship Care Provider
Contract Template, OOH Provider List and
Associated Rates.
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of Department's Child Welfare 2021-22 SFY Out -of -Home
(OOH) CWS-7A Individual Provider Contract for Purchase of Foster Care Services with
Exhibit A, Foster and IGuship Care Provider List, and Associated Rates. The State requires
Counties to enter into agreements with providers for the purchase of OOH services and has
established the CWS-7A as the State prescribed agreement for County certified foster and
kinship care services. Counties are unable to alter the State CWS-7A agreement, therefore Weld
County has chosen to add County specific requirements for these providers within the Exhibit A.
This Exhibit has been reviewed by Assistant County Attorney, Gabe Kalousek, and approved for
use for the 2021-22 contract year. Upon approval by the Board, individual provider contracts
will be issued and processed through CMS.
The term of these contracts is based on the certification/recertification date of each provider and
is valid for one year. The following information is attached for your review:
1. CWS-7A Individual Provider Contract template with Exhibit A,
2. List of out -of -home providers for SFY 2021-22.
The service rate will be the State approved base anchor rate as outlined by the Colorado Office
of Children, Youth & Families Division of Child Welfare, unless the Provider and County agree
to utilize the Inventory for Client and Agency Planning (1CAP) assessment and corresponding
rate structure for children who have significant intellectual or developmental disabilities or
intensive medical or physical needs. The Joint Budget Committee has indicated that there may be
a rate change to OO14 provider rates for SFY 2021-22, but the Department has not been officially
notified at this time.
Pass -Around Memorandum; June 15, 2021 — Not in CMS
Page I
2021 -1 642
{-18009 3
PRIVILEGED AND CONFIDENTIAL
I do not recommend a Work Session. I recommend approval of the contract exhibit template,
provider rates, and listed OOH County foster/kinship providers and authorize the Chair to sign
approved contracts.
Approve Schedule
Recommendariori Work Session Other/Comments:
Perry L. Buck
Mike Freeman
Scott K. James, Pro-Tem
Steve Moreno, Chair
Lori Saine
Pass -Around Memorandum; June 15, 2021 —Not in CMS
Page 2
COLORADO
Office of Children,
Youth & Families
Department of Human Services
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date, by and between the Weld County
Department of Human Services, P. O. Box A, Greeley, CO 80632, hereinafter called "County Department" and
<Last Name>, <First Name(s)>, <Address>, <City>, <ST> <Zip>, hereinafter called "Provider".
2. This Contract and Agreement shall be effective from and continue in force until or
until the facility certificate is revoked or surrendered. This contract and agreement may be renewed at any time
during the term of the valid facility certificate. This contract and agreement is in lieu of and supersedes all prior
purchase contracts between the parties hereto and relating to the services herein described.
3. The Provider holds a valid certificateas a <Foster or Kinship> Care home. Such certification standards shall
be maintained during the term hereof. The provider has read and is fully familiar with the "Rules Regulating
Foster Care Homes" issued by the Colorado Department of Human Services.
4. The County Department may but shall not be obligated to purchase foster care home services. The County
Department or any duly authorized agent may request such services to be provided to any child or youth at any
time within the limits of the certificate and without prior notice. At such time or as soon as possible after the
acceptance of a child or youth for services, the County Department and the Provider shall verify foster care
placement of each child or youth in writing on the required form, which shall become an addendum to this contract,
subject to all the terms and conditions hereof.
5. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and Addendum 1,
which form integral parts of this Agreement. Exhibit A and Addendum 1 are specifically incorporated herein by this
reference.
The Provider agrees:
1. To furnish foster care services to eligible children and youth at the established rate based on the individual
child or youth rates negotiated between the county department and the provider;
2. To safely provide the 24 -hour physical care and supervision of each child or youth until removed or
until the agreement is renewed;
3. To accept a child or youth, only with the approval of the certifying agency;
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans -for a child or youth in placement, including visits with their
parents, siblings, relatives, or to transition to another foster care facility;
5. To maintain approved standards of care as set by the Colorado Department of Human Services;
6. To maintain the confidentiality of information shared about the child or youth and his/her family;
7. Not to accept money from parents or guardians;
8. Not to make any independent agreement with parents or guardians;
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John W. Hickenlooper, Governor Reggie Bicha, Executive Director
1
9. Not to release the child or youth to anyone without prior authorization from the County Department;
10. To allow representatives of the County Department to visit the foster care home and to meet with the
child or youth at any reasonable time, including scheduled and unscheduled visits; and,
11. To give the County Department a 30 -day notice, except in an emergency, to remove a child or youth
for placement elsewhere, and to work with the County Department as requested to prepare the child or
youth for another placement.
12. To provide transportation to the child or youth. The amount of transportation to be provided will be
agreed upon at placement and may be changed upon mutual agreement of the provider and the
County Department, as recorded in the Family Service Plan. Transportation must be provided or
arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For children or youth to participate in age or developmentally appropriate extracurricular, enrichment,
cultural, and social activities.
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
d. Any significant change in the sleeping arrangement for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, school/school district staff, or other persons
in authority;
g. Any emergency;
h. Any pertinent discussion with parents or guardians about the child or youth or supervising agency; and,
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA of 1990, concerning
discrimination on the basis of race, color, sex, age, sexual orientation, expression, or identity, religion, political beliefs,
national origin, or handicapping condition.
15. To complete pre -service training prior to the placement of a child or youth.
16. Toannually:
a. Update the Training Development Plan with the County Department;
b. Complete ongoing, quality, and relevant training that will build competencies to meet the needs of the
children and youth served in the foster care home as required by the Colorado Department of Human
Services regulations; and,
c. Obtain certification to use and apply the reasonable and prudent parent standard for each child or youth served
in the foster care home.
17. To attend semi-annual Administrative Reviews for a child or youth in placement.
18. To be knowledgeable of, and comply with the "Rules Regulating Foster Care Homes" and the "General Rules for
Child Care Facilities;
19. Not to enter into any subordinate subcontract hereunder;
20. To keep required and necessary records for audit/review purposes by state and federal personnel. These records
shall document the type of care and dates that care is provided for each child or youth. In addition, medical,
educational, and progress summary records shall be maintained for each child or youth as required pursuant to the
Colorado Department of Human Services' Rules Regulating Family Foster Care Homes.
21. To complete or schedule a medical examination for the child or youth within 14 days after initial placement and a
dental examination within eight weeks of initial placement;
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
2
The County Department agrees:
1. To share all available information about the child or youth, including relevant social, medical and educational history,
behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics
of the child or youth, with the provider before placement and to share additional information when obtained while
the child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as meeting medical needs,
visitation, special psychological needs, trauma and other grief/loss issues, and the child's or youth's identification with
his/herfamily;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the Family Service Plan, as it pertains to their expectations for meeting the needs of the
child or youth in the foster care home, at the time of placement or when it is completed following placement;
7. To give at least a 30 -day notice of plans to remove a child or youth from the foster care home. The 30 -day notice may
be waived by mutual consent to allow and permit immediate removal of a child or youth for placement elsewhere,
or without such waiver in the event of an emergency. An emergency is defined as any situation in which a provider's
inability to provide services threatens the health, safety or welfare of a child or youth.
8. To pay the provider at the rates established by the Colorado Department of Human Services or as authorized and
negotiated between the provider and the County Department:
a. Payment shall be made by electronic banking transfers (EBT) drawn by the duly authorized county officer; and,
b. Provider shall notify the County Department of any payment or billing dispute within 60 days of the month
when service was provided. Failure to do so will result in forfeiture of the payment. The Provider understands
that, pursuant to the Colorado Department of Human Services' Rules for the General Reimbursement for Child
Welfare Services, when reimbursement is warranted current and (2) preceding months.
9. To provide or arrange through statewide contracted training, a minimum of twelve hours of core pre -service
training for foster care homes and 15 hours of pre -service training directed at the needs of the child or youth to be
served in the foster care home.
10. To annually complete the following:
a. Update the Training Development Plan with the provider;
b. Provide or make available quality and relevant training for each foster parent that will build competencies to
meet the needs of the children and youth served in the foster care home;
c. Provide training that prepares each foster parent to use and apply the reasonable and prudent parent
standard; and,
d. Pursuant to the Colorado Department of Human Services' Rules Regulating Family Foster Care Homes,
document that the provider is trained in, and can use and apply the reasonable and prudent parent standard
for each child or youth placed in the foster care home.
11. The County Department is responsible for providing information on county specific procedures.
12. To invite the provider to Administrative Reviews for each child or youth in placement.
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
3
13. To incorporate provider information in planning for the child or youth placed in the foster care home.
14. To assure that the service described herein has been accomplished and a record made thereof on a case by case
basis.
15. To provide notice of court hearings for each child or youth placed in the foster care home.
County Department (type or print)
Signature Date
WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above.
COUNTY:
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Clerk to the Board Steve Moreno, Chair
PROVIDER:
Provider (type or print)
Signature Date
Provider (type or print)
Signature Date
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
4
jE)CHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase Foster Care
Services and Foster Care Facility Agreement CWS-7A
The following additional provisions in this Exhibit A and Addendum 1 apply to the agreement entitled, "Individual Provider
Contract for Purpose of Foster Care Services and Foster Care Facility Agreement," by and between the Weld County
Department of Human Services, hereinafter referred to as, "County," and <Last Name>, <First Name(s)> Provider
ID#<Provider Number>, hereinafter referred to as, "Provider."
GENERAL PROVISIONS
1. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least
thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon
the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first,
and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon
cease; however, the parties shall not be released from the duty to perform their obligations up to the date of
termination. This provision does not affect removal of a child in an emergencysituation.
2. Provider agrees that Provider is an independent contractor and that neither Provider nor Provider's agents or
employees are, or shall be deemed to be, agents or employees of the County for any purpose. Provider shall
have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The
parties agree that Provider will not become an employee of County. Provider shall be solely and entirely
responsible for its acts or of any agent, employee, servants and sub -Providers during the performance of this
Agreement. Provider is not entitled to unemployment insurance or workers' compensation benefits
through Weld County and Weld County shall not pay for or otherwise provide such coverage for Provider.
Unemployment insurance benefits will not be available to Provider for services provided under this
Agreement. Provider shall pay when due any/all applicable employment taxes and income taxes and local
head taxes (if applicable) incurred as a result of the services provided under this Agreement.
3. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the
purpose thereof.
4. This Exhibit A is intended to be applied in conjunction with the attached Agreement as the complete integration of
all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment
hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation,
renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part
of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this
Agreement in writing, if agreed to by both parties. The Agreement, this Exhibit A and the rate Addendums are
intended to be in lieu of and supersede all prior agreements between the parties hereto and relating to the care
and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is permitted to monitor
the service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are
carried out for the benefit of the aforementioned child or youth. Monitoring may occur through review of program
reports, on -site visits where applicable and other Agreements as deemed necessary. Provider understands that
the State Department and the County may provide consultation to Provider to assure satisfactory performance in
the provision of purchased services under this Agreement.
6. County shall have access to Provider's service program, financial and other records, which will sufficiently and
properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement for
purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder
and shall be retained and available for audit purposes for at least five years after final payment hereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
8. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to
perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable
control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the
Exhibit A to the CWS-7A
5 Revised 6/2021
other party at that party's address as stated in this Agreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to perform services of
the same or similar nature.
11. Provider certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will
perform work under this contract. Provider will confirm the employment eligibility of all employees who are newly
hired for employment in the United States to perform work under this Agreement, through participation in the E -
Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Provider shall
not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a
contract with a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement. Provider shall not use E -Verify Program or
State of Colorado program procedures to undertake pre -employment screening or job applicants while this
Agreement is being performed. If Provider obtains actual knowledge that a sub -contractor performing work under
the public contract for services knowingly employs or contracts with an illegal alien Provider shall notify the sub-
contractor and County within three (3) days that Provider has actual knowledge that a sub -contractor is employing
or contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not stop employing
or contracting with the illegal alien within three (3) days of receiving notice. Provider shall not terminate the
contract if within three days the sub -contractor provides information to establish that the sub -contractor has not
knowingly employed or contracted with an illegal alien. Provider shall comply with reasonable requests made in
the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of
Labor and Employment. If Provider participates in the State of Colorado program, Contract Professional shall,
within twenty days after hiring a new employee to perform work under the contract, affirm that Provider has
examined the legal work status of such employee, retained file copies of the documents, and not altered or
falsified the identification documents for such employees. Provider shall deliver to County, a written notarized
affirmation that it has examined the legal work status of such employee, and shall comply with all of the other
requirements of the State of Colorado program. If Provider fails to comply with any requirement of this provision or
of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Provider
shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5 103(3), if Provider receives
federal or state funds under the contract, Provider must confirm that any individual natural person eighteen (18)
years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such
individual applies for public benefits provided under the contract. If Provider operates as a sole proprietor, it
hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise
lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification
required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by
C.R.S. § 24-76.5-103 prior to the effective date of the contract.
12. Provider assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily
excluded from covered transactions by a federal department or agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting
to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state,
or local) with commission of any of the offenses enumerated in paragraph (B) above.
d. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal,
state, and local) terminated for cause ordefault.
13. In addition to terminating this Agreement in accordance with the provisions herein, County may exercise the
following remedial actions if the County finds and determines that the Provider has substantially failed to satisfy
the duties found in this Agreement and Exhibit A Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider. These remedial actions include, but are not
limited to, any one or more of the following:
Exhibit A to the CWS-7A
6 Revised 6/2021
a. Withhold payment to Provider until the necessary services or corrections in performance are satisfactorily
completed.
b. Deny payment or recover reimbursement for those services or deliverables which have not been performed
and which due to circumstances caused by Provider cannot be performed or if performed would be of no
value to County. Denial of the amount of payment shall be reasonably related to the amount of work or
deliverables lost to County.
c. Recover from Provider any incorrect payment to Provider due to omission, error, fraud, and/or defalcation by
deducting from subsequent payments under this Agreement, or other agreements between County and
Provider, or as a debt to County, or otherwise as provided by law.
14. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all
rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their
assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by
any other person not included in this Agreement. It is the express intention of the undersigned parties that any
entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement
shall be an incidental beneficiary only.
15. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or
employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that
did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge
and agree that no part of this Agreement is intended to circumvent or replace such immunities.
16. Provider shall promptly notify County in the event in which it is a party defendant or respondent in a case, which
involves services provided under the agreement. The Provider, within five (5) calendar days after being served
with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative
agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure.
17. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in
accordance with the policies, procedures, and practices of County. Provider shall strictly comply with all
applicable federal and State laws, rules and regulations in effect or hereafter established.
18. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose
being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not
create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year.
19. County agrees to purchase, and Provider agrees to provide the care and services, which are listed in this
Agreement. The State approved rate for Child Maintenance/Respite will be paid for any child placed with the
Provider unless the Inventory for Client and Agency Planning (ICAP) assessment has been completed due to
Intellectual or Developmental Disabilities, intensive medical/physical needs, or limitations that interfere with daily
life functioning. The ICAP assessment will determine the reimbursement rate as specified in Addendum 1.
20. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's temporary absence from a
facility; however, if the absence is a result of hospitalization the maximum bed hold authorization may be up to 14
days. Bed hold requests must have prior written authorization from the Department Administrator or Designee
before payment will be release to Provider.
21. Any additional costs for specialized services, which may include but are not limited to; Co -pays, deductibles, or
services not covered by Medicaid, will need to be authorized, in writing by the Department Administrator, prior to
the service being performed. Any payment for specialized services not authorized in writing may be denied.
22. All reimbursement requests shall:
a. Be submitted in a format approved by the County. If submitted in an unapproved format or inadequate
documentation is provided, the County reserves the right to deny payment.
b. Be submitted by the 4th of each month following the month of service. If the reimbursement request is not
submitted within twenty-five (25) calendar days ofthe month following service, it may result in forfeiture of
payment.
Exhibit A to the CWS-7A
7 Revised 6/2021
c. Placement service reimbursement shall be paid from the date of placement up to, but not including the day of
discharge.
d. Transportation reimbursement shall be for visitation purposes or transportation to school if out of county and
with prior approval only If medical transportation is needed, Provider will arrange reimbursement through
Medicaid. Any other special requests for transportation reimbursement shall require prior approval by the
Resource Manager or the Department Administrator.
e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the clothing allowance
form provided by the Foster Care Coordinator.
23. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal
items brought to Provider by the children, Provider shall be released from responsibility for loss or damage to such
personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado
Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal
laws and regulations, as such, which may be amended from time to time, and shall be binding on Provider and
control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services provided under this
Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the express written
approval of the Director of the County Department or his/her appointed designee.
4. Maintain at all times during the term of this Agreement a liability insurance policy of atleast $25,000 for property
damage liability, $150,000 for injury and/or damage to any one person, and $500,000 for total injuries arising from
any one accident. Provider shall provide a certificate of insurance provided by its insurer upon request by County.
5. Indemnify the County against any and loss against all claims and actions based upon or arising out of damage or
injury, including death, to persons or property caused or sustained in connection with the performance of this
Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation
and the defense of any such claims or actions.
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings, if requested by the
Department. County staff shall notify the Provider of the dates and times attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations. These requests
shall be made through the child's caseworker and/or the Provider's Foster Care Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors hired by the Weld
County Department of Human Services to preserve placement in the least restrictive placement appropriate,
comply with the treatment plan of the child, and attend court hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completedwithin 8 weeks of the
child being placed with Provider. All documentation of these examinations will be placed in the foster child's
placement binder.
10. Attend all necessary school meetings and support any plan that is developed regarding the child in order to
promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or suspected child abuse or
neglect as set forth in Section 19-3-304, C.R.S.
12. Maintain, access and review information monthly on Binti.
13. Maintain/update information in the foster child's binder, either hard copy or in Binti. The binder will be reviewed on
a monthly basis and signed off by child's caseworker and/or the Provider's Foster Care Coordinator.
Exhibit A to the CWS-7A
8 Revised 6/2021
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. Comply with all County and State certification requirements as set forth in the State Department rules, Staff Manual
Volume VII and the Weld County Department of Human Services Policy and Procedure manual.
Exhibit A to the CWS-7A
9 Revised 6/2021
ADDENDUM 1
Inventory for Client and Agency Planning (ICAP) Rates
ICAP IDD Level
Child Maintenance
Daily Rate
Level 1
$97.11
Level 2
$112.64
Level 3
$123.75
Level 4
$134.86
Level 5
$154.94
Level 6
$194.75
Medically Fragile
Level 1
$54.73
Level 2
$110.30
Level 3
$165.88
Level 4
Negotiate up to $200
Exhibit A to the CWS-7A
10 Revised 6/2021
Weld
County Foster and Kinship Providers
SFY 2021-2022
-
Provider Last Name Provider First Name
Co -provider Last
Name
Co -provider First
Name
Address street City
State
Zip Code
Trails ID
Family
Type
1
AGONE
TALIA
,E ORE
LANSING
833 Columbine Drive
WINDSOR
CO
80550
1694421
Foster
2
AIKENS
CARLY
AIKENS
GEORGE
22250 WCR 62
GREELEY
CO
80631
1718610
Foster
3
ALLEY
MICHAEL
MAI
TRENTON
1966 E 167th Dr.
THORNTON
CO
80602
1702702
Foster
4
Arce
Johanna
3038 17th Street Apt B
Greeley
CO
80631
1745668
Kinship
5
ARMSTRONG
NICOLE
ARMSTRONG
ZACHARY
108 N 50th Ave
GREELEY
CO
80634
1723158
Foster
6
Augustin
Le'Andra
Speier
William
5115 W. 16th Street
Greeley
CO
80634
1752483
Kinship
7
BALDWIN
TIERNEY
BALDWIN
DANNY
10377 S Crescent
FIRESTONE
CO
80504
1717778
Foster
8
BAUER
JENNIFER
BAUER
MICHAEL
442 La Costa Lane
JOHNSTOWN
CO
80534
1733364
Foster
9
BERRELEZ
YVETTE
BERRELEZ
MATTHEW
247 63rd Ave
GREELEY
CO
80634
1728772
Foster
10
BERRY
CYNTHIA
8390 Brandywine Ave
FREDERICK
CO
80504
1734868
Foster
11
BORCHERT
JESSICA
BORCHERT
DAVID
625 Dukes Way
Dacono
CO
80514
1729136
Foster
12
Borskie
Lea
Borskie
John
N. 3332 Laurel Rd
Lake Geneva
WI
53147
1748636
Kinship
13
BRAUNAGEL
KAREN
1775 Laurus Lane
JOHNST0WN
CO
80534
1714402
Foster
14
BRINKERHOFF
SAMANTHA
BRINKERHOFF
ZAQURI
1968 Sweet Pea Drive
WINDSOR
CO
80550
1739843
Foster
15
BROWN
SAMANTHA
BROWN
DUSTIN
1114 50th Ave
GREELEY
CO
80634
1739396
Foster
16
Call
Paula
Call
Shaun
533 E 28th Street, Rd
Greeley
CO
80631
1737209
Foster
17
Cano
Leah
Cano
John
515 Ruby Dr
Fort Collins
CO
80525
14703
Foster
18
CASEY
ROBERT
CASEY
ELYSE
2330 6th Ave
GREELEY
CO
80631
1734522
Foster
19
CASTANEDA
NATALIE
CASTANEDA
FREDDY
2837 Avocado Avenue
GREELEY
CO
80631
1678403
Foster
20
Chavez
Sonia
10437 Butte Dr
Longmont
CO
80504
1748760
Kinship
21
CLARK
KACI
CLARK
DAVID
1862 18th Ave
GREELEY
CO
80631
1725980
Foster
22
CLARK
WENDY
SMITH
JOSHUA
7220 Fort Morgan Drive
FORT COLLINS
CO
80525
1603929
Foster
23
Collins
Arnie
Collins
Justin
8211 Mentra Street
Anchorage
AK
99518
1749447
Kinship
24
CRAMER
ANA
CRAMER
EUGENE
501 Sundance Circle
DACONO
CO
80514
1736004
Kinship
25
Crawford
Cassy
Rutledge
Ryan
342 Scotch Pine Court
Severance
CO
80550
1748633
Foster
26
Cross
Hannah
Cross
Taylor
22975 County Road 40
LaSalle
CO
80645
1739954
Foster
27
CUNLIFFE
ANNE
CUNLIFFE
LEVI
1211 Nova Place
ERIE
CO
80516
1740368 i
Foster
28
Curley
Brett
Ochoa
Belinda
1117 Nantucket St.
Windsor
CO
80550
1745625
Foster
29
DENNIS
ESTHER
GRIGSBY
MICHAEL
5502 W 3rd Street
GREELEY
CO
80634
1687385
Foster
30
Deutsch
Celine
Deutsch
Nicolas
2198 30th St., Apt 123
Greeley
CO
80631
1751838
Foster
31
DUNN
JAMES
DUNN
GARI
413 Ash Street
KERSEY
CO
80644
1714413
Foster
32
Ebert
Charlotte
402 West Frontier Parkway
Oberlin
KS
67749
1724521
Kinship
33
Egret
Cookie
Shillington
Meghan
8216 Hallett Ct
FORT COLLINS
CO
80528
1741160
Foster
34
Fretwell
Crystal
Fretwell
Steven
4121 W 4th Street Rd
Greeley
CO
80634
1749771
Foster
35
GILBERT
TATUM
GILBERT
CHRISTOPHER
2109 Outer Banks
WINDSOR
CO
80550
1744875
Kinship
36
Grigson
Megan
Grigson
Coniah
2139 68th Ave
Greeley
CO
80634
1749221
Kinship
37
GROSS
JENNIFER
GROSS
NATHAN
1861 12 Avenue
GREELEY
CO
80631
1718928
Foster
38
Grover
Chelsey
Grover
Andrew
24474 CR 26
LaJunta
CO
81050
1756011
Kinship
39
Hammond
Nikki
Hammond
Winston
888 Willow Dr
Lochbuie
CO
80603
1743809
Foster
40
Hecker
Angela
Hecker
Kaci
2303 76th Ave Ct
Greeley
CO
80634
1743691
Foster
_ Weld County Foster and Kinship Providers
SFY 2021-2022
- Provider Last Name
Provider First Name
Co -provider Last
Name
Co -provider First
Name Address street
City
State Zip Code
Family
Trails ID Type
41
Heller
Molly
Heller
Brian
5568 Longs. Peaks Street
Brighton
CO
80601
1752136
Kinship
42
Hernandez
Shelby
Hernandez II
Matthew
8823 15th Street
Greeley
CO
80634
1750326
Kinship
43
IBARRA
ERIC
GOMEZ
MAIRA
200 N 35th Ave #219
GREELEY
CO
80634
1707673
Foster
44
JEFFERY
JAMIE
WALKER
TIMOTHY
339 Valley Ave
LOCHBUIE
CO
80603
1708865
Foster
45
Johnson
Alana
Johnson
Joshua
9981 Bountiful Street
Firestone
CO
80504
1625365
Foster
46
Johnson
Trevor
Johnson
Angela
1914 84th Ave
GREELEY
CO
80634
1723996
Foster
47
KLEIN-TROYER
CYNTHIA
TROYER
RODNEY
2625 28th Ave
GREELEY
CO
80634
98370
Foster
48
Knutson
Melissa
932 Charlton Dr.
Windsor
CO
80550
1747566
Foster
49
KORBY
STEPHANIE
KORBY
TRENTON
3105 70th Ave
GREELEY
CO
80634
1659973
Foster
50
Larson
Lynnelle
Larson
Shannon
550 Birch
Dacono
CO
80514
1753870
Kinship
51
LAZUICK-MARIN
JUSTINE
MARIN
GILBERT
25000 CR 69
KERSEY
CO
80644
1661206
Foster
52
LECHMAN
PAMELA
LECH MAN
JAY
3608 Palermo Ave
EVANS
CO
80620
1587465
Foster
53
Ledford
Dylan
Ledford'
Taylor
5177 Crowther Lane
Alamosa CO
CO
81101
1746201
Kinship
54
Lind
PATRICIA
DALBY
KATHERINE
1611 15th Ave
GREELEY
CO
80631
1658999
Foster
55
LOPEZ
VINCENT
LOPEZ
ROSE
1110 Ibex Drive
Severance
CO
80550
1725071
Foster
56
Mann
Jocie
Mann
Kyle
615 E 23rd Street
Greeley
CO
80634
1749150
Kinship
57
MARCOS
SHANTAY
MARCOS
MARCEL
501 Dakota Ct,
WINDSOR
CO
80550
1732887
Foster
58
MARONEK
PATRICIA
2929 56th Ave.
GREELEY
CO
80634
1520627
Foster
59
MARS
MADDISEN
MARS
ZACHARY
180 Muscovey Lane
JOHNSTOWN
CO
80534
1721766
Foster
60
Martin
Sherry
Martin
Nicholas
2304 Talon Parkway
Greeley
CO
80634
1746250
Foster
61
MATHIES
LEILANI
MATHIES
ROBERT
1106 S. Park Ave
JOHNSTOWN
CO
80534
1694008
Foster
62
MAXWELL
SHAY
MAXWELL
WILLIAM
3114 66th Avenue Ct.
GREELEY
CO
80634
1737476
Foster
63
McCubbin
Crystal
Kennedy
Jesse
4919 St. Vrain Rd.
Firestone
CO
80504
1748208
Foster
64
McDonald
Angela
McDonald
Tad
8526 Seattle Slew Lane
Wellington
CO
80549
1753177
Kinship
65
MCKETA
STEVE
MCKETA
CLORISA
1870 Chesapeake Circle
JOHNSTOWN
CO
80534
1728774
Foster
66
MENZEL
KATHRINA
MENZEL
JARED
6025 Lynx Creek Circle
FREDERICK
CO
80530
1707638
Foster
67
MUTH
RACHEL
MUTH
BRYAN
2306 Sunset Lane
GREELEY
CO
80634
1742038 'Foster
68
Nix
Amanda
Nix
Randall
2124 Village Drive
Milliken
CO
80543
1747311
Foster
69
Parrish
Joani
Parrish
Nicholas
5810 Graphite Street
Timnath
CO
80547
1634299
Foster
70
Pino
Ruby
Pino
Anthony
5012 W. 6th street Rd
Greeley
CO
80634
1742641
Kinship
71
POWELL
TERRIE
POWELL
ROBERT
19031 WCR 72
EATON
CO
80615
1643044
Kinship
72
PRIBBLE
KELLY
2000 80th Ave Ct
GREELEY
CO
80634
1659978
Foster
73
Puga-Oliver
Lynette
Oliver
Justin
1559 S Dusk Drive
Milliken
CO
80543
1738985
Foster
74
PURTELL
NICOLE
PURTELL
CHRISTOPHER
2391 Tate Ave
FORT LUPTON
CO
80620
1708813
Foster
75
Quinones Rivera
Kimberly
1808 1st Street Apt 3
Greeley
CO
80631
1748273
Kinship
76
Rivera
Angela
1769 30th Street Apartment 3
Greeley
CO
80634
1718391
Kinship
77
ROJAS
KATHLEEN
ROJAS MUNOZ
JOSE
4367 37th Street
EVANS
CO
80620
1553794
Foster
78
ROSALES
EMILIO
MARTINEZ
ESMERALDA
4315 W. 20th St. Rd
GREELEY
CO
80634
1636676
Kinship
79
SANCHEZ
TRACY
SANCHEZ
ISIDRO
423 28th Ave
GREELEY
CO
80634
1687293
Foster
80
Sanchez
Stephanie
135 20th Ave Ct
Greeley
CO
80631
1756851
Kinship
Weld County Foster and Kinship Providers
SFY 2021-2022
Provider Last Name
Provider First Name
Co -provider Last
Name
Co -provider First
Name
Address street City
State Zip Code
Family
Trails ID Type
Yp
81
SCHEER
JAMES
SCHEER
ELIZABETH
2744 County Fair lane
FT. COLLINS
CO
80528
1666078
Foster
82
SCHULZ
LINDSEY
6005 West 13th Street Road
GREELEY
CO
80634
1665608
Foster
83
SCUDDER
MIST!
SCUDDER
NATHAN
747 Rock Rd
EATON
CO
80615
1521113
Foster
84
SEADER
ERIN
SEADER
RYAN
319 Hackberry CT
EATON
CO
80615
1694425
Foster
85
Seitz
Lindsey
Seitz
Jonathan
5424 West 7th St. Rd.
Greeley
CO
80634
1748218
Foster
86
Snow
Nichole
Snow
Austin
2036 Day Spring Dr.
Windsor
CO
80550
1745854
Foster
87
STUMP
PATRICK
SOMMERS
MEGAN
5893 Maidenhead Dr
WINDSOR
CO
80550
1740805
Foster
88
Thomas
Maria
Thomas
Gary
3766 Rockaway Street
Fort Collins
CO
80526
1751061
Kinship
89
Thurman
Lauren
Thurman
Joel
4138 w 31st Street
Greeley
CO
80634
1708802
Kinship
90
Tisdale
Amy
Barnes
Wyatt
7694 N 63rd Street
Longmont
CO
80503
1754196
Foster
91
TORRES
DANIEL
TORRES
JEANNIE
6756 Sage Ave
FIRESTONE
CO
80504
1556847
Foster
92
VANCE
MORGAN
KINDVALL
BRANDON
500 Campbell Street
KERSEY
CO
80644
1703052
Foster
93
VANDENELZEN
DAWN
5819 W. 16TH St, Ln
GREELEY
CO
80634
44282
Foster
94
Vasquez Gonzales
Alma
Gasca
Felipe
3500 35th Ave Lot 75
Greeley
CO
80631
1740200
Foster
95
VEYETTE
AMANDA
VEYEIit
BRANDON
316 Cottonwood Ave
EATON
CO
80615
1733697
Foster
96
WALKER
KAYLA
WALKER
RENAE
235 W Shafer Ave
Pierce
CO
80650
1693525
Foster
97
WALKER
KURT
WALKER
JENNIFER
7681 Carlson Ct
FORT COLLINS
CO
80524
1546248
Foster
98
Weisdorfer
Stephanie
230 Platte Ct.
Eaton
CO
80615
1746103
Foster
99
WHITE
KRISTEN
1651 Kelmsley CT
WINDSOR
CO
80550
1711814
Foster
100
Wilson
Shelby
Wilson
Brian
15670 Havana Way
Brighton
CO
80602
1751247
Foster
101
Wilson
Shelly
Wilson
Scott
1391 South Foothill Drive
Lakewood
CO
80228
1743804
Kinship
102 WINTERFELD
RACHEL
4907 W 23rd Street Rd
GREELEY
CO
80634
1712735
Foster
103 Zetye
Rebecca
Zetye
Ken
2350 Black Duck Ave.
Johnstown
CO
80534
1750254
Foster
Hello