HomeMy WebLinkAbout20201732.tiffRESOLUTION
RE: APPROVE STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR
AMENDMENTS TO 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 Amendments to Individual Provider Contracts for Purchase of Foster Care
Services in a Foster Care Home between the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the Department of Human
Services, and the various providers as shown on the attached provider list, with further terms and
conditions being as stated in said standard form, and
1. Exhibit A to CWS-7A Individual Provider Contract for Purchase
of Foster Care Services in a Foster Care Home
WHEREAS, after review, the Board deems it advisable to approve said standard form,
rates, and provider list, copies of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Standard Form of Agreement, Rates, and Provider List for
Amendments to 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 contract/agreement amendments consistent with said standard form.
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2020-1732
HR0092
STANDARD FORM OF AGREEMENT, RATES, AND PROVIDER LIST FOR AMENDMENTS TO
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 10th day of June, A.D., 2020.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: dithA) ;e1
Weld County Clerk to the Board
County Attorney
Kevin D. Ross
Date of signature: CCd 931 &O
'120
Mike Freeman, Chair
2020-1732
HR0092
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: June 2, 2020
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Weld County Department of Human Services' Child
Welfare Request to Update 2020-21 SFY Out -of -
Home (OOH) Department Policy for Foster
Care/Kinship Care, Foster Care Provider Contract
Template (CWS-7A), and Weld County 2020-21
Foster and Kinship Provider List
Please review and indicate if you would like a work session prig to placing this item on the
Board's agenda.
Request Board Approval of Department's Child Welfare 2020-21 SFY OOH Policy for
Foster Care/Kinship Care, CWS-7A Individual Provider Contract for Purchase of Foster
Care Services in a Foster Care Home with Exhibit A, Foster Care/Kinship 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 these 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. Listed below and attached for your reference are the proposed updates to
WDHS policy 2.3.330 and the CWS-7A template with Exhibit A for the purchase of foster care
services. This updated policy and template have been reviewed by Assistant County Attorney,
Gabe Kalousek, and have been approved for our use for the 2020-21 contract year, at which time
individual provider contracts will be submitted through the CMS process. The term of these
contracts is based on the certification/recertification date of each provider and is valid for one
year. Weld County certified foster and kinship care homes will be reimbursed utilizing the Child
and Adolescent Needs and Strengths (CANS) assessment tool for children age 13 and older or
the state rate for children ages birth to 12 years of age. The following information is attached for
your review:
1. Updated Department Policy 2.3.330 regarding OOH Placements with County Certified
Foster Care and Kinship Care Homes (tracked and clean version)
2. CWS-7A Individual Provider Contract with Updated Exhibit A
3. Weld County 2020-21 Foster and Kinship Provider List
Pass -Around Memorandum; June 2, 2020 — Not in CMS
2020-1732
HRoo9a
PRIVII.,EGED AND CONFIDENTIAL
The Joint Budget Committee has indicated that there may be a rate change to OOH provider rates
for SFY 2020-21, but the Department has not been officially notified at this time. If informed by
the State that there will be changes, those rate adjustments will be communicated to the BOCC
for review and approval at which time new provider contract addendums may be issued.
I do not recommend a Work Session. I recommend approval of this Policy, Contract Template,
and Provider List.
Mike Freeman, Chair
Scott James
Barbara Kirkmeyer
Steve Moreno, Pro -Tern
Kevin Ross
Approve Schedule
Recommendation Work Session
Other/Comments:
Pass -Around Memorandum; June 2, 2020 — Not in CMS Page 2
AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND (VENDOR)
This Agreement Amendment, made and entered into day of 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 [Vendor], hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement to [for] , (the "Original
Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. fTyler
#1, approved on [BOCC Approval Datel.
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 [Date].
• 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.
2.
• 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.
COUNTY:
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Clerk to the Board (Current BOCC Chair Name), Chair
CONTRACTOR:
[Vendor]
[Address]
[City, State Zip]
By:
Date:
[Signature Authority], [Title]
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 theWeld 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
and 2, which form integral parts of this Agreement. Exhibit A and Addendum 1 and 2 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;
•Co
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
/876
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/her family;
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 Mike Freeman, 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
EXHIBIT 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 and Addendum 2, 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)>, 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 thisAgreement.
6. County shall have access to Provider's service program, financial and other records, which will sufficiently and
properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement for
purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder
and shall be retained and available for audit purposes for at least five years after final paymenthereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
Exhibit A to the CWS-7A
5 Revised 6/2020
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
other party at that party's address as stated in thisAgreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to perform services of
the same or similar nature.
11. Provider certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will
perform work under this contract. Provider will confirm the employment eligibility of all employees who are newly
hired for employment in the United States to perform work under this Agreement, through participation in the E -
Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Provider shall
not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a
contract with a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement. Provider shall not use E -Verify Program or
State of Colorado program procedures to undertake pre -employment screening or job applicants while this
Agreement is being performed. If Provider obtains actual knowledge that a sub -contractor performing work under
the public contract for services knowingly employs or contracts with an illegal alien Provider shall notify the sub-
contractor and County within three (3) days that Provider has actual knowledge that a sub -contractor is employing
or contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not stop employing
or contracting with the illegal alien within three (3) days of receiving notice. Provider shall not terminate the
contract if within three days the sub -contractor provides information to establish that the sub -contractor has not
knowingly employed or contracted with an illegal alien. Provider shall comply with reasonable requests made in
the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of
Labor and Employment. If Provider participates in the State of Colorado program, Contract Professional shall,
within twenty days after hiring a new employee to perform work under the contract, affirm that Provider has
examined the legal work status of such employee, retained file copies of the documents, and not altered or
falsified the identification documents for such employees. Provider shall deliver to County, a written notarized
affirmation that it has examined the legal work status of such employee, and shall comply with all of the other
requirements of the State of Colorado program. If Provider fails to comply with any requirement of this provision or
of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Provider
shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5 103(3), if Provider receives
federal or state funds under the contract, Provider must confirm that any individual natural person eighteen (18)
years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such
individual applies for public benefits provided under the contract. If Provider operates as a sole proprietor, it
hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise
lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification
required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by
C.R.S. § 24-76.5-103 prior to the effective date of the contract.
12. Provider assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily
excluded from covered transactions by a federal department or agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting
to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by agovernment entity (federal, state,
or local) with commission of any of the offenses enumerated in paragraph (B) above.
d. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal,
state, and local) terminated for cause ordefault.
Exhibit A to the CWS-7A
6 Revised 6/2020
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:
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 thisAgreement, 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 ofColorado and be in
accordance with the policies, procedures, and practices of County. Provider shall strictly comply with all
applicable federal and State laws, rules and regulations in effect or hereafter established.
18. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose
being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not
create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year.
19. County and Provider agree that the State approved base rate shall be used for the Child Maintenance rate for any
child age birth to 12 unless the child has severe behavioral challenges and is receiving intensive services and the
Child Welfare Director or designee approves use of the Child and Adolescent Needs and Strengths assessment
to determine the rate as specified in the Addendum 1. For any child age 13 or older, the Child and Adolescent
Needs and Strengths assessment will automatically be completed to determine the rate as specified in the
Addendum. If the child, regardless of age, has Intellectual or Developmental Disabilities or intensive
medical/physical needs or limitations that interfere with daily life functioning, the Inventory for Client and Agency
Planning (ICAP) assessment will be completed to determine the reimbursement rate as specified in Addendum 2.
20. County agrees to purchase, and Provider agrees to provide the care and services, which are listed in this
Agreement. The State approved rate of payment will be paid for the Child Maintenance level of service, unless the
Child and Adolescent Needs and Strengths or the Inventory for Client and Agency Planning assessment has been
completed and the rate determined as , designated in Addendum 1 or Addendum 2, respectively for children
placed within the Weld County Certified Foster Care Home identified as Provider ID# XXXXXXX. These services
will be for children who have been deemed eligible for social services under the statutes, rules and regulations of
the State of Colorado.
21. All bed hold authorizations and payments are subject to a 7 -day maximum fora 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
Exhibit A to the CWS-7A
7 Revised 6/2020
days. Bed hold requests must have prior written authorization from the Department Administrator or Designee
before payment will be release to Provider.
22. 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.
23. 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.
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 DepartmentAdministrator.
e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the clothing allowance
form accessed through the Foster Parents Database On-line System (FIDOS).
24. 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,
Exhibit A to the CWS-7A
8 Revised 6/2020
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 weekly on FIDOS.
13. Maintain/update information in the foster child's binder. The binder will be reviewed on amonthly basis and signed
off by child's caseworker and/or the Provider's Foster Care Coordinator.
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. Comply with all County and State certification requirements as set forth in the State Department rules, Staff Manual
Volume VII and the Weld County Department of Human Services Policy and Procedure manual.
Exhibit A to the CWS-7A
9 Revised 6/2020
ADDENDUM 1
Child and Adolescent Needs and Strengths (CANS) Rates
Level of Service
CANS Score
Child Maintenance
Daily Rate
0 and 1
$35.70
2
$42.28
3
$48.86
ADDENDUM 2
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 6/2020
2020-21 WELD FOSTER AND KINSHIP PROVIDERS (FINAL)
1
LNAME(1)
Aikens
FNAME(1)
George
LNAME(2)
Aikens
FNAME(2)
Carly
ADDRESS
22250 WCR 62
CITY
Greeley
ST
CO
ZIP
80631
TYPE
Foster
ID
1718610
2
Alley
Michael
Mai
Trenton
1966 E. 167th Drive
Thornton
CO
80602
Kinship
1702702
3
Anderson
Wayne
Anderson
Lauren
8137 22nd Street
Greeley
CO
80634
Foster
1717024
4
Archuleta
Christopher
Shively
Carmen
2329 78th Avenue
Greeley
CO
80634
Kinship
1727875
5
Armstrong
Zachary
Armstrong
Nicole
108 North 50th Avenue
Greeley
CO
80634
Foster
1723158
6
Baldwin
Danny
Baldwin
Tierney
10377 South Crescent
Firestone
CO
80504
Foster
1717778
7
Ballard
Crystal
Ballard
Melissa
2700 West C Street, #155
Greeley
CO
80631
Kinship
1745580
8
Basye
Robert
Basye
Debra
721 Best Avenue
La Junta
CO
81050
Foster
1697741
9
Bauer
Michael
Bauer
Jennifer
442 La Costa Lane
Johnstown
CO
80534
Foster
1733364
10
Bauer
Steven
Bauer
Christine
29569 WCR 70
Gill
CO
80634
Foster
1726438
11
Berrelez
Matthew
Berrelez
Yvette
247 63rd Avenue
Greeley
CO
80634
Foster
1728772
12
Berry
Cynthia
8390 Brandywine Avenue
Frederick
CO
80504
Foster
1734868
13
Bickle
Gregory
Bickle
Debra
2449 County Road 45
Hudson ;'
CO
80642
Foster
1733935
14
Blank
Matthew
Blank
Emily
1251 Vail Lane
Longmont
CO
80503
Foster
1669659
15
Borchert
David
Borchert
Jessica
625 Dukes Way
Dacono
CO
80514
Foster
1729136
16
Braunagel
Karen
1775 Laurus Lane
Johnstown
CO
80534
Foster
1714402
17
Brinkerhoff
Zaquiri
Brinkerhoff
Samantha
150 Veronica Drive
Windsor
CO
80550
Kinship
1739843
18
Brown
Dustin
Brown
Samantha
114 50th Avenue
Greeley
CO
80634
Foster
1739396
19
Cano
John,
Cano
Leah
515 Ruby Drive
Fort Collins
CO
80525
Foster
14703
20
Carrigan
Thomas
Carrigan
Robin
7312 North Country Trail
Ault
CO
80610
Foster
1728752
21
Casey
Robert
Casey
Elyse
2330 6th Avenue
Greeley
CO
80631
Foster
1734522
22
Castaneda
Freddy
Gutierrez-Castaneda
Natalie
2837 Avocado Avenue
Greeley
CO
80631
Foster
1678403
23
Claffey
Tyson
Claffey
Emily
481 Wind River Drive
Windsor
CO
80550
Foster
1739517
24
Clark
David
Clark
Kaci
1862 18th Avenue
Greeley
CO
80631
Foster
1725980
25
Cole
Andrew
Long
Kiley
1883 Sunset Circle
Milliken
CO
80543
Foster
1687316
26
Cramer
Eugene
Cramer
Ana
501 Sundance Circle
Dacono
CO
80514
Kinship
1736004
27
Cross
Taylor
Cross
Hannah
22975 County Road 40
LaSalle
CO
80645
Foster
1739954
28
Cunliffe
Levi
Cunliffe
Anne
1211 Nova Place
Erie
CO
Foster
1740368
29
DeSwarte
Jeremy
DeSwarte
Melissa
1302 South 32nd Street
Manitowoc
WI
54220
Kinship
1729279
30
Diekroeger
James
Diekroeger
Elizabeth
22321 Road 124
Cheyenne
WY
82009
Kinship
1731188
31
Dinino-Emmerson
Mary
5854 Maidenhead Drive
Windsor
CO
80550
Kinship
1744717
32
Duarte
Tanya
420 East 57th Street, #196
Loveland
CO
80538
Kinship
1719596
33
Dunn
James
Dunn
Gari
413 Ash Street
Kersey
CO
80644
Foster
1714413
34
Ebert
Charlotte
402 West Frontier Parkway
Oberlin
KS
67749
Kinship
1724521
35
Egret
Cookie
Shillington
Meghan
8216 Hallett Court
Fort Collins
CO
80528
Foster
1741160
36
Emore
Lansing
Agone
Talia
833 Columbine Drive
Windsor
CO
80550
Foster
1694421
37
Garcia >
Fernando
Garcia
Aracely
3919 28th Avenue
Evans
CO
80620
Foster
1561879
2020-21 WELD FOSTER AND KINSHIP PROVIDERS (FINAL)
38
Gilbert
Christopher
Gilbert
Tatum
2109 Outer Banks
Windsor
CO
80550
Kinship
1744875
39
Grigsby
Michael
Dennis
Esther
5502 West 3rd Street '
Greeley
CO
80634
Foster
1687385
40
Gross
Nathan
Gross
Jennifer
1861 12th Avenue
Greeley
CO
80631
Foster
1718928
41
Haines
Ryan
Haines
Kara
2737 West 14th Street
Greeley
CO
80634
Foster
1714134
42
Hecker
Angela
Hecker
Kaci
2303 76th Avenue Court
Greeley
CO
80634
Foster
1743691
43
Helmer
Sara
3000 West 19th Street
Greeley
CO
80634
Foster
1547292
44
Ibarra
Eric
Gomez
Maira
200 North 35th Avenue, #219
Greeley
CO
80634
Foster
1707673
45
Johnson
Trevor '
Johnson
Angela
1914 84th Avenue
Greeley
CO
80634
Foster
1723996
46
Johnson
Joshua
Johnson
Alana
9981 Bountiful Street
Firestone
CO
80504
Foster
1625365
47
Korby
Trenton
Korby
Stephanie
3105 70th Avenue
Greeley
CO'
80634
Foster
1659973
48
Lake
Austin
Lake
Carlie
2212 34th Avenue
Greeley
CO
80634
Foster
1725170
49
Lamont
Gary
Lamont
Vanessa
10111 West 11th Street
Greeley
CO
80634
Kinship
1704049
50
Lease
Joshua
Lease
Ashlee
3306 Laguna Court
Evans
CO
80634
Foster
1732090
51
Lechman
Jay '
Lechman
Pamela
3608 Palermo Avenue
Evans
CO
80620
Kinship
1587465
52
Lind
Patricia
Dalby
Katherine
1611 15th Avenue
Greeley
CO
80631
Foster
1658999
53
Long
Joshua
Long
Jennifer
2548 Palmer Avenue
Mead
CO
80542
Foster
1712147
54
Lopez
Vincent
Lopez
Rose
1280 Lake Circle, #G
Windsor
CO
80550
Kinship
1725071
55
Lozen
Jon
Lozen
Teri
471 Stonebrook Drive
Windsor -
CO
80550
Foster
1735498
56
Marcos
Marcel
Marcos
Shantay
501 Dakota Court
Windsor
CO
80550
Foster
1732887
57
Marn
Gilbert
Lazuick-Marin
Justine
25000 CR 69
Kersey
CO'
80644
Foster
1661206
58
Maronek
Patricia
2929 56th Avenue
Greeley
CO
80634
Foster
1520627
59
Mars
Zachary
Mars
Maddisen
180 Muscovey Lane
Johnstown
CO
80534
Foster
1721766
60
Martin
Nicholas
Martin
Sherry
2304 Talon Parkway
Greeley
CO
80634
Foster
1746250
61
Mathies
Robert
Mathies
Leilani
1106 South Park Avenue
Johnstown
CO
80534
Foster
1694008
62
Maxwell
William
Maxwell
Shay
3114 66th Avenue Court
Greeley
CO
80634
Foster
1737476
63
Mazak
Aileen
Lower
Courtney
90 Pike Lane
Severance
CO
80550
Foster
1743387
64
McKeta
Steve
McKeta
Clorisa
1870 Chesapeake Circle
Johnstown
CO
80534
Foster
1728774
65
Menzel
Jared
Menzel
Kathrina
6025 Lynz Creek Circle
Frederick
CO
80530
Foster
1707638
66
Moore
Jay
Moore
Candice
1712 26th Avenue Court
Greeley
CO
80634
Foster
1692443
67
Munoz
Daniel
Munoz '
Andrea
7681 Kearney Drive
Commerce City
CO
80022
Kinship
1728859
68
Muth
Bryan
Muth
Rachel
2306 Sunset Lane
Greeley
CO
80634
Foster
1742038
69
Nix
Randall
Nix
Amanda
2124 Village Drive
Milliken
CO
80543
Foster
1741917
70
Oliver
Justin
Puga-Oliver
Lynette
1559 South Dusk Drive
Milliken
CO
80543
Foster
1738985
71
Perez -Maldonado
Abigael
71 Bonita Loop
Los Lunas
NM
67031
Kinship
1735757
72
Porras-Valencia
Feliciano
Pulido
La Tasha
312 North 44th Avenue
Greeley
CO
80634
Kinship
1744641
73
Powell
Robert
Powell
Terrie
19031 WCR 72
Eaton
CO
80615
Kinship
1643044
74
Pribble
Kelly
2000 80th Avenue Court
Greeley
CO
80634
Foster
1659978
75
Purtell
Christopher
Purtell
Nicole
2391 Tate Avenue
Ft. Lupton
CO
80620
Foster
1708813
2020-21 WELD FOSTER AND KINSHIP PROVIDERS (FINAL)
76
Rojas Munoz
Jose
Rojas
Kathleen
3607 Myrtle Street
Evans
CO
80620
Kinship
1553794
77
Rosales
Emilio
Martinez -Rosales
Esmeralda
4315 West 20th Street Road
Greeley
CO
80634
Foster
1636676
78
Saavedra
Elias
Saavedra
Alejandra
3704 Beaver Swamp Road
Loganville
GA
30052
Kinship
1742273
79
',Sanchez
Isidro
Sanchez
Tracy
423 28th Avenue
Greeley
CO
80634
Foster
1687293
80
Scheer
James
Scheer
Elizabeth
2744 County Fair Lane
Fort Collins
CO
80528
Foster
1666078
81
Schmidt
Donald II
Schmidt
Constance
17900 County Road 5
Berthoud
CO
80513
Kinship
1511343
82
Schulz
Lindsey
6005 West 13th Street Road
Greeley
CO
80634
Foster
1665608
83
Scudder
Nathan
Scudder
Mistie
747 Rock Road
Eaton
CO
80615
Foster
1521113
84
Seader
Ryan
Seader
Erin
319 Hackberry Court
Eaton
CO
80615
Foster
1694425
85
Segura Jr.
Renato
Hillin
Rachel
255 East Bradley Avenue, Space 6
El Cajon
CA
92021
Kinship
1739871
86
Sellman
Rodney
Hise
Samantha
1268 Tiller Lane
Milliken
CO
80543
Kinship
1731690
87
Smith
Lynn
Clark
Wendy
7039 Woodraw Drive
Fort Collins'
CO
80525
Foster
1603929
88
Sparks
Lynette
332 Sycamore Avenue
Johnstown
CO
80534
Foster
1725998
89
Stump
Patrick
Sommers
Megan
5893 Maidenhead Drive
Windsor
CO
80550
Foster
1740805
90
Tanguma-Gutierrez
Victoria
3115 56th Avenue
Greeley
CO
80634
Kinship
1697327
91
Taylor
Jeff
Taylor
Alexander
4943 West C Street
Greeley
CO
80634
Foster
1712176
92
Thorman
Joel
Thorman
Kira
1315 20th Street, Unit A
Greeley
CO
80631
Foster
1725276
93
Torres
Daniel
Torres
Jeannie
6756 Sage Avenue
Firestone
CO
80504
Foster
1556847
94
Troyer
Rodney
Klein -Troyer
Cynthia
2625 28th Avenue
Greeley
CO
80634
Foster
98370
95
Van Den Elzen
Dawn
5819 West 16th Street Lane
Greeley
CO
80634
Foster
44282
96
Vance
Morgan
Kindvall
Brandon
500 Campbell Street
Kersey
CO
80644
Foster
1703052
97
VanWinkle
Jonathon
VanWinkle
Michelle
10163 Sandy Ridge Court
Firestone
CO
80504
Foster
1731807
98
Vasquez Gonzalez
Alma
Gasca
Felipe
3500 35th Avenue, Lot 75
Greeley
CO
80631
Foster
1740200
99
Veyette
Brandon
Veyette
Amanda
316 Cottonwood Avenue
Eaton
CO
80615
Foster
1733697
100
Visser
Ryan
Visser
Amanda
3212 68th Avenue Court
Greeley
CO
80634
Foster
1673369
101
Voigt
Joshua
Voigt
Keri
1954 18th Avenue
Greeley
CO
80631
Kinship
1725001
102
Walker
Timothy
Jeffery
Jamie
339 Valley Avenue
Lochbuie
CO
80603
Foster
1708865
103
Walker
Kayla
Walker
Renae
318 Trailwood Drive
Windsor
CO
80550
Foster
1693525
104
Walker
Kurt
Walker
Jennifer
7681 Carlson Court
Fort Collins
CO
80524
Foster
1546248
105
Watts
Daniel
Watts
Rachel
305 South 5th Street
LaSalle
CO
80645
Kinship
1726192
106
Wells
David
Wells
Cassondra
606 3rd Street
Windsor
CO
80550
Foster
1734374
107
White
Kristen
1651 Kelmsley Court
Windsor
CO
80550
Foster
1711814
108
Williams
Buddy
Williams
Allison
5540 South Helena Street
Centennial
CO
80015
Foster
1687324
109
Winterfeld
Rachel
3405 West 16th Street Road, #89
Greeley
CO
80634
Foster
1712735
110
Wipf
Keith
Wipf
Bethany
3313 Carson Avenue
Evans
CO
80620
Foster
1706601
111
Woodyard
Ira
Woodyard
Erin
12659 Stone Creek Court
Firestone
CO
80504
Foster
1738615
Hello