HomeMy WebLinkAbout20190816.tiffRESOLUTION
RE: APPROVE REVISIONS TO OPERATIONS MANUAL, SECTION 6.000, COLORADO
WORKS AND CHILD CARE, OF THE DEPARTMENT OF HUMAN SERVICES
OPERATIONS MANUAL
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 Revisions to Manual, Section 6.000,
Colorado Works and Child Care of the Department of Human Services Operation Manual, and
WHEREAS, after review, the Board deems it advisable to approve said revisions, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Revisions to Section 6.000, Colorado Works and Child Care, of the
Department of Human Services Operations Manual, be, and hereby are, approved.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 25th day of February, A.D., 2019.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY,, COLORADO
ATTEST:
Weld County Clerk to the Board
BY:
Deputy C rlWto the Board
APP R ED AS TO
rney
Date of signature: `"1"\S
Barbara Kirkrfieyer, Chair
Mike Freeman, Pro -Tern
C
Sean P. Conway
ck.; '�Sfl,�&yitfl
3/LI /la
2019-0816
H R0090
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: February 20, 2019
TO: Clerk to the Board
FR: Judy A. Griego, Director, Human Services
RE: Department of Human Services' Policies and
Guidelines Manual Revisions
A work session was held on said topic, February 19, 2019. The Board gave approval to have the
item placed on Monday's Board Hearing Agenda, February 25, 2019.
This policy was revised to reflect current processes and/or further define the Department's activities and
responsibilities and includes the integration if Child Welfare Child Care and Protective Services Child
Care. The policy was developed by involved Department staff and was provided to Legal for review and
comments.
• 6.2.10. - 6.2.70. Child Care Policy (Revised)
This policy was revised to reflect the current Child Care Program. The revisions include:
1. Update to income eligibility percentages to reflect current State and Federal requirements.
2. Integration of Child Welfare Child Care and Protective Services Child Care.
3. Update from six years to five years for the defined "school age" for Weld County Department
of Human Services school -aged licensed child care providers.
4. Update to the Weld County tiered reimbursement model for licensed child care centers and
school -age sites to increase allowable absences to 4 annually and holidays 6 annually, across
all levels. This increase will be reviewed on a State Fiscal Year and are subject to change on
an annual basis.
5. Eliminate monetary references specific to the Weld Plus program and now emphasizes quality
improvement. These revisions are a result of State denial related to rate increases based on
HB18-1335.
6. Added language to the Child Care Provider Reimbursement section to accommodate
anticipated rate changes from the State.
2019-0816
Memorandum; February 20, 2019 Page 1
/(5
CHAPTER 6 - COLORADO WORKS AND CHILD CARE
ARTICLE II — Child Care
Sec . 6 . 2 . 10 Child Car, Assistance Program for Low Income
A. I troductione Colorado Child Care Assistance Program ( CCCAP ) is a program of the t< �t -
Divi& i . n .f Child Carey which provides child care subsidies t. fiamilies in the f®Ilo�ving
programs :
1 . Low- Income )
uE� ss.. ,,, € 'f -,-, . ;;,4 > 'f•bqg 's`"'.'"'�. ' 7> 53N5(7""' ` 'zr
2 . Colorado Works , and ',Cr- 4„7-r =:� „_£ �. ,-7 • ,.
�s • x
„ }
4 , • •... x
3 . Child Welfare Child Care . € . < .. M " � : .,
SGK' %a t w f V•=;•„--/v>>.,. .., '=L .Pte, ,FN$" •hf' �
Z •
> : f}f t K
I_ow-Income Child Care Eli ibilit Low-income � ' »� ® z dies who meet
Y SJuc• ,3 •3 3: ,
' �. '�f F T✓ /ys ris n. 6�;Y." f •fis n • wf L 'se: il E f w= f t ,f0 ,�\
eligibility requirements ofi section 3 of t' , @y }� gwq � �Servvices9 Staff
:u <' �,₹ i8/. : T W YT �J a Ott f .<� s. L E ss f } .''
£ F i�. <f x'im h„so ..,,, nY / Akre. .„53 x vs. ir< g :,4.,s
�j�p ,}> ...R. ,. 3 S ;v£> r- �`x.₹ %f Fs f" ..,£... " d 'L• "Y
Manual
IVolume 4rJ a �a,£}i it h,,,,,--47,
` Y£N,,,"'t;• ;.-. .V. ry,. "` .-d 'sx',' }s.`�sn .x 3.i3x
9 B G D 0 YF. £s �;,.E=i,,\ x. ,• wx f}'/.:Y... "S'' 6'€3'5}5
i -,•414440
' •
? x E 5 'tY I €x' • '~>rke'~'.,...v ,Sst £ '>, } ", • ' €f, „ , €•'' ttiotif S f F,F ' 7 .... t ��"" E� S
1 . The entry income eli ibilit level for the LoY ° < ' _ ® � at overty•
Y s > m' _ hF % . ZIP `G's's v " }L>? > ``°`�.v sr JF , `
€€ 3 { r : ₹ff ts }. .
2at7.:
. The exit income eligibility level for the Lo ; -etAw7anift. t� ` i $!±1 !Cis f . n s•
• f State Median
g Y
Income . V } } „ � 3Rr> . . •t, r f
's 'Ni.'io3 ✓r'r7''0,",�i 'c`I- •.₹'x" f., I /.....
n £ s .E.' � L)• ..
Or ., St,v.e .mac ^^z
AIV 1A3 41,V'3 . Applicants and recipients m ;.4150 Q ' ° x• =3 • . w p . n m ... } by providing
verifiable information about the}x _ :3tit : :: . >
a ) Individual circumstances16. k, _ ow `� ` nt to apply for a "good cause"
for nonparticipation with 's } .2f ,,• µ•'�._
,} . ....€;€ x , E, " ,..ter ., "i eI�.
�s� � : � „ • � r £gin, � a � '• �'
• r
b} food cats- � < `a _ :: <� " I. r �.> DI x Dorado Department of Human
} s� ; s ;ri•��p %. �.,,oA. yam.,. C�' Ei₹5 : rsY ,s w.. ^ i E ° _ '"'f
n . s x' ::. i . ' ; ' .as�x c f i
n 3 ..'' �' f s „' "J £.".z t s,n� s„s Alt
r .... <'v
Services, k, 3
,<� �fF �. ,yin J
MA <t > ti; .. fG6^�d %3 {J„f : > fE'TI,.',Y�'. £, •YxY
EZi <., ,.�Y..t f f„ 1.
• �, f, eiktt• ,'5J °4v � EK 140,046,111C
< x .s f .i` �.! .€• 35 ,., 01# ✓r }s - f.. z
c} Teen pare 6 abes : Si; k w .u� _ ndary education or GED program
`�Si �sz'i s s x}£. £x 3"' si / f } ,;=z t 4."�s n, . ' r } z ,�.;
£k 3,4' l• r�c`₹€£sa`€x z _ e,T x f" '„rf3 .A ,,�s ., , •"
will be exec- } �r , � s f` " t €
'
•} .. :��; f.x € •Qt %x.. x • v . M �• EE:} E`.Y.V
• ilI,.i..,,. . .'xd r=f '=.< ,, .f' it. •:,££ `,,. s ₹ , -,,s':,t, •<, %3 „ ss
• •" ` £ T @ �. 3 ,r`x"x..,.... . a '„e•‘.54.r , ,7, •€€ : ..., ray
s ,n •€ •.=• ..z W5fixJi}ss J3 jat Rri�. " `°f x T. E• '}.e ifb 3
ffIM,£{ �,a�rs£ c�".'. 3si .. €E'£ ;i ,s, v 1f €'.c•nE s t�H3 < R3 >. 's f '' .,.'\x.. €, ui l w <giic t,£";�.s.im • �"^•�3Atc• ₹3F u, t,,, '•i > Amt44 .- r'"i < f₹ Y ry
- ! F t„„"�' < _ 4,T,e,.., ° s # F '�' ss £ " "}x< .`E IF
5 x .%'<�� fi
-4,6x•-•4-'5! E MY••=, f£x"#' ; . s?��"aL• J •- w...,.._ a m T i R • E tE EfiQ <` t € ` 'K�vL'S 1-'t
✓..if„`�: 55 f�^,�/.
Sec. Pp ®} pA �u y 4F 1+ „'{� l i S 4 £r4} M 1I 35iitk z.
S V !/ µ �r
2£3 w s8 sr4 m > o 5 f fR Qr C G e s i0� > C
• 4: •`-�3 " -'�'><< > ar �xf ₹`as'n s ..₹.x e. f�x,s •, "e""$ z, ff'5F s� yy,�'! :..,: =ff.€.,, ° Cs3 ••E.'•f{` x f} i. ,..'s.'r f>i€'.f"{f fp.
x: ...'.4< < ,), r x i .€s r R, s :': wy.. x....� s <' ,' f''° ' w >;,> „<y: ..•'usFz£. i•, 4 " ,'5 t r..
£ < A n E , a �,F . , ..., i
3,�w wj f ' . * n 5° Vrks Basic Cash Assistance Program® f' d e e t: 5 s • f "i" �j ! ap p
9 9 e 1 . , ®9 �= s ' 3 A € I d. iA A. .tl• s r } ?? em
Y�1 a £ .�a "« . n y J` `, G9 ® s.Cp. Cq L.
�'> r x { > R ��s 9• Or � 3 a� .{}�. ,^ � � ",£I : '?'14"..4D,<,
"s 3�Ys'
fx f3 > ''s t 1€' v rt 3, f th -1, t 3•• s�° < x.E
s� ^'f €₹ee .F£₹ • '£• vF, 'xin:s7zm. a, •� %ff' _ J s .
.f„•<""(&fis3du f' "".v u ?fi:f.£1. �2 s n < .� ,,Way 4" .3• J w w y ₹ r<5> . 3 .i.
x °, n " f£ �,f: w3L ,tt f 12 J„als�uu<a� u . f. < s
x „Lva s r s.} W s s , 3 m mot° > s
1 P1 �zc -" -. § '= 4gN ce�sary State applications to determine eligibility
r w -
S 4 � , sus °� 0 � e 'o - 4, ' <, ,
$ ; ".� 3 .€,sa'w 3> n t• - :sss sEE �"f„' ,•- t .
2 . = f t 30 ,€: U . w °44m ill complete an additional Individual Assessment and an Individual
° Y� i . € _ Low- Income Child Care Program , to be compliant with Colorado gel f' .. e4:74,11>
T < a Efts ".. & ' f £:
s E"�f�c «,L 'Y s�.. ;< Si f = a .YES ,.
, 5 " ' t � } L ' €€ h their Individual Responsibility Contracts to continue to be eligible
3 f� " ro i„.. : } , .bc a ':ca
to receive Colorado Works Ch•
ild Care •
4 . Recipients who are no longer eligible for Basic Cash Assistance may still be eligible for Low-
Income Child Care per the Colorado Department of Human Services , Staff Manual volume 3 .
a ) Eligibility will be determined based on Volume 3 and this Section .
Eligibility for - `. pplicants of the Colorado Works Diversii no
1 , Requests for diversions for the applicant may be submitted by the applicant and/or Weld County
Department of Human Services' (WCDHS ) staff.
1
Revised February 2019
2 . The Diversion Committee will review Colorado Works Child Care diversion requests . Diversions
may be approved by the Director of the WCDHS or his/her designee , in lieu of the Diversion
Committee .
Sec 602030. ® Child Welfar- Child Care and Protective Services Child Care
Aa The purpose of the Department of Human Services ( OHS ) Child Welfare Child Care ( CWCC ) and
Protective Services Child Care ( P CC ) policy is to :
1 . Increase staff knowledge by providing common defi � .i. ip� `� ' » _. novweinfo Ls.::� S'£ t s • f�' >3 > n "2.Z axs
is aa, Fx x33 ^..a. ..i <
2 . Identify the appropriate funding stream used for the • m , °
€£ x . t
3'
3 . Identify DHS department responsibilities and proce ,t ,
Y
4 . Create efficiencies in referrals between DHS divisi •; : a1>k
t
_
; sf� a.�M w s>Sv.. • Y^' � '4 4: ' > , o `.�ve ),` 3 - 1ff3
5 . Communicate the rocess to ® HS staff � r= R � » ts, Employment
: a = > ₹ £ .w.CAi = <.f€' 3 ' l3 44 ;^ s ?is '.
Services of Weld County ( ESWC ) , and an � _-� .s:�' u. . . '
} _}e .: ,•, x 3₹ , = Y �' .try
B . fi "al a,1340:14.)14> s �YF i. <. �<• s; tm' f '= >'i o.≥a. �( " �x
;: i F of } '.SL'.E."• ."..> ZQ ` �y'"£w' y:i,,ii.otetAt 1 . Child Welfare Child Care ( CWCC ) can in -tit it ' d° �` : 4. a iP 04• = "z= Vh _ home or in the
f„' ` S w�. s t $`..S., ,: • ).,,, • f3\s = i 3!flbj:
•least restrictive setting when : �� • , c: kft
e r � O\ M 0 ,1; Farre.n7 ' ® ' m , ` 5 4 4r � ,< G�ealfare Child Care
f•• ` <<• R.
�o;'c%',3 3"` 33 L; c3sz.` , .n € t.� • ' r , £ 55 s '= f ;R-- •zt��t+
eligibility is to be determined bas "€ � ,4 Cr �; � tati y: t <3 m ' _ . :� J olume Seven .
_"». ; _ • `. r, , a` -, , s for a child who has an open
2 . Protective Service Child Care ( " ; f £f " zp
child welfare case and has bed- "�� a f` a. » •• e agency , into a non -certified
kinship care home , a family foh. • o e , 0 3 rare home . Children living with
` ^• s s �" ac cis s• €f F
• ii*'"Ci -! =Ri' £5PY<; f f i z Y.3A H > ' f `x'.� '.G -,�3.t•s. >a •' ":
their parents ,�z x i0F wla [ _� t, ,t9tz re :. •. i '
s s "' .E'o~'< 33" 3 L .£EE3 w. =t ft f 37 -
•} s,....4= : , •.' •fit₹_ " =r f. • #5 ^••mo.,'[a s >s'.11/4 Funding . st •„Vl'-‘'-'41=3C''''15'''
Gl �' •t i E• <f'A�„ t ^ u "� 5 '4 'St
c a o ' x3 xx.~`s�a."v3. , :;. :` • 3a}iEu.y `s " .._.: tx.'d„ 3 'F • ; i .f iF .%^t.xxc`..£z�. •�S� "" fFs<' ,a,
` • ., . ' i C
Ve0.
SZt .its • �x. e the care is in the priority of the"Ce ; F
The funds are detaY •ilt % t' s
_ f€t.jh¶no 3.\£ • '`s s ` ,53 . E �F _ ! • s�'£
funding structurec.: � _ , �3 r s ; ® ing note : All PSCC cases will be
' , r, ''Nk. fvkai ` ,f € n f.?: ...,, M frr 3 .•
s ₹ i'E ₹ .Eo., s z,,,' ` .r•sax,x'€f� ✓
ri a oparental fees , due to the nature
con:s� - t, 04,..> or >' � � � r :a" s� 3 r �
₹' f; ;`¢>' 4'3 a =�a y� a. ,.: < jf•=, i ` gq,^3f^n`3V Fti, h , '. od, f" E>� ze• y �'_ �• �€ "4,xf '_' 'k An x„;x,R'<
;3 Ads' ₹. •••
t '''."1
s ». . ^'� ` .,, f .< ! , a=.fw. A= ¢ r • ff f s33" rzi f
of t ' 1: . _ , •.3 f 3f y, 41S3 f funding secondarily .
:₹' " ₹=Y", zs > iii" Mi sue."xxrw s „fh `• i f`• t •f ` s"^• ^s', g,; 777,..„
potx. ."^ �»�sf'f ";:s, h < ^ jT -Fi• >f' i>€f• a x'ss.^ssi ?' 2`.
'Y'.'Yx$� ,,..''� €€₹ " �`y��cc". • 2-... _ ma ss�.'¢t a • y •E�s ••< i£• f"fs.�, r c ma x „, �o ra f"
"yc . , sa; 0
fa= or. we:' ttF 'tom '{y.C7 Yi cif �. bad i _ ' ?' f xy��y� .
. S. eatY • s .v'-"'1Rr. i . 3 •'� t _ ^ax -n.e c "' Qs. %s4 „^cM s£`.E
g €<` f�₹;.... ?'rt "xsvmz>�f s •sir 2 M .'� >€ s..<
€ ' l- 0 tli0 } � V� BG } which is inclusive of CCCAP funding , and
" an,`x i,,5?>< z • .. ,.a1{� _ , .« �5 3� c. a o, n L, ttx. Vi a^'. € ` T
P •i₹f 35 ii = .r rS f a N #1.A€M . s3£ /s' CS'�.�. cY• €e .)' +r,,.. .•. -.w<.. Eo - 3.'
_• s s r" i < s₹A'"; sz ��� h ₹5 " ...,,, 3,frax ''',1 a rs Ell &7. ( s F t af✓. s t'-z. D. (Et�. €' `IN.s y'=.7. • .a�. 'Cx fE €z . aw h•3 >
S' . r,. . Yf r ',f f , .-.i, < . 3/ \ '}F c 4
; f � y �� s ^'₹ £,£3 .`�Y.. . 4 aft s 's£5 '; fis: a :. 'r 'vi
t
�. f �d M •
' 1 CWCC includes :
2 F$ `
< F
s.
p•'' mn �. ra
E Cr c'''
41,
Sx :�sestir
' ' rGy = K:.s
d
�, 0.3.."2. s 3 3353 • ' "f "
ffz •' Is x'53'» 3 ₹,'.w•vitiW .. �•
y F ₹ '
3• J\ f3't is •�i.>C fi',.<S.fS ,.,F,'ct�. t i = .. , ',•..'sGS• �_. / RE x i2 Ka rpit,��/wi� ;G 'k «.� w "f�' x p3fss "�s"sss 43'Y€5xx (•„ 'y f£>', '\: . 34'
S V' 6, Os I t t„„ 4 s nf•.% s<i a O xx'•:: . € •
0. - d ounty: Prr°orit ` iron
A. I ®tally Defined Prioritization for Weld County Department of Human Services , CCDDG .
B . Subject to avail ;. bl am appropriation or capacity to raise federal or state fundong9 Weld county
®epartr ent if H � r� a Services pri® ritoz.- s in order9 the following categories of child care
options through the Child Care Development Fund , CLAP .
1 . Adult caretaker or teen parent, at or below 185 % of federal poverty , are employed and/or self-
employed , and provided all other CCCAP eligibility requirements are met.
2 . Adult caretaker or teen parent transitioning off the works program due to employment or job
training without requiring the family to apply for low-income child care , providing all other CCCAP
2
Revised February 2019
eligibility requirements are met. Adult caretaker or teen parent shall re-determine the eligibility
within twelve months after the transition .
3 . Protective Service Child Care ( PSCC ) for families caring for a child who has an open child welfare
case and has been placed by the county child welfare agency , into a : non-certified kinship care
home , a family foster care home , or a kinship foster care home . Children living with their parents
are not eligible for PScc . All PSCC cases will be considered a household of one with zero
countable income and zero parental fees , due to the nature of case .
4 . Adult caretaker or teen parent, enrolled in a postsecondary education program or a workforce
training program , is eligible for CCCAP for at least any two years of the postsecondary education
or workforce training program , provided all other CCCAP eligibility requirements are met during
those two years . . A ,r is . , <f
. 3:F r _ = 3„ .
5 . Adult caretaker or teen parent who is not ern IID rF =-€! 9 a :e c5 i #;<. a minimum of
,
thirteen weeks for each instance of non -temporary , 9 :;�`„T G ° F, L ' ^
t FF Es: :: f Y ? 45;
sn > 'F• 3 rF x ;w N '=`V =' „ ir: u
6 . Adult caretaker or teen parent who is enrolled n \ t f W : program or a
., :�. f<
workforce training program is eligible f . Al ee: 7.5-:",," _ e qa postsecondary
(i,%.Y• �'-:. '>SW' > N ' -- i £ • 4L "' xL -2,a
: '[
education or workforce training program�< ' «�• b:i .
�. : ., , Kr- .� .,.F. '. :. � _, �:. ,., �• � :�. quirements are
met during those four years . se �< ':aw .F: .... ..;
4,,,;e:, £ FF,' :#< -VAr -arr.-.tosw,,A -•,£.. :.`as „ s € ' sr 3 y tt w YLs ' i
”Ate -710"C . Referral/Approval Process . 4 € , _A ,:_ ,' „. AtikAkeSse
,. • ir-,,-lL:
® .ti4:'a :`a. s„€.,s€ '. wen
r. . 3 < . "> s Fr •ss x;
< �• :5 �3;•L�3 \ � "3 %,isw '�,' . `if s' ^' S i >tk
alms, 3 .L .n3 .5f'7 ,F..�.< v`.(�V+ , _ s, __,'R� •N; 3f qi Before
•gyp
• �5` ,. < Jf Sb555\' �< A�,'. V :. T 0 St«i`.;. L 5:15.5 . be e f o r e
Initial referral for Child Welfare and Protective � : <r a m5L . _ Y ^t a
the end of the initial referral approuxr , rt` � ; >g
54, „ ' '` { � y the approving
s n c; p 's ,...,b,:,,,,..:, ff✓ 4, <r r n,v 7 ¢ .€EF5 0/L•
.
•
supervisor, manager, or child Welf m �� q L ₹, .` 9 � _ .., e i continuation of child care
assistance is required ( Exhibit A — r = M _ zf` ₹'' - z.: 3 , , " ^
• ,£ ..£, •,� =s• rx £ ads; "===x' <,> :n.£ ;?.'' ["' "'zf • z3 ,
1 . Approving staff: ; II€ • a 3Irx 'C
�£� x r 3
=C „'izi ,f:
.Z`€ £,t(£L'€€,' s' ,.c: •. ,,r ,,,.,„ ..,,,. r\R •
• M F ••••', i2'•. .,raE'i L F`L3 3
a) All foster ll n !t .4E _ • • ' Erus de
ervisor.
•
0 , uat r s ` '�i s ss s€ ^re.et L- 11%1 s, i «, „
ii • \ '13° _ - rx- ='are Supervisor.
=�J7,�'a. EL: ' t`aa=' Lr M
b) All kinshi i, i °aria =€. aSzaL� ,g y ` ; �t < L a
.c. _ P., '• 55 5 b� 3 F `,: - Swat. Yv « LL <• : L< S3'zS>�i.:;
c) All child _ _ � s .w •tw. • t: �. ® : he Child Welfare Deputy Division
'� sE< £ s ,° a ss, x• :.? ,i. s�„„ 3 L •• u < Sag
,t runt",
l ,s ,a n, £ sH sit , mx,r\ £ a , , € :•, f ;< ''€₹fi tz
Head . :: : ,.,
^ak -fi 3Z £'. '<, ■•4uk y s. •• ae4 "F • Li , 4 `_ € < „ E,1t 4-Sa4e ^~L< ₹ 5:"z S�
• ` r. . :. � kin; F€ M cs ,.s•^ ,L :« =L€ ""a ;;•p ,oh ••,:Fr..efrAt q�� ", 3 ,,. is 3f y, < .._ „cs g .3," r .3€ /< F< ,s Mkent, .) �€ ' < „^,•V>4\_3,
<te,e � • - a L ”Ci < Fi < r � .. ey e •�. .: . :s< „< �` to their supervisor for review.
•
(f= €\.i=\.€FY'a': s z etTa .• _:/t 314014 s iu ,£L' _"'^• "" ". £ _ '
Fr ' ` ..a: s oIv,'
₹L <.. � ,,: ;a=2,�, !� " � ��� £ 3`� L £- v �d₹ � �ee.
3 n5Igir , €< _ 6 set. _
_ 1 4 referral to the approving supervisor (as outlined
s Yrs £r£ „, "' x,.r,P�-tea € €� L , .,5 ge,a. , . n „ : YF ) t L '£ s
3s •
£F ..,\ 2W k•:?5 "V en " ° < sf ',.. �Y<ts • x.im
Iprinlo:=,.,:f 4
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3 . ' 0- gay reassessment of nee • to be completed 14 business days prior to the 90 days period , and
will include :
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to reassess .
b) The referring worker will provide an emailed narrative to the approving supervisor with
information pertaining to :
I . Reason for continued child care need ,
3
Revised February 2019
ii . Alternative resources family has utilized to child care/
iii . Benefits to child and family,
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-r ;.f° Q n, _, fix; fir. = : 0a `nd Child Welfare deputy Division Head .
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>�t = -44011, - .'£fi ` :, .4 -°' E rosE' ^ .k�'''Id welfare Deputy Division Head and ernailed to the Child Welfare
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5 . Beyond 6- month approvals :
a ) Any child care needs beyond a 6- month approval will be staffed by the referring worker,
every three months with the Child Welfare Deputy Division Head . Input from the assigned
Caseworker, Coordinator, and supervisor will be required .
b} The original referral form will be en`lailed from the Child Ifvelfare Eligibility Technician to the
approving supervisor and the referring worker indicating a need to reassess .
4
Revised February 2019
c) The referring worker will staff, in -person or via email , the need for continued child care
services . The referring worker should be prepared to discuss plans to move forward
should the child care services be denied .
d ) Approved or denied child care referrals will be returned to the Child Welfare Eligibility
Technician via email for processing and tracking .
e) A report listing the families receiving services past 6 -months will be provided by the Child
Welfare Eligibility Technician to the Child Welfare Division Head , Child Welfare Deputy
Division Head and Resource Manager monthly who will staff monthly with Human Services
Director or proxy .
D . Criteria Requirements for Child Care . ._..._._�_ . �. ....._........_.......w.. . . w.. . ...: .
1 . All foster and kinship families must be compliant with State and County, agreements to qualify for
services . Weld County foster families will have an active Individual Provider Contract in place and
must follow all provider agreements within the contract ( Exhibit B - Individual Provider Contract) .
2 . Weld County foster families must notify their Foster Care Coordinator within 24 hours of any child
care changes such as facility , days , and/or hours of child care changes .
3 . All kinship families must comply with their Kinship Agreement ( Exhibit C - Kinship Agreement) .
4 . All kinship families will actively work with their assigned Caseworker and Kinship Coordinator.
5 . All kinship families must notify their Caseworker or Kinship Coordinator within 24 hours of any
child care changes such as facility, days , and/or hours of child care changes.
6 . Recipients of CWCC must be engaged with their child welfare treatment plan .
E . Non -compliances l
1 . The Referring Caseworker, Foster Care Coordinator, and Kinship Care Coordinators will
determine compliance on an ongoing basis .
2 . If non -compliance is determined , additional steps may be required to continue child care . A
reassessment of family will be required by caseworker and coordinator.
3 . Non -compliance may result in child care being terminated .
F . Tracking/Reporting :
1 . The Child Welfare Eligibility Technician will track CWCC cases on the Division of Early Care and
Learning approved tracking form (Exhibit D — approved tracking form ) .
2 . The Child Welfare Eligibility Technician will provide the tracking form to the DHS Fiscal Division no
later than the 5th of the month following the quarter ending .
3 . Child Care Unit will be responsible for providing the tracking sheet by the 10th of the month
following the quarter end , per the Colorado Office of Early Childhood Policy . The Child Welfare
Eligibility Technician will provide a spreadsheet monthly to the Child Welfare Division Head and
Resource Manager.
4 . The Fiscal Division will provide the Child Welfare Division Head , Child Welfare Division Head
Deputy , and Resource Manager a monthly report as to child care expenditures .
5 . It will be the Child Welfare Division Head and Resource Manager' s responsibility to review all data
including : financial reports , any compliance issues , length of service , projected length of service ,
and outcomes and recommendations to the Director of Human Services on monthly basis .
6 . Compliance issues will be measured by length of services , placement stability , and notification of
agreement violations . Information will be obtained via financial reports and the referring worker' s
reassessment of need .
5
Revised February 2019
7 . Approval of assistance continuation will be made in writing by the Child Welfare Division Head , or
proxy on the Childcare Referral Form . The Human Services Director will be provided a monthly
list of all active Child Welfare and Protective Services Child Care referrals .
Records of each case will be maintained in a confidential manner according to state policy .
G . Child Care Assistance Transition Program .
The WCDHS does not currently offer a transition program .
Sec . 6. 2050. - Child Care Parental Fee Reduction for Hardship and 20% Rule _...._ .�... ...__.
A. Parental Fee Reduction for Hardship .
The Weld County Department of Human Services (WCDHS) may grant a child care parental fee
reduction for hardship on occasion . Guidelines for approving a reduction are as follows :
1 . All requests for a child care parental fee reduction for hardship must be received in writing , using
the Hardship Fee Assessment Form — Exhibit A.
2 . Supporting documentation must be provided to verify the income and expenses listed on the
Hardship Fee Assessment Form .
3 . Child care parental fee reductions will be considered when all forms of income exceed basic
monthly expenses such as rent, electricity, gas, basic phone , and medical/health .
4 . Other funding sources may beutilized prior to receiving aparental fee reduction for child care due
to hardships .
5 . Child care parental fee reductions will be re-evaluated every six months , or sooner, when
circumstances change ,
6 . Child care parental fee reductions for hardship decisions will be made by the Director of Human
Services or designee .
7 . Written justification and approval of child care parental fee reductions will be placed in the case file
and noted in the case record in the Child Care Automated Tracking System ( CHATS ) .
B . 20 % Rules
WCDHS . does not utilize the 20% Rule , per Section 3 . 9 of the Colorado Department of Human
Services (CD ) , Staff Manual Volume 3 .
Co Child Care Authorizations for Low-Income and Colorado Works Child Care .
Child Care authorizations will be based on the caretaker or the caretaker' s eligible activity , as well as ,
the children and adolescents' verified need . In some occasions , verified need will exceed the total
number of hours needed for an eligible activity .
D . Verified Needs that Exceed Eligible Activities .
1 . Travel Time . Extra care can be approved for children that have a caretaker(s) that travels to and
from their approved eligible activity .
a ) Verification is required when authorizing additional care .
2 . Study Time . Extra care can be approved for children that have a caretaker( s) in an educational
activity .
a) Verification is required for authorization of additional care .
3 . Decoupled Schedule . WCDHS can authorize care for hours differing from when the caretaker(s )
are in the caretaker' s eligible activity . For example , care could be approved for a caretaker who
works full-time overnight and requires care during the day to allow time for sleep .
6
Revised February 2019
4 . Caretaker(s ) are required to fill out a Child Care Needs Assessment if they are asking for
additional care .
a) Additional verification may be requested , to verify the additional care needed .
i . This verification must be in writing .
b) Authorizations of care , in addition to the eligible activities , must be approved by the Child
Care Program Manager.
E . Training and Education .
Low-income child care recipients are eligible for up to forty-eight (48 ) months of training and
education which include :
1 . Regionally accredited post-secondary training for a bachelor's degree or less ; or
2 . A workforce training program , including but not limited to:
a) Vocational or technical job skills training ,
b ) High school diploma educational activities ,
c) High school equivalency examination ,
d ) English as a second language , or
e) Adult basic education .
Sec . 6 . 2 . 60. - Licensed Child Care Providers
A . Quality Child Care Levels for Centers and Licensed Homes ( Exhibit A) .
Weld County Department of Human Services (WCDHS) will use the Colorado Department of Human
Services ' Quality Rating and Improvement System . This system can be found on the State of
Colorado's Office of Early ,: Childhood Education website , via
http : //coloradoofficeofearlychdhood . force .Vcom/oec? lang= en The Colorado Department of Human
Services (OOHS) is the designated entity that will certify the child care provider's level .
B . School Age.
WCDHS defines "school age" as being five (5) years of age and older.
C . Center Quality Child Care Levels for Schoolages Five (5) and Older ( Exhibit B ) .
The current CDHS Colorado Shines Model does not recognize or evaluate school -age classrooms , in
centers or in school age sites. Weld County , with the assistance of community input, has developed a
tiered quality improvement reimbursement model for licensed child care centers and school-age sites ,
for the purpose of recognizing quality in school-age classrooms and school-age sites .
1 . School-Age Tiered Reimbursement Model .
a) Level 1 Rating : Current Child Care License with the State of Colorado .
b) Level 2 Rating :
i . Meeting Level 1 requirement.
ii . Registration in the State of Colorado' s Professional Development Information System
( PDIS ) by all staff that provides child care for school-age children .
iii . Successful completion of Level 2 training modules ( 10 hours each ) by 75 % of all staff
that provides child care for school-age children .
7
Revised February 2019
iv . Successful completion of self-assessment/professional development plan within PDIS
by 75 % of all staff that provides child care for school-age children .
v . Successful completion of the Mental Health First Aid Training by the Director or Program
Lead .
c) Level 3 Rating :
i . Meeting Level 2 requirements .
ii . Minimum score of 3 . 75 on the School-Age Care Environmental Rating Scale or
equivalent evidence-based rating scale , as approved by the WCDHS .
iii . Successful completion of the Mental Health First Aid training by 50 % of all staff that
provides child care for school-age children .
iv. Director or Program Lead obtain a current Colorado Department of Education Early
Childhood Professional Credential I .
v . Have one of the following Family Partnership Domains in place, at the site :
1 ) Home language/Cultural Competency;
2 ) Care Coordination/Transitions ; or
3 ) Family Engagement.
vi . Successful completion of one of the cultural respectfulness trainings by 75 % of all staff
that provides child care for school-age children :
1 ) Drug Culture Awareness and Prevention Training , as approved by WCDHS ; which
includes a zero-tolerance policy, included the parent's handbook.
2 ) Gang Culture Awareness and Prevention Training ; as approved by WCDHS ; which
includes a zero-tolerance policy included in the parent' s handbook .
3 ) Violence , Bullying and Awareness Prevention Training , as approved by WCDHS ;
which includes a zero-tolerance policy included in the parent' s handbook.
d ) Level 4 Rating :
...... ....... ........ .. .. .
i . Meeting Level 2 requirements .
.. . . . ... ..... .
ii . Minimum score a 4 . 75 on the School-Age Care Environmental Rating Scale or
equivalent evidence-based rating scale , as approved by WCDHS .
iii . : Successful completion of Mental Health First Aid training by 75 % of all staff that
provides child^ care for school-age children .
iv. Director or Program Lead obtain a current Colorado Department of Education Early
Childhood Professional Credential II .
v. Have any two of the following Family Partnership Domains in place , at the site :
1 ) Home language/Cultural Competency ;
2 ) Care Coordination/Transitions ; or
3 ) Family Engagement.
vi . Successful completion of two of the cultural respectfulness trainings (as outlined in
3 . vi . 1 -3 ) by 75 % of all staff that provides care for school age children .
vii . Be willing and able to accept special needs children , as identified by a professional , in
the school-age setting .
e ) Level 5 Rating :
i . Meeting Level 2 requirements .
8
Revised February 2019
ii . Successful completion of Level 2 training modules ( 10 hours each ) by 100 % of all staff
that provides care to school-age children .
iii . Completion of a self-assessment/professional development plan within PDIS by 100 % of
all staff that provides care to school-age children .
iv . Minimum score a 5 . 75 on the School-Age Care Environmental Rating Scale or
equivalent evidence- based rating scale , as approved by WCDHS .
v . Successful completion of Mental Health First Aid training by 100 % of all staff that
provides child care for school -age children .
vi . Director or Program Lead obtain a current Colorado Department of Education Early
Childhood Professional Credential III .
vii . Have all three of the Family Partnership Domains in place, at. the . site :
1 ) Home language/Cultural Competency;
2 ) Care Coordination/Transitions ; and
3 ) Family Engagement-Early Intervention or Resources given to families prior to
suspension or expulsion .
viii . Successful completion of three of the cultural respectfulness trainings (as outlined in
3 . vi . 1 -3 ) by 75 % of all staff that provides care for school age children .
ix . Be willing and able to accept special needs children , as identified by a professional , in
the school-age setting .
D . Verification and Renewal Requirement
This section addresses the documentation that is required from the provider to prove to WCDHS that
the school -aged provider has met the identified level of quality within the site . It also addresses ,
where required , how often trainings and ratings need to be renewed , to maintain or increase levels of
quality within the site .
1 . Center or School-age Child Care License must provide current verification of license from the
Colorado Department of Human Services (CDHS) .
a) Renewal is based on CDHS requirements .
.. . . ..... .
2 . Verification that all current staff providing care for school age children are registered in the State of
Colorado Professional Development Information System , including :
a) A log of all current staff that provide care for school age children and verification of the
percentage of staff that have completed the registration process .
b) PDIS printouts detailing each staff member' s registration .
3 . Verification for all staff that provides care to school age children have completed the required
training , in PDIS , by Level , which includes :
a) A log of all staff that. provides care to school-age children and verification of the percentage of
staff that have completed the required training .
b ) PDIS printouts , that the appropriate percentage of staff have completed the required
trainings .
c) Renewals for these trainings are based on the Colorado Shines Standards .
4 . Verification for all staff that provides care to school age children have completed the required self-
assessments/professional development plans , including :
a ) A log of all staff that provide care to school-age children working at the site and verification of
the percentage of staff that have completed the required self-assessment/professional
development plans .
9
Revised February 2019
b) PDIS printouts , indicating the appropriate percentage of staff have completed the required
self-assessment/professional development plans .
5 . Verification for all staff that provides care to school age children have completed the Mental Health
First Aid training , every three years , including :
a ) A log of all staff that provides care to school-age children working at the site and verification
of the percentage of staff that have completed the required Mental Health First Aid Training .
b) Document certifying successful completion of the Mental Health First Aid Training .
6 . Verification of the Director or Program Lead 's Colorado Department of Education (CDE ) , Early
Childhood Professional Credentialing , of Level 3 , 4 or 5 .
.. ...... .... ..
7 . Verification of School -Age Care Environmental Rating Scale, rating or equivalent evidence-based
rating model , which includes a certified original or copy, showing proof of rating .
a) If equivalent evidence- based rating model is used , it must be pre-approved by WCDHS ,
before being used for the tiered reimbursement model .
8 . Verification of Family Partnership .
a ) Home Language/Cultural Competency includes: . .
i . A current policy stating that the site will accommodate family's linguistic needs , which is
included in the parent' s handbook.
ii . Proof that information and materials are given to families , based on families preferred
language .
iii . Completion of parent surveys indicating parents' satisfaction with the provider' s
communication style ,
iv . Advertisement of program to accommodate multiple languages , based on needs of
families .
b ) Care Coordination/Transitions Policy and Procedures including :
i . Current policy on picking children up from school or for school-age sites , have a central
For care location , included in the parent's handbook.
c) Family Engagement includes :
L A current policy stating availability of early intervention services to the students and
families , either internally or externally, prior to suspension and/or expulsion , included in
the parent's handbook.
ii . Must have documented evidence of giving community services referrals , to parents , if
needed .
9 . Verification of Cultural Respectfulness :
a) Drug Culture Awareness and Prevention :
i. .A log of all staff that provide care to school-age children working at the site and
verification of the percentage of staff that have completed the required training .
ii . Originals or copies , certifying successful completion of this training .
iii . A current policy stating that the site has a zero tolerance on drug use . This must also be
in the parent's handbook .
iv . Proof that information and materials are given to families about drug awareness ,
prevention and community resources .
v . Provider agrees to participate in provider and parent surveys and/or assessments , to
evaluate the outcomes of this awareness and prevention training and policy . The
10
Revised February 2019
surveys and/or assessments will be conducted by WCDHS or WCDHS approved
vendor.
10 . Gang Culture Awareness and Prevention .
a) A log of all staff that provide care to school-age children working at the site and verification of
the percentage of staff that have completed the required training .
b) Originals or copies , certifying successful completion of this training .
c) A current policy stating that the site has a zero tolerance on gang activity within the provider's
site . This must also be in the parent's handbook .
d ) Proof that information and materials are given t� f�rnilie� ab� ut aang culture awareness ,
prevention and community resources .
e) Provider agrees to participate in provider �� r� p���r�t ui� r�r�y� an�l�sr � ssessments , to
evaluate the outcomes o# this awareness a �id �r�e��r��ec�n t��ir� rt�c� � �€� �� licy . The surveys
and/or assessments will be conduci�r� �ay V1,o� � � � �� �1,'� L� �I � � ��r��r�� e��ndor.
11 . Violence and Bullying Awareness and �' r��� ��tie�r� . '
a) A log of all staff that provide care fio ��€����-��� �h [ i� r�� u�r��ki �� r� �� �t� � �i₹� �i� d verification of
the percentage of staff thaf have c� mpl���� �h� ���� �� � r�d ₹r�� �ing ,
b) Originals or copies , certifying succ���f�.t ; le�c� r� g�l �tic�� �� ��� d� �� i� tr�ir� [n� .
c) A current policy stating �h �� t�s � �i�� 9� �� � �� rc� tc� €� r�nc� �ar� �rscal�;e�c� �r�d �€allying within the
provider's site . This must �1�� �� iir� �h � �� s��t" � 4� � �d ��� k.
d ) Proof thaf information �r�d � �₹�rs� l� � �� � fv�n cc� f�r� � Ii�� about violence and bullying
awareness , prevention aroc� e;� rr� r�t !� n �ty r��c�� ���� .
e ) Provider �� re�� tc� p� ���it;ip�t� in pr���c�� �° �n � p�r�n� �ur��eys and/or assessments , to
evaluat� �h� �utc:t� rrt�� af this �w� r�t��'�s � � � pre�enfie� n �r� ining and policy . The surveys
and/or a�s���rr�� �ts uui61 b� �� ndu�t�d by `�� [� 4� � o� !r`�� � �IS approved vendor.
12 . Verification of F� r�a�� s�:iir� � �� � � �r� � ���i� � � ��d� � �°� ifr.Ar�� . ',
�} �4 vurr� :�t p�iic�y i� i � �il��,�; � ��xs�c� �h � Y �I�i� �ot��s� � r ����p�s children with special needs and
! v�ai � l �c��a�� m �d�f� ir� � i�� � u �� 4 °� �s ���� .
�} � r�fc�r�at��r� i� ir� �{�� p�r��t"� h� ��i ���+l� ����prg �that the provider accepts children with � pecial
' � ��;d � ��� e����ll �cca�s � €���.���t� Er��.� i�Bc� � �a'� r� ��c# � .
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13 . � ��i�! �t��s��r�, '
�� � rc�U���r� �� n r�� €� ��fi L��rei ���i �v�rs , "f�.� � �ic;rease their ratings , at the beginning of every
; � t�� r��r (J �� u � ry , �pra ' , July , and October) .
i . � ����c��r� s�rvs �ut '� u �a� ii all complete documentation , at the same time .
�) V`�� 6� N � �if1 ! r��i�w �i�� ��vel request and make a determination within 30 calendar days .
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���° ���' �"��_���`�:` ��1��`��"effe�#iv�e�� d �te��"�f the Level and corresponding reimbursement rate will be in
accordance with the Colorado Department of Human Services Rules .
c) Level ratings may be good for up to three years , depending on the times and expirafiion
dates , for the individual requirements within each Level .
i . The criterion within each Level must be kept current, to maintain the Level rating .
d ) Level reviews can be appealed by the provider and will be conducted withiri 15 days of the
request for appeal .
i . A current The Director' s decision on the appeal , is firral and not appealable to the
Golorado Department of Human Services .
11
Revised February 2019
e ) WCDHS reserves the right to visit and audit provider records , as applicable to this model , at
any time , with notice .
Sec . 6 . 2 . 70. - Child Care Provider Reimbursement.
A. Child Care Provider Rates .
1 . Weld County Department of Human Services (WCDHS) cannot reimburse a child care provider
more than what the provider charges its private-pay families unless mandated otherwise by State
regulation .
2 . Reimbursement rates are outlined by State regulation .
3 . Reimbursement rates for centers can be found in the attachment, °Center Rates° ( Exhibit A) .
4 . Reimbursement rates for qualified homes can be found in the attachment, "Qualified Home Rates"
( Exhibit B ) .
B . Activity , Transportation and Registration .
1 . WCDHS will not reimburse providers for activity , transportation , and registration fees .
C . Absences and Holidays .
Effective March 1 , 2019 , WCDHS will pay for the following absences and holidays fior all providers .
The number of absences and holidays is subject to change and will be evaluated each state fiscal
year, to include evaluation of available funding .
1 . Level 1 : 4 absences per month and 6 hoiidays : New Year's Day, President' s Day , Memorial Day ,
Independence Day , Thanksgiving , and Christmas . ' lfi the holiday falls on a Saturday, the Friday
before will be recognized as the holid�y. If the holiday fialls on a Sunday , the Monday after will be
recognized as the holiday .
2 . Level 2 : 4 absences per month and 6 holidays: New Year's Day , President's Day, Memorial Day ,
Independence Day, Thanksgiving , and Christmas . If the holiday falls on a Saturday , the Friday
before will be recognized as the haliday: If the holiday falls on a Sunday , the Monday after will be
recognized as fhe holiday .
3 . Levels 3-5 ; 4 absence� per month and 6 holidays: t�ew Year's Day , President' s Day , Memorial
Day , Independence Day, Thanksgiving , and Christma� . If the holiday falls on a Saturday, the
Friday befiore will be recognized as the holiday . If the hofiday falls on a Sunday , the Monday after
wwll be recognized as the holiday .
The Levels �pply to the Coiorado Shine� Model .
All qualified exempt providers will be considered Level 1 .
D . Provider Part-Time Daily Rates .
The provider part-time daily rate is calculated at fifty-five percent ( 55 % ) of the full-time daily rate . Rates
will be rounded up to the highest cent.
E . Special Needs Rates .
Providers caring for a disabled child can be reimbursed up to two (2 ) times the regular reimbursement
rate . A disabled child is defined in Section 3 . 9 of the Colorado Department of Human Services , Staff
Manual Volume 3 .
F . Traditional and Non -traditional Hours and Rates .
Providers will be paid the rate type in which more than fifty percent ( 50 °/o ) of the care is provided .
Traditional hours start at 6 : 00 AM until 6 : 00 PM , Monday through Friday. All other hours within the
week are considered non -traditional hours .
G . Child Care Payroll Adjustments .
12
Revised February 2019
1 . Provider payments are made for services rendered for the current month plus two prior months .
2 . Decisions concerning provider payments beyond the current month plus two preceding months will
be decided on a case by case basis and must be approved by either the Employment Services
Division Head or the Child Welfare Division Head . Any request for payment that would require
non-reimbursable , county-only funding , due to the length of delay , must be approved by the
Human Services Department Head , or her designee .
3 . Documentation of any manual payments will be retained for auditing purposes .
4 . Providers may submit one manual billing per rrronth for all care provided , but not already
reimbursed , during that service month . Exceptions may be granted if additional manual billing is
necessary to correct an error on the part of the Department.
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13
Revised February 2019
I Department of Human Services' Policies
CHAPTER 6 - COLORADO WOftKS AND CHILD CARE
ARTICLE II — Child Care
Sec . 6 . 2 . 10. - Child Care Assistance Program for Low Income .-
A. —Introduction . Colorado Child Care Assistance Program ( CCCAP )_�is a program of the State
Division of Child Care= which provides � hild care subsidies to families in the following
programs :
1_Low- I ncome ,
2 . Colorado Works� and
3 . Child Welfare Child Care .
B . —Low-Income Child Care Eligibility . Low-income child care pertains to families who meet
eligibility requirements of Section 3 . 9 of the Colorado Department of Human Services , Staff
Manual Volume 3 .
1 . —The entry income eligibility level for the Low- Income Program is �9185 % of Federal poverty .
2 . —The exit income eligibility level for the Low-Income Program is the �85t"- p�ercentile of State
Median Income°� ^f �o� or� � ^^„o.+"
3 . —Applicants and recipients must cooperate with Child Support Services ( CSS) by providing
verifiable information about the absent parent.
� a ) —Individual circumstances may warrant the applicant and recipient to apply for a "good
cause" for nonparticipation with CSS .
� b) —Good cause criteria can be found in Section 3 . 9 of the Colorado Department of Human
Services , Staff Manual Volume 3 .
c) —Teen parents enrolled full-time and participating in a secondary education or GED
programs will be exempt from cooperating with CSS .
Sece 6. 2 .20. — Colorado Works Child Care Eli�ibilitv
e
e • �
A�-. —Eligibility for Applicants/Recipients of Colorado Works Basic Cash Assistance Program .
1_��Each applicant and recipient will complete the necessary State applications to determine
eligibility for Colorado Works .
2_�)—Each applicant and recipient will complete an additional Individual Assessment and an
Individual Responsibility Contract for the Low- Income Child Care Program� to be � ^ ^^�!,�Uno
aw#-�compliant with Colorado Works' eligibility requirements .
3_c�—Recipients must cooperate with their Individual Responsibility Contracts to continue to be
eligible to receive Colorado Works Child Care .
� 4_�—Recipients who are no longer eligible for Basic Cash Assistance may still be eligible for Low-
Income Child Care per the Colorado Department of Human Services , Staff Manual Volume 3 .
a�� —Eligibility will be determined based on Volume 3 and this Section .
�o� Eligibility for Applicants of the Colorado Works Diversion .
1 . a} —Requests for diversions for the applicant may be submitted by the applicant and/or Weld
County Department of Human Services' (WCDHS ) staff.
ID� partment of Human Services' Policies
� 2 . � —The Diversion Committee will review Colorado Works Child Care diversion requests .
Diversions may be approved by the Director of the WCDHS or his/her designee , in lieu of the
Diversion Committee .
Sec . 6. 2 .30. — Child Welfare Child Care and Protective Services Child Care
�:�qB1�4Al�f,�. r �—o, o�;a-�W�e--���--Pr-e��*ive �erviee� hila G�r� . �°—a,h�:��n:�lf�r�-�la ' ' !1-�e
v
A. The purpose of the Department of Human Services IDHS) Child Welfare Child Care ( CWCC) and
Protective Services Child Care ( PSCC1 policv is to :
1 . Increase staff knowledqe by providinp common definitions ;
2 . Identify the appropriate fundinq stream used for the child care received �
3 . Identify DHS department responsibilities and process flow;
4 . Create efficiencies in referrals between DHS divisions ; and
5 . Communicate the process to DHS staff within Child Welfare Assistance Pavments Employment
Services of Weld County ( ESWC) , and anv other impacted departments .
� . Definitions :
1 . Child Welfare Child Care (CWCC ) can be used to maintain children in their own home or in the
least restrictive setting when no other child care options are available. Child Welfare Child Care
eliqibility is to be determined based on Colorado Department of Human Services' Volume Seven .
2 . Protective Service Child Care ( PSCC ) can be used for families carinq for a child who has an open
child welfare case and has been placed bv the countv child welfare agency into a non-certified
kinship care home , a family foster care home or a kinship foster care home . Children livinq with
their parents are not eliqible for PSCC .
C . Fundinq :
The funds are determined by the available appropriation and where the care is in the priority of the
fundinq structure , which is provided below and subject to the following note : All PSCC cases will be
considered a household of one with zero countable income and zero parental fees due to the nature
of the case . PSCC will primarily use CCCAP fundinq first and CWCC fundinp secondarilv.
1 . The fundinq streams available for PSCC include :
a ) Child Care Developmental Block Grant ( CCDBG ) which is inclusive of CCCAP fundinq and
b ) Child Welfare Block Grant
2 . The fundinc� stream available for CWCC includes :
a) Child Weltare Block Grant
See . 6 . 2 .40. — Weld Countv Prioritization
A. Locallv Defined Prioritization for Weld Countv Department of Human Services ' CCD �G .
� . � ubiect to available appr�riation or capacity to raise federal or state fundinq , Weld Countv
D�partment of Ht� rnan Services prioritaaes , � n � rder, the followinq cateq�aries �f chiid care
aptions thr�u� Fi tH � Child Car� Development Fund , GC�RP :
1 . Adult caretaker or teen parent, at or below 185 % of federal povertv are employed and/or self-
employed , and pravided all other CCCAP eligibility requirements are met.
IDepartment of Human Serviees' Policies
2 . Adult caretaker or teen parent transitioninq off the works proqram due to emplovment or job
traininq without requirinq the famil ty o apply for low-income child care providinq all other CCCAP
eliqibilifv requirements are met Adult caretaker or teen parent shall re-determine the eli iq bilitY
within twe {ve months after the transition .
3 . Protective Service Child Care ( PSCC ) for families carinq for a child who has an open child welfare
case and has been placed by the county child welfare agencv into a : non -certified kinship care
home , a familv foster care home , or a kinship foster care home . Children livinq with their parents
are not eliqible for PSCC . All PSCC cases will be considered a household of one witFr zero
countable income and zero parental fees due to the nature of case .
4 . Adult caretaker or teen qarent enrolled in a postsecondary education proqram or a workforce
traininq proqram , is eliqible for CCCAP for at least anv two vears of the postsecondary education
or workforce traininq proqram provided all other CCCAP eliqibility requirements are met during
those two ey ars .
5 . Adulfi caretaker or teen parent who is not emploved is eliqible for CCCAP for a minimum of
thirteen weeks for each instance of non-temporary job loss or activity cessation .
6 . Adult caretaker or teen parent who is enrolled in a postsecondary education proqram or a
workforce traininq program is eliqibie for CCCAP ₹or up to four vears of the postsecondary
education or workforce training proqram provided all other CCCAP eliaibility re uirements are
met durinq those four vears .
C . Referral/Approval Process :
Initial referral for Child Welfare and Protective Services Child Care will be uq to three months Before
the end of the initial referral approval a redetermination of needs will be reviewed by the approving
supervisor, manaqer or Child Welfare Deputy Division Head to determine if continuation of child care
assistance is required ( Exhibit A — Referral Form ) .
1 . Approving staff:
a ) All foster care referrals will be approved bv the Foster Care Supervisor.
b) All kinship care referrals will be approved bv the Kinship Care Supervisor
c) All child welfare child care referrals will be approved by the Child Welfare Deputv Division
Head .
2 . Initial review:
a ) The referrinq worker will submit a Child Care Referral Form to their supervisor for review.
b) Once reviewed , the worker will submit the referral to the approvinq supervisor (as outlined
above) and the Child Welfare Eliqibility Technician .
c) The approvinq supervisor will review the referral form The referral may be approved for up
to 3 months , or denied based on the need , with an option to renew for 3 additional months
d ) The Child Welfare Eliqibilitv Technician will receive the approved or denied referral for
processinq and tracking_
e) All referrals will be processed within two (2 ) business days .
3 . 90-Dav reassessment of need to be completed 14 business days prior to the 90 days period and
will include :
a ) The original referral form and an Outlook calendar appointment emailed bv the Child Welfare
EI_igibilitV Technician to the approvinq supervisor and the referrinq worker indicatinq a need
to reassess .
b ) The referrinq worker will provide an emailed narrative to the approving supervisor with
information pertaininq to :
I Department of Fiuman Services' Policies
i . Reason for continued child care need ,
ii . Alternative resources familv has utilized to child care ,
iii . Benefits to child and family,
iv . Anticipated end date for child care services, and
v. Attempts made to eliminate the need for childcare .
1 ) The approvin� supervisor mav approve up to 3 additional months .
2 ) The approved email will be forwarded to the Child Welfare Eli�ibilitv
Technician for trackin� .
4 . 6-Month reassessment of need , to be completed 14 business days prior to the 6-month period
and will include :
a) The oriqinal referral form and an Outlook calendar appointment emailed by the Child Welfare
Eliqibilitv Technician to the approvinq supervisor and the referrinq worker indicating a need
to reassess .
b) The referring worker will provide an emailed narrative to the approviny supervisor with
information pertaininq to :
i . Reason for continued child care need ,
ii . Alternative resources family has utilized to child care ,
iii . Benefits to child and family,
iv. Anticipated end date for child care services , and
v . Attempts made to eliminate the need for childcare .
1 ) Information will be shared and staffed by the approvin� supervisor with the
Child Welfare Division Head and Child Welfare Deputv Division Head .
2 ) The Child Welfare Division Head or Child Welfare Deputy Division Head will
review and mav approve for an additional 30-60 days .
� The Child Care Referral Form will be si� ned by the Child Welfare Division
Head or Child Welfare Deputv Division Head and emailed to the Child Welfare
Eli�ibility Technician for trackin � .
5 . Beyond 6-month approvals :
a ) Anv child �are needs bevond a 6-month approval will be staffed bv the referrinq worker
every three months with the Child Welfare Deputy Division Head . Input from the assiqned
Caseworker, Coordinator, and Suqervisor will be required .
b) The oriqinal referral form will be emailed from the Child Welfare Eliqibility Technician to the
approving supervisor and the referrinq worker indicating a need to reassess .
I Department of Human Services' Policies
c) The referrinq worker will staff, in-person or via email , the need for continued child care
services . The referrinq worker should be prepared to discuss plans to move forward
should the child care services be denied .
d ) Approved or denied child care referrals will be returned to the Child Welfare Eligibility
Technician via email for processing and trackinc,�.
e ) A report listing the families receivinq services qast 6-months will be provided by the Child
Welfare Eliqibility Technician to the Child Weifare Division Head , Child Welfare Der� uty
Division Head and Resource IVlanager monthlv who will staff monthly with Human Services
Director or proxV .
D . Criteria Requirements for Child Care.
1 . All foster and kinship families must be compliant with State and Countv aqreements to qualifX for
services . Weld County foster families will have an active Individual Provider Contract in place and
must follow all provider aqreements within the contract ( Exhibit B - Individual Provider Contract) .
2 . Weld Countv foster families must notify their Foster Care Coordinator within 24 hours of any child
care chanqes such as facility , days , and/or hours of child care changes .
3 . All kinship families must camply with their Kinship Aqreement ( Exhibit C - Kinship Aqreement) .
4 . All kinship families will activelv work with their assiqned Caseworker and Kinshiq Coordinator.
5 . All kinship families must notify their Caseworker or Kinship Coordinator within 24 hours of any
child care chanqes such as facility , days , and/or hours of child care chanqes .
6 . Recipients of CWCC must be engaged uvith their child welfare treatment plan .
E . IVon -compliance :
1 . The Referrinq Caseworker Foster Care Coordinator, and Kinship Care Coordinators will
determine compliance on an onqoing basis .
2 . If non -compliance is determined , additional steps may be required to continue child care . A
reassessment of family will be required by caseworker and coordinator.
3 . Non-compliance may result in child care being terminated .
F. Trackinq/Reportinq :
1 . The Child Welfare Eliqibilitv Technician will track CWCC cases on the Division of Early Care and
Learninq approved tracking form Exhibit D �- approved tracking form ) .
2 . The Child Welfare Eliqibilitv Technician will provide the tracking form to the DHS Fiscal Division no
later than the 5th of the month followinq the quarter endinq .
3 . Child Care Unit will be responsible for providinq the trackinq sheet by the 10th of the month
followinq the quarter end , qer the Colorado Office of Earlv Childhood Policy . The Child Welfare
Eligibility Technician will provide a spreadsheet monthlv to the Child Welfare Division Head and
Resource Manager.
4 . The Fiscal Division will provide the Child Welfare Division Head , Child Welfare Division Head
DeputV , and Resource Manaqer a monthly report as to child care expenditures .
5 . It will be the Child Welfare Division Head and Resource Manager's responsibilitv to review all data
including : financial reports , any compliance issues lenpth of service proiected lenqth of service
and outcornes and recommendations ta the Director of Human ServiGes on monthly basis.
6 . Compliance issues will be measured bv lenqth of services , placement stabilitv and notification of
aqreement violations . Information will be obtained via financial repor�s and the referrinq worker's
reassessment of need .
ID�ar#ment of Human Services' Policies
7 . Approval of assistance continuation will be made in writinq by the Child Welfare Division Flead , or
�roxy on the Childcare Referral Form . The Human Services Director will be provided a monthly
list of all active Child Welfare and Protective Services Child Care referrals .
Records of each case will be maintained in a confidential manner accordinq to state polic rL.
G�. —Child Care Assistance Transition Program .
The WCDHS does not currently offer a transition program .-_
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I Department of Human Services' Policies
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Sec . 6. 2 .�50. - Child �are Parental Fee Reduction for Hardship and 20% Rule:
IDepartment of Human Services' Policies
A. —Parental Fee Reduction for Hardship.
The Weld County Department of Human Services (WCDHS) may grant a child care parental fee
reduction for hardship on occasion . Guidelines for approving a reduction are as follows :
1 . —All requests for a child care parental fee reduction for hardship must be received in writing ,
using the Hardship Fee Assessment Form — Exhibit A.
2 . —Supporting documentation must be provided to verify the income and expenses listed on the
Hardship Fee Assessment Form .
3 . Child care parental fee reductions will be considered when all forms of income exceed basic
monthly �asfs expenses such as rent, electricity , gas , basic phone� and medical/health .
4 . —Other funding sources may be utilized +^ ^ ro� ion+ iitili� innprior to receivinq a parental fee
reduction for child care pa�t� ' f�� �n,a � �^+;^ ^ � f^rdue to -hardships .
5 . —Child care parental fee reductions will be re-evaluated every six months� or soonerl when
circumstances change .
� 6 . —Child care parental fee reductions for hardship decisions will be made by the Director of Human
Services or designee .
� 7 . —Written justification and approval of child care parental fee reductions will be placed in the case
file and noted in the case record in the Child Care Automated Tracking System ( CHATS) .
I � . -20% Rule .
WCDHS does not utilize the 20 % Rule� per Section 3 . 9 of the Colorado Department of Human
Services (CDHS ) , Staff Manual Volume 3 .
C . —Child Care Authorizations for Low-Income and Colorado Works Child Care .
Child Care authorizations will be based on the caretaker or fhe caretaker' s� eligible activity , as well as�
the children and adolescents' verified need . In some occasions , verified need will exceed the total
number of hours needed for an eligible activity .
D . —Verified Needs that Exceed Eligible Activities .
1 . —Travel Time . Extra care can be approved for children that have a caretaker( s) that travels to and
from their approved eligible activity .
a ) —Verification is required when authorizing additional care .
2 . —Study Time . Extra care can be approved for children that have a caretaker(s) in an educational
activity .
a ) Verification is required �^ �" � ^ � �+" ^ r�� ��for authorization of additional care .
3 . —Decoupled Schedule . WCDHS can authorize care for hours differing from when the caretaker( s)
are in the caretaker' s�' eligible activity. As -anFor example , care could be approved for a caretaker
who works full-time overnight and +" �n-«^�«��re uires care during the day , f� +�"��T«,;:.�;-�
s4eep to allow time for sleep .
4 . —Caretaker( s ) are required to fill out a Child Care Needs Assessment if they are asking for
additional care .
a ) —Additional verification may be requested , to verify the additional care needed .
i . —This verification must be in writing .
b) —Authorizations of care , � ^ ��,,,-� ^�-9#in addition to the eligible activities , must be approved by
the Child Care Program Manager.
E . Training and Education .
I Department of Numan Services' Policies
Low- i�ncome cGhild cSare recipients are eligible for up to forty-eight (48 ) months of training and
education� � ^ �� � ^ � h �� �^+����+�� , which include :
1 . —Regionally accredited post-secondary training for a bachelor's degree or less ; or
2 . —A w�orkforce training program , including but not limited to :
a ) —Vocational or technical job skills training�; e�
b) —High school diploma educational activities��
c) —High school equivalency examination��
d ) —Engiish as a second language�; or
e ) —Adult basic education .
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�' hilrY /'` � wo I'lneimli+ mm �ro}' I Rlrar4 (_` ranf_Plnrn Cen � li �or!
Sec. 6 .2 .�60. - Licensed Child Care Providers .-
A. —Quality Child Care Levels for Centers and Licensed Homes r � �h��;.
Weld County Department of Human Services (WCDHS ) will use the Colorado Department of Human
Services° Quality Rating and Improvement System . This system can be found on the State of
Colorado's Office of Early Childhood Education website, via
h� : //coloradoofficeofearlvchildhood . force . com/oec? lang =en . The Colorado Department of Human
Services (CDHS ) is the designated entity that will certify the child care provider' s level .
� . —School Age .
WCDHS defines "school age" as being si�-(-6}five 5 years of age and older.
C . —Center Quality Child Care Levels for School-Ages Si� (�}Five 5 and Older ( Exhibit B ) .
-The current CDHS Colorado Shines Model does not recognize or evaluate school-age classrooms , in
centers or in school age sites . Weld County , with the assistance of community input, has developed a
tiered quality improvement reimbursement model for licensed child care centers and school-age sites ,
for the purpose of recognizing quality in school-age classrooms and school-age sites .
1 . —School-Age Tiered Reimbursement Model .
a ) —Level 1 Rating : Current Child Care License with the State of Colorado .
b) —Level 2 Rating :
i . —Meeting Level 1 requirement.
ii . —Registration in the State of Colorado' s Professional Development Information System
( PDIS ) by all staff that provides child care for school-age children .
I �epartrnent of Human Services' Policies
� iii . —Successful completion of Level 2 training modules ( 10 hours each ) by 75 % of all staff
that provides child care for school-age children .
� iv. —Successful completion of self-assessmentlprofessional development plan within PDIS
by 75% of all staff that pravides child care for school-age children .
� v. —Successful completion of the Mental Health First Aid Training by the Director or
Program Lead .
c) —Level 3 Rating :
i . —Meeting Level 2 requirements .
ii . —Minimum score of 3 . 75 on the School-Age Care Environmental Rating Scale or
equivalent evidence-based rating scale , as approved by the WCDHS .
� iii . -Successful completion of the Mental Health First Aid training by 50% of all staff that
provides child care for school-age children .
� iv. —Director or Program Lead obtain a current Colorada Department of Education Early
Childhood Professional Credential I .
v. —Have one of the following Family Partnership Domains in place , at the site :
1 ) —Home language/Cultural Competency ;
2 ) —Care Coordination/Transitions ; or
3) —Family Engagement.
vi . —Successful completion of one of the cultural respectfulness trainings by 75% of all
staff that provides child care for school-�ge children :
� 1 ) —Drug Culture Awareness and Prevention Training , as approved by WCDHS ;
which includes a zero-tolerance policy , included the parent's handbook.
� 2 ) —Gang Culture Awareness and Prevention Training ; as approved by WCDHS ;
which includes a zero-tolerance policy included in the parent's handbook .
� 3) Violence , Bullying and Rwareness Prevention Training , as approved by WCDHS ;
which includes a zero-tolerance policy included in the parent's handbook .
d ) —Level 4 Rating :
i . —Meeting Level 2 requirements .
ii . —Minimum score a 4 . 75 on the School-Age Care Environmental Rating Scale or
equivalent �„��',�c^��—"a���evidence-based rating scale , as approved by WCDHS .
iii . Successful completion of Mental Health First Aid training by 75 % of all staff that
provides child care for school-age children .
� iv. —Director or Program Lead obtain a current Colorado Department of Education Early
Childhood Profiessional Credential II .
v . —Have any two of the following Family Partnership Domains in place , at the si₹e :
1 ) —Home language/Gultural Competency ;
2 ) —Care Coordination/Transitions ; or
3) —Family Engagement.
vi . —Successful completion of two of the cultural respectfulness trainings (as outlined in
3 . vi . 1 -3 ) by 75 % of all staff Yhat provides care for school age children .
� vii . —Be willing and able to accept special needs children , as identified by a professional ,
in the school-age setting .
I Department of Human Services' Policies
e) —Level 5 Rating:
i. —Meeting Level 2 requirements.
ii. —Successful completion of Level 2 training modules (10 hours each) by 100% of all staff
that provides care to school-age chiidren.
� iii. —Completion of a self-assessment/professional development plan within PDlS by 100%
of all staff that provides care to school-age children.
� iv. —Minimum score a 5.75 on the School-Age Care Environmental Rating Scale or
equivalent evidence-based rating scale, as approved by WCDHS.
� v. -Successful completion of Mental Health First Aid training by 100% of all staff that
provides child care for school-age children.
� vi. —Director or Program Lead obtain a current Colorado Department of Education Early
Childhood Professional Credential III.
vii. —Have all three of the Family Partnership Domains in place, at the site:
1)—Home language/Cultural Competency;
2)—Care Coordination/Transitions; and
3) —Family Engagement-Early Intervention or Resources given to families prior to
suspension or expulsion.
� viii. —Successful completion of three of the cultural respectfulness trainings (as outlined in
3.vi.1-3) by 75% of all staff that provides care for school age children.
ix. —Be willing and able to accept special needs children, as identified by a professional, in
the school-age setting.
D.—Verification and Renewal Requirements.
This section addresses the documentation that is required from the provider to prove to WCDHS that
the school-aged provider has met the ident�fied level of quality within the site. It also addresses,
where required, how often trainings and ratings need to be renewed, to maintain or increase levels of
quality within the site.
� 1. —Center or School-age Child Care License must provide current verification of license from the
Colorado Department of Human Services (CDHS).
a)—Renewal is based on CDHS requirements.
2. —Verification that all current staff providing care for school age children are registered in the State
of Colorado Professional Development Information System, including:
� a) —A log of all current staff that provide care for school age children and verification of the
percentage of staff that have completed the registration process.
b)—PDIS printouts detailing each staff inember's registration.
3. —Verification for all staff that provides care to school age children have completed the required
training, in PDIS, by Level, which includes:
� a) —A log of all staff that provides care to school-age children and verification of the percentage
of staff that have completed the required training.
� b) —PDIS printouts, that the appropriate percentage of staff have completed the required
trainings.
c) —Renewals for these trainings are based on the Colorado Shines Standards.
4. —Verification for all staff that provides care to school age children have completed fhe required
self-assessments/professional development plans, including:
I Department of Human Services' Policies
� a) —A log of all staff that provide care to school-age children working at the site and verification
of the percentage of staff that have completed the required self-assessment/professional
development plans .
� b ) —PDIS printouts , indicating the appropriate percentage of staff have completed the required
self-assessment/professional development plans .
� 5 . —Verification for all staff that provides care to school age children have completed the Mental
Health First Aid training , every three years , including :
� a ) —A log of all staff that provides care to school-age children working at the site and
verification of the percentage of staff that have completed the required Mental Health First
Aid Training .
I b) —Document certifying successful completion of the Mental Health First Aid Training .
6 . —Verification of the Director or Program Lead ' s Colorado Department of Education (CDE ) , Early
Childhood Professional Credentialing , of Level 3 , 4 or 5 .
� 7 . —Verification of School -Age Care Environmental Rating Scale , rating or equivalent evidence-
based rating model , which includes a certified original or copy , showing proof of rating .
� a) —If equivalent evidence- based rating model is used , it must be pre-approved by WCDHS ,
before being used for the tiered reimbursement model .
8 . —Verification of Family Partnership .
a ) —Home Language/Cultural Competency include� :
i . —A current policy stating that the site will accommodate family's linguistic needs , which
is included in the parent' s handbook.
� ii . —Proof that information and materials are given to families , based on families preferred
language .
� iii . —Completion of parent surveys indicating parents' satisfaction with the provider's
communication style .
� iv . —Advertisement of program to accommodate multiple languages , based on needs of
families .
b ) —Care Coordination/Transitions Policy and Procedures including :
i . —Current policy on picking children up from school or for school-age sites , have a central
care location , included in the parent's handbook .
I c) —Family Engagement includes :
i . —A current policy stating availability of early intervention services to the students and
families , either internally or externally , prior to suspension and/or expulsion , included in
the parent's handbook .
� ii . —Must have documented evidence of giving community services referrals , to parents , if
needed .
9 . Verification of Cultural Respectfulness :
a) —Drug Culture Awareness and Prevention :
i . —A log of all staff that provide care to school-age children working at the site and
verification of the percentage of staff that have completed the required training .
I ii . —Originals or copies , certifying successful completion of this training .
iii . —A current policy stating that the site has a zero tolerance on drug use . This must also
be in the parent' s handbook.
I Departrnent of Human Services' Policies
� iv. —Proof that information and materials are given to families about drug awareness,
prevention and community resources.
� v. —Provider agrees to participate in provider and parent surveys and/or assessments, to
evaluate the outcomes of this awareness and prevention training and policy. The
surveys and/or assessments wiil be conducted by WCDHS or WCDHS approved
vendor.
10. —Gang Culture Awareness and Prevention.
a) —A log of all staff that provide care to school-age children working at the site and verification
of the percentage of staff that have completed the required training.
I b) —Originais or copies, certifying successful completion of this training.
c) —A current policy stating that the site has a zero tolerance on gang activity within the
provider's site. This must also be in the parent's handbook.
� d) —Proof that information and materials are given to families about gang culture awareness,
prevention and community resources.
� e) —Provider agrees to participate in provider and parent surveys and/or assessments, to
evaluate the outcomes of this awareness and prevention training and policy. The surveys
and/or assessments will be conducted by WCDHS or WCDHS approved vendor.
11. —Violence and Buliying Awareness and Prevention.
I a) —A log of all staff that provide care to school-a e children workin at the site and verification
9 9
of the percentage of staff that have completed the required training.
b)—Originals or copies, certifying successful completion of this this training.
c)—A current policy stating that the site has a zero tolerance on violence and bullying within the
provider's site. This must also be in the parenYs handbook.
� d) —Proof that information and materials are given to families about violence and bullying
awareness, prevention and community resources.
� e) —Provider agrees to participate in provider and parent surveys and/or assessments, to
evaluate the outcomes of this awareness and prevention training and policy. The surveys
and/or assessments will be conducted by WCDHS or WCDHS approved vendor.
12. —Verification of Providing Care to Special Needs Children.
a)—A current policy is in place stating that the provider accepts children with special needs and
will accommodate individual's needs.
� b) —Information is in the parenYs handbook stating that the provider accepts children with
special needs and will accommodate individual's needs.
I 13. —Level Reviews.
a) —Providers can request Level reviews, to increase their ratings, at the beginning of every
quarter(January, April, July, and October).
i. —Providers must submit all complete documentation, at the same time.
b)—WCDHS will review the Level request and make a determination within 30 calendar days.
i. —The effective date of the Level and corresponding reimbursement rate will be in
accordance with the Colorado Department of Human Services Rules.
� c) —Level ratings may be good for up to three years, depending on the times and expiration
dates, for the individual requirements within each Level.
i. —The criterion within each Level must be kept current, to maintain the Level rating.
I Department �f Human Services' Polieies
� d ) —Level reviews can be appealed by the provider and will be conducted within 15 days of the
request for appeal .
� i . —A current The Director's decision on the appeal , is final and not appealable to the
Colorado Department of Human Services .
� e) —WCDHS reserves the right to visit and audit provider records , as applicable to this model ,
at any time , with notice .
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Sec. 6.2 .�70. - Child Care Provider Reirnbursement.
A. —Child Care Provider Rates .
1_Weld County Department of Human Services (WCDHS) cannot reimburse a child care provider
more than what the provider charges ifs private-pay families unless mandated otherwise bv State
requlation . .-
�-2 . Reimbursemenf rates are outlined bv State requlation .
3 . —Reimbursement rates for centers can be found in the attachment, "Center Rates" ( Exhibit A) .
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�4 . —Reimbursement rates for qualified homes can be found in the attachment, "Qualified Home
Rates" ( Exhibit BS) .
B . —Activity, Transportati�n and Registration .
1 . —WCDHS will not reimburse providers for activity , transportation , and registration fees .
C . —Absences and Flolidays .
—Effective March 1 , 2019 , WCDHS will pay for the following absences and holidays for all
providers_: The number of absences and holidays is subject ta chanqe and will be evaluated each
state fi�cal year, fo include evaluation of available funding, e�f
1_Level 1 : 4�- absences per month_.-and -6 holidays_ New Year's Day , President's Dav Memorial
Day, Independence Day, Thanksqiving , and Christmas . If the holiday falls on a Saturdav the
Fridav before will be reco� nized as the holiday. If the holiday falls on a Sundav the Monday after
will be recoqnized as the holida�
2_Level 2 : 4�- absences per monfh a�4nd 6 holidays : New Year's Day , PresidenYs Qav , Memorial
Dav , Independence Dav , Thanksqivinq , and Christmas . If the holidav falls on a Saturday the
Fridav before will be recoqnized as the holiday . If the holiday falls on a Sunda r� the Monday after
will be recoqnized as the holida�
3 . Levels 3-5 : 4� absencess per month and 36 holidays : New Year's Day , President' s Day� Memorial
Day , Independence Day , Thanksgiving , and Christmas . If the holiday falls on a Saturday , the
Friday before will be recognized as the holiday . If the holiday falls on a Sunday , the Monday after
will be recognized as the holiday.
The Levels apply to the Colorado Shines Model_-a ^ '� +^ +ho � nros,� oi c nn ,� �
All qualified exempt providers will be considered Level 1 .
D . —Provider Part-Time Daily Rates .
The provider parf-time daily rate is calculated at fifty-five percenf (55% ) of the full-time daily rate . Rates
will be rounded up to the highest cent.
IE . —Special Rleeds Rates .
i
� Providers caring for a disabled child can be reimbursed up fo two (2 ) time� the regular reimbursement
rate . A disabled child is defined in Section 3 . 9 of the Colorado Department of Human Services , Staff
Manual Volume 3 .
I F . —Traditional and Non -traclition � l Hours and Rates .
Providers will be paid fhe rate type in which more than fifty percent ( 50 % ) of the care is provided .
Traditional hours start at 6 : 00 AM until 6 : 00 PM , Monday through Friday. All other hours within the
week are considered non -traditional hours .
G . —Child Care Payroll Adjustments .
1 . Provider pavments are made for services rendered for ₹he current month plus two prior months.
2 . Decisions concerninq provid �r pavments bevond the currenf month plus fwo precedinq monfhs will
be decided on a �ase by case basis and must be approv�d bv ei₹her the Employment Services
Division Head or the Child Welfare Division I-lead . �ny request for pavment that would require
non-reimbursable , countv-only funding , due to the l� ngth ofi delay must be approved by the
Human Services Department Nead , or her desiqnee .
3 . Doeumentation of anv manual pavments will be retained for audifiinq purposes .
4 . Providers mav submii one rnanual billinq per month for all care provided but not alreadv
reirmbursed , durina ₹hat service monih . Excep₹ions may be qranted if aclditional manual billinq is
necessar� to correct an error on the part of the �e �artment:
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Revi5ed February �019
, \ /f,. D � I� � R 1 �VIGIY 1 Or � UIYII'11Y � CRV I �,✓ CeJ
�`� 1 $ 61 / IEMPLOYMENT SERi/ ICES � F 19VELD � Ol1fVTY
315 IVORTH 11TH AVENUE BLDG B
PO BOX 1805
� GREELEY, CO 80632
'\, (970) 353-3800
� FAX (970) 346-7981
e� G O U � '� �1'
__--
Weld County Child Care Providers :
On behalf of the Board of Weld County Cominissioners, the Department of Human Services is pleased to
announce an increase of absences and holidays for recipients of the Colorado Child Care Assistance Program
(CCCAP) who are placed with Weld County Child Care Providers . Effective March l , 2019 , Weld County
CCCAP will reimburse providers up to four (4) absences each month and six (6) holidays (New Year ' s Day,
President' s Day, Memorial Day, Independence Day, Thanksgiving, and Christmas) annually.
Weld County values the partnerships established with Child Care Providers accepting Colorado child Care
Assistance Program families and are committed to supporting local providers . Each State Fiscal Year, CCCAP
allocations are subject to change along with increased rules and requirements set forth by the State . As such,
absences and holiday policies will be reviewed annually and are subject to change .
If you have additional questions , please contact Anna Korthuis at 970-400- 6377 .
Sincerely,
Judy A . Griego , I�irector
Weld County Department of Human Services
315 N l lth Avenue BLDG B
Greeley, CO 80631 -2014
6 . 2 . 40 . EXHIBIT A - CHILD�ARE REFERRAL FOR19/I
Care must be approved by Weather Walker or Supervisor on duty to ensure payrner�t to daycare providero
Complete form and submit #o the Supervisor for review.
Childcare is being requested for: � Foster Care ❑ Kinship ❑ Parent
Request is for: ❑ New ❑ Continued Care ❑ Change of Provider ❑ Close Childcare ❑ End Date :
Custodial Person's :
Last Name : First Name : DOB : S5#:
Address:
Phone #: Email :
Relationship :
Household # : Trails Case #: CHAT5#:
Biological Mother:
Last Name : First IVame :
CHILD CQ►RE NEEDED :
START DA�E : EIVD DATE :
REASON F012 CHILDCAI2E : EMPLOYMEIVT: ❑ SOCIAL/EMOTIONAL: ❑
F= Full Time ( Over 5 Hours) P= Par4 Tim� ( Under 5 Hours) -Use "F" or "P" to Indicate Length of Care Each Day
Name of Child : Gender: DOB : SS# Mon Tues Wed Thur Frl Sat Sun
�`� — — — —
Does child(ren) need Full-time on IVon-School Days? ❑ Yes ❑ No If "Yes", School Attending:
List Any Variation of above Schedule for each child :
Provider Information :
Provider #1 Name: License #:
(Street Address) (City) (Zip )
Provider #2 Name: License #:
(Street Address ) (City) (Zip)
Caseworker IVame: Extension :
Date: ❑ Approved ❑ Denied
Director/Admir►Istrator/Mancrger Signature
❑ Initial Approval ❑ 90-Day approval ❑ 6-month approval ❑ �eyond 6-month approval
( Up to 90 days)
Date : Date : Date:
6 . 2 . 70 .
EXHIBIT A - WELD COUNTY CENTER
RATES 9/1/2018
Care Type Level Rate Type 0 Months -12 Months 12 months-18 Months 18 months-24 Months 24 months-36 Months 30 months - 36 Months 36 Months to School Age School Age
Full-Time 1 Base Rate $37 . 09 $37 . 09 $34 . 54 $34 . 54 $34. 54 $30 . 29 $34 .39
Full-Time 2 Base Rate $38 . 94 $38 .94 $3622 $36 . 22 $3622 $31 . 66 $34 . 39
Fuil-Time 3 Base Rate $41 . 85 $41 .85 $41 . 85 $37. 98 $37 . 98 $33. 13 $41 . 82
Full-1'irrse 4 Base Rate $46 .93 $48.45 $50 .33 $40 . 98 �39. 83 $37 . 73 $42 .87
Full-Time 5 Base Rate $46 . 93 $48.45 $50 . 33 $41 . 78 $41 . 78 $37 . 73 $42 .87
Care Type Level Rate Type 0 Months - 12 fVlonths 12 months-18 Months 18 months-24 Months 24 months-36 Months 30 months - 36 Months 36 Months to School Age School Age
Part-Time 1 Base Rate $20 .40 $20.40 $ 19 .00 $ 19.00 $ 19 . 00 $ 16 . 66 $ 18.91
Part-Time 2 Base Rate $21.42 $21.42 $ 19 .92 $ 19 .92 $ 19 .92 $ 17 .41 $ 18 .91
Part-Time 3 Base Rate $23 .02 $23 .02 $23 .02 $ 20.89 $20.89 $ 18.22 $23 .00
Part-Time 4 Base Rate $25 . 81 $26.65 $27 . 68 $ 22 . 54 $21 .91 $20 . 75 $23 . 58
Part-Time 5 Base Rate $25 .81 $26 .65 $27. 68 $ 22.98 $22 .98 $20. 75 $23 .58
4 absences monthly
6 holidays: New Mears, President's Day, Memorial
Day, Independence Day, Thanksgiving,
Christmas
pdated February 2019
6 . 2 . 70 .
0 Months - 18 School
Care Type Level Rate Type Months 18 months-24 Months* 24 months-36 Months * 36 Months to School Age * * Age * *
�ull-Time 1 Base Rate $45 . 84 $ 36 . 48 $ 30 . 34 �27 . 70 $26 . 73
Ful1-Time 2 Base Rate $48 . 12 $ 36 . 48 $ 31 . 81 $ 27 . 92 �27 . 92
Fcall-Tirne 3 Base Rate $ 50 . 53 $42 . 22 � 34 . 41 $ 31 . 54 $29 . 18
Full-Tirrae 4 Base Rate $ 53 . 06 $48 . 48 $ 3 � . 69 � 35 . 50 $ 32 . 89
FuII �Tirne 5 Base Rate � 55 . 72 $48 .48 $ 38 . 69 $ 35 . 50 �32 . 89
0 Months -18 School
Care Type Level Rate Type IVlonths 18 months-24 Months * 24 months-36 Months * 36 Months to School Age * * Age * *
Part-Time 1 Base Rate $ 25 . 21 $ 20 . 06 $ 16 . 69 $ 15 . 24 $ 14 . 70
Part-Time 2 �ase Rate $ 26. 47 $ 20 . 06 $ 17 . 50 $ 15 . 36 $ 15 . 36
Part-Tirr�e 3 Base Rate $ 27 . 79 $ 23 . 22 $ 18 . 93 $ 17 . 35 $ 16 . 05
Part-Tirne 4 Base Rate $ 29 . 18 $ 26 . 66 $ 21 . 28 $ 19 . 53 $ 18 . 09
Part-Time 5 Base Rate $ 30 . 65 $ 26 . 66 $ 21 . 28 $ 19 . 53 $ 18 . 09
6 holidays: Nevv Years, President's Day, Memorial
Day, Independence Day, Thanksgiving,
Christmas
Updated February 2019
� QLd � A
a t ,_
� ; Office of C1lildren,
. ' Youth & Families
� Department of Human Services
EXHIBIT � - 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
e<Agency» , «Agency_Mailing_Address » , «Agency_City_State_Zip » , hereinafter called " Provider" .
2 . This Contract and Agreement shall be effective from July 1 , 2018 and continue in force until June 30 , 2019 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 Care Home or ❑ Kinship Foster Care Home (check
applicable blank) . 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 isrenewed ;
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 ;
,�'o� _�i �...,
,%w� f \ ;.�Y�
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303 -866- 5932 F 303 - 866- 5536 www. colorado . gov / cdhs � " �
O '
�', � � *�;
John W . Hickenlooper, Governor � Re�gie Bicha , Executive Director ` � � ''
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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 firom 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 audif/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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1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303 - 866- 5932 F 303 - 866- 5536 www. colorado. gov / cdhs i " � '
John W . Hickenlooper, Governor � Reggie Bicha, Executive Director ��� =;'�*�I
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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 , �ibling 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 invoive 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 fwelve 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 � Reg�ie Bicha, Executive Director � �,\* , \ , •;i'��
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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 (typeor print) Signature Date
WHEREFORE , the parties have herein set their hands and affixed their seals the day and date first writtenabove .
ATTEST: BOAFdD 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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1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303- 8b6- 5932 F 303 - 8b6- 5536 www,colorado . gov / cdhs ���'/ ' ` ' �" '�'�,���r`
John W. Hickenlooper, Governor � Reggie Bicha, F�ecutive Director �1 � ., ' ;;% � J
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EXHI � IT A to the CWS-7A
Additional Provisions for the Agreement to Purchase
Fosfier Care Services and Foster Care Facility Agreement
CVVS-7,W
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 <cAgency» , 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 , nor is Provider entitled to any employee benefits from County as
a result of the execution of this Agreement. 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.
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 purposethereof.
4 . This Amendment is intended to be applied in conjunction with afitached Agreement and the Needs
Based Care Addendum as the complete integration of all understandings between theparties .
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 or the Needs Based Care Addendum in writing , if agreed to by both
parties . The Agreement, this Exhibit A and the Needs Based Care Addendum 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 5/2018
8 . Neither par�y to this Agreement shall be liable to the other for delays in delivery or failure to
deliver or atherwise 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 , earfhquakes or Governmental actions .
9 . Any notice required to be given under this Agreement �hall 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 personsto
perform services of the same or similarnature .
11 . Provider certifies , warrants , and agrees fhat 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 zmployment 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 . FZ . 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 wifih Provider fihat 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 orjob applicants while fhis 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 �hall 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-contrac#or 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 Pravider 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 . FZ . 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 . F2 . 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 Stafies or is otherwise lawfully present in the
United States pursuant to federal law, ( b) shall produce one of the forms of identifiication required
by C . R . S . § 24-76 . 5- 101 , et seq . , and (c) shall produce one ofi 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 declaredineligible
or voluntarily excluded from covered transactions by a federal department oragency .
Exhibit A to the CWS-7A 6 Revised 5/2018
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 affenses 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, Exhibit A or the
Needs Based Care Addendum . 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 correctionsin
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 thisAgreement.
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 beneficiaryonly .
15 . No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties
or their of₹icers or empioyees may possess , nor shall any portion of this Agreement be deemedto
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/orforeclosure .
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
Exhibit A to the CWS-7A 7 Revised 5/2018
for that purpose besng 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 a child specific Needs Based Care Assessment, designated as
Addendum 1 shall be used to determine the Child Maintenance and Medical Needs, if applicable ,
for each child placed with Provider unless otherwise negotiated and approved by the County .
20 . County agrees to purchase and Provider agrees to provide the care and services , which are
listed in this Agreement, based on the Needs Based Care Assessment levels determined . The
specific rate of paymenfi will be paid for the Child Maintenance level of service , as indicated by
the Needs Based Care Rate Table , designated as Addendum 2 , for children placed within the
Weld County Gertified Foster Care Home identified as Provider ID# «Agency_ID » .
Th�se services will be for children who have been deemed eligible for social services
under the �tatutes , rules and regulations of the State of Colorado .
21 . All bed hold authorizations and payments are subject to a 7-day maximum for a child ' s temporary
absence from a facility , including hospitalization . Bed hold requests must have prior written
authorization from the Department Adminis₹rator before payment will be release to Provider.
22 . Any additional co�ts for specialized s�rvices , which may include but are not limited to ; Co-pays ,
deductibles , or services not covered by Medicaid , will need to be authorized , in writinq by the
Department Administrator, prior to the service being performed . Any payment for specialized
services not authorized in writinq may bedenied .
23 . All reimbursement requests shall :
A. Be �ubmitied in a format approved by the County. If submitted in an unapproved format
or inadequate documentation is provided , the County reserves the right to denypayment.
B . Be submitted by the 4t" 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 ofpayment.
C . Placement service reimbursement shall be paid frorr� the date of placemenfi up to , but not
including the day ofdischarge .
D . Transportation reimbursement shall be for visitation purposes only. If inedical
transportation is needed , Provider will arrange reimbursement through Medicaid . Any
other special requests for transportation reimbur�ement shall require prior approval by
the Resource Manager or the DepartmentAdministra₹or.
E . Clothing allowance reimbursement shall be approved and reimbursed as indicated on the
clothing allowance form accessed through the Foster Parents Databa�e 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 .
PRO9/IDER SFBALL :
1 . Confiorm 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 fime to time , and shall be binding on Provider and control any disputes in this Agreement.
2 . IVot 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
Exhibit A to the CW5-7A 8 Revised 5/2018
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
attend � nce 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 FosterCare
Coordinator.
8 . Actively participate in achieving the child 's permanency goal , cooperafe 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 attendcourt
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 placementbinder.
10 . Attend all necessary school meetings and support any plan that is developed regarding thechild
in order to promote educational success .
11 . Immediately report fo 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 takingmedications .
15 . Maintain behavior observation notes as required by the level of care assessed for each child .
16 . 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 manuai .
Exhibit A to the CWS-7A 9 Revised 5/2018
ADDENDUM1
Needs � ased Care Assessment
IVBG ( NEEDS BA� � D CAF2E AS � ESSIIIIIENT)
Answers to the following questions will determine the NBC Care Payment. For each question below please select the
closest rating for this child . The following seven ( 7) questions are mutually exclusive .
P1 . How often does the child require transportation by the foster care provider for the Select One
following :
Therapy ; Medical Treatment; Family Visitation ; Extraordinary Educational Needs ; etc. , as
outlined in the treatment plan ?
P2 . How often is the foster care provider required to participate in child ' s therapy or Select One
counselin sessions?
P3 . How much time is the provider required to intervene at home and/or at school with the Select One
child in conjunction with a regular or special education plan ?
P4. How often does the child require special and extensive involvement by the provider in Select One
scheduling and monitoring of time and/or activities and/or crisis management?
P5. How much time is the provider required to assist the child because of impairments Select One
beyond aqe appropriate needs with feeding , bathing , grooming , physical , and/or
occupational therapy?
A1 . How often is CPA/County case management required ? ( Does not include therapy) Select One
*'` Please Note : The Case Management level may be assessed on a combined basis
if a sibling group or more than one County foster child is with the same provider.
T1 . How often are therapy services needed to address child ' s individual needs per N �C Select One
assessment?
NBC ( NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment
Assessment Areas : Comment : Rating :
Aggression/Cruelty to Animals Select One
Verbal or Physical Threatening Select One
Destructive of Property/Fire Setting Select One
Stealing Select One
Self-injurious Behavior Selecfi One
Substance Abuse Select One
Presence of Psychiatric Symptoms/Conditions Select One
Enuresis/Encopresis Select One
Runaway Select One
Sexual Offenses Select One
Inappropriate Sexual Behavior Select One
Disruptive Behavior Select One
Delinquent Behavior Select One
Depressive-like Behavior Select One
� Medical Needs - ( If condition is rated "severe" , Select One
please complete the Medically fragile NBC )
Emancipation Select One
Eating Problems Select One
Boundary Issues Select One
Requires Night Care Select One
Education Sefect One
Involvement with Child ' s Family Select One
AI)DE1�iDU1VI 2
�deeds �ased Care ate Table
�'elcl County Departrtient of IIuman Services
(Effective 7/01 /201 �)
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Addendum 2 11 Revised 8/2018
6 . 2 . 50 .
Adult Caretaker NAME : Case # SSN
lst Adult Gross 2"d Adult Gross
Monthly Monthly
Income Inc� rvae
Narne : Name : TOTAL
Expenses
(Vame :
Arnount: TOTAL
Last time Hardship was assessed ?
Is the current Provider quality rated three ( 3 ) or above ?
SURVEY OF NEED : Provide a statement below why a parent fee hardship should be considered .
Client si�nature : Date Caseworker s ��nature : Date
NIanager Date
Hardships are not � uaranteed and if approved , it' s up to six ( 6 ) months or re- determination whichever occurs
first .
� • Y � � � � - � �
(Vame (s) of Child ( rer� )/Y� uth : ��
Name (s) af Kinship Caregiver(s) :
12eiationship of Kinshi p Caregiver( s) to Child ( ren )/Youth :
Address af Kinship C� r�giver( s} �
�� taf � �� � �t� i�iv� r� r�r� sa � � ro� o
I� �ir� a �° � �- :
TFiIS AGREEEMENT PRO\/ IDES GENERAL REQUIREMEIVTS AND INFORMATIONa COUNTY
DEPARTIldIENTS OF HllIVIAN/SOCIAL SER\lICES MAY HAilE ADDITIONAL COUNTY
SPECIFIC REQUIREMENTS .
� ta rp�� �� m
m To address the needs of the child ( ren )lyouth , f� miiy and kinship p c� regiver(s } and to achieve the goals of
safety , permanency , � nd wellbeing for the child { ren )fyauth .
� To provide kinship caregivers with infarm �tion abaut their options , possible services , and the expectations of
the county dep� rtment af human/sacial services .
When a child ( ren )lyouth c� nnofi safely remain at home , the first pref� rence is to consider relatives and adufts with
a signific� nt relatic� nship for piacement. The county departments a� human/social s� rvice� conduct a search for
refativ�s nr other� �vith a significant rei�tian �hip p to the child ( r� n )lyouth as possible placement options .
� r� w in� i � � r� �ver ti � r� �
I . Chifdren/youth may reside wifih a kinship caregiver temporarify while shart-fierm and long-ferm plans are
dev� lop�d . There is no gu �rantee the child ( rer� )/youth will remain with the kinship caregiver for � longer period .
9n partnership p/con � ultation with the family, the county d� p� rtment af human/sacial services wiff make
recommer�datior� s regarding placement fc�r the child ( r�n }/yauth if needed .
2 . If out-of-home plac� ment is required and the kinship caregiver �ants to continue as a placement c� ption , kinship
caregivers must decid� whether to � pply to be � certified kinship fcaster home or remain a non-certified kinship
caregiver, with the goal of �ssuming custody of the child ( ren )/yaufh fihrough the court with jurisdiction of ₹he
case .
CiP- 1 ihtn5}'u �� Prc3�ranr i<,iiishi� Cr�st; 4rraGnacnP}
Rev.9il �d ` IS
R�ritten }�ez�nission froir7 the C'oloi�adt� BeE3ar±it�ant o1'�f�lumtan Se�rvice�s. Divisioi� pFCliild Welf��rz is rec�uireci tc� mpdify tl�is fonv -
The requirements and passible benefits for certified kinship p foster care and non-certified kinship p care are as
follows :
Kinship Foster Car� Home (the county department of human/social services retains legal custody of the
child ( ren )/youfih and the kinship caregiver meets all requirements for a foster care home) :
The county departmenfi of human/social services will assist kinship providers i n the certification process . Below are
some of the requirements :
• An application to provide foster care
• Background checks for all adults age 18 ar older living in the home :
o Fingerprint-based criminal history with the Colorado Bureau of Investigation ( CBI ) and the Federal
Bureau of Investigatian ( FBI �
o Child abuse/neglecfi recards in every state where each adult has resided in the five ( 5 ) years
precedina the date of application
o Colorado Court Access database
o CBI Sex Ofifender Registry and the Natianal 5ex Offender Public Website
p Structured Analysis Family Eval uatian ( 5AFE) home study
• Home inspection
• 27 hours of pre-certificatian training
• CPR/First Aid
• Health eval uations for all residents in the home
• C7ngaing compliance with certification requirements
� 20 hours aftr� ining annu � lly
Possible Benefits ( subject ta eligibiiity) :
• Foster care reimbursement when the kinship foster care home is provisionally or fully certified
- Medicaid for Yhe child ( ren )lyouth
• TRICARE Standard military benefits farthe child ( ren }lyouth ( as applicable)
• Core services ( including but not limited to horr� e- based services , rntensive family therapy, life skills , special
econamic assistance and county designed services )
• IV- E or state adoption assistance if there is termination of parental rights and the kinship caregiver adopts
the child ( ren )lyauth
� Relative Guardianship Assisfi� nce Program (assistance and legal permanency)
N � r� -C � rtr�ied �Cinshit� Florne (the kinship caregiver obtains temporary legal custody of the child ( ren )/youth
through the court ofjurisdiction ) :
Requirements :
• An application to provide kinship care
• Background checks for all adults age 18 or older I iving in the hame :
o Fingerprint-based criminal hisfiory check with Colorado Bureau of Investigation ( CBI ) and the Federal
Bureau of Investigation ( FBI )
o Child abuse/ neglect records in every state where each adult has resided in the five ( 5 ) years
preceding the date of appiication
o Golorado Court Access database
o CBI Sex Offender R�gistry and the National Sex Offender Public Website
• Evaluate the nan -cerfified kinship family addressing the areas of: safety , parenting 5kills ,
potential for permanency , needs of the kinship family , a support system , strengths and any other
areas deemed necessary by the county department . A wal k through/inspection of the home to assess
safety .
l� P- 1 ( Kin ;liiE�� Pro��ram- I<iiiship C'aae Ar,rc.civent)
Rcv. 9i 1 �4i 1 $
\-Vrittc'n l�ezmission from the Cblor��dc� Deprirtm��nt of Human �c��rvi� e3. Divisi�tn nfC(�ild bt elt.ire is requrrecl Yo modi (}� Chis form
Passible Benefits (subject to eligibility) :
Q Child suppart �rom the absent parent( s)
� Social �ecurity and/ar death benefrts
o Supplemental Security incom€: ( SSI )
o Sup �lemental �ecurity for Disability Income { SSDI )
- T�mpprary A�sisfance for Ne�dy Families (TAI� F )
• Medicaid (for the child ( ren )lyouth )
� TRICARE Stand � rd military benefits (for the child ( ren )/youth ) {as applicabie)
• Cor� services ( including but nnt limited to home-based services , intensive family therapy , life skills , speciai
economic assistance and county d �signed services)
• Child Welfare Child Care ( dependent upon county department policy and funding }
• Golorada Child Care Assistance Program ( CCCAP-based on kinship caregiver's income )
�� r� � � � xpe��a�i��� c�fi � on� hip �ar�gi�� r�
The ki nship caregiver is expected ₹o wark wrth and under the supervision ofi the county dep� rtment of human/social
services . Thi� includ �� participation in case planning and activities that pramote reunification for the
child ( ren )/yc� uth , and other responsibilities including but not limited to :
i . Transporting the child ( ren )lyouth ta therapy ; visitation with parents ; schaoVdaycare ; medical appointments ; or
ofiher transporfiation requests that may be necessary , depending an the specific needs of the child ( ren )/yauth .
2 . Scheduling a medical examinatipn with an Early and Periodic Screening , Diagno�tic and Treatment ( EPSDT)
appraved provrder vuithin 14 calendar days of placement of the child ( ren )lyouth � nd a dental examination
within 8 weeks of placement for the child ( ren }/yauth .
� . G' articipating ( if r�quested ) in th � rapy for fhe child ( ren }/youfh and/ar follow through with therapeutic
recomm �ndations forthe child ( re � )/ya �.ath inthe home .
4, Keeping the caseworker infiormed abaut the progress and ne�ds of the child { ren )/youth , � eeds or
ch � lienges of the kinship caregiver , and any other infarmation th �t may rm �act the ��f�ty , perman � ncy, or
vuell- being of the child ( ren )/youth .
5 . Permit�ing telephane calls and visits to the home by ths caseworker and the Guardian ad Litem .
6 . A1lowing p� rent �ccess to the child ( ren )/youth as direct�d by the caseworker cr court order.
7 . Documer�ting information forthe c�seworker reg �rding the visitation (when appiicable} , including the
re� ctrc� r� or behavior of the parent( s) andlar the child ( ren )/youth related to the visits . This responsibility
occurs on � ca�e- by-case basis .
� . Permission must be ob�ain �d from the county department or fhe court with jurisdiction in advance rn order
far a child ( r� n )/youth to travel outside of Colorado .
9 . Camplying with any and all caurt ord � rs pertaining to fhe child ( ren )/you₹h ' s r� eeds .
10 . Completing any other requirements specific to the county department ofi human/soci� l s� rvices .
F'art � : [� i� � opli �a� F'€� micy
aiscipline must be constructive or educational in nature and may include talking with the child ( ren )/youth about the
situation , praise fnr appropriate behavior, div�rsian , separation from the problem situation , and withholding
privilege � .
Discipline :
I . Children/youth have the right to basic necessities including , but nat limited to food , ciothing , adequate rest,
and shelter.
2 . Spanking and cruel/unu � uaE punishment are not perrnitted . This i nclude� but is nat limited to :
p Any punishment that is intended tc� cause physicai parn ar is inflict�d upon the bady of a child(youth , and/or
p Any humiliating c� r frightening discipline intended ta cantrol the actions of � child/youth .
3 . Punishmenfi for toileting accrdent� is nat permitted .
4 . Verbal abuse or derogatory remark� � bout the child ( rer� )/youth , their f� mily , race, religian or cultural
backgrnund i � nof permitted .
h: l?- 1 ('I� In,sh.ip 1'rogr��77- Kiushil7 C'ar<�, 4Qac�eme¢lY)
Reti- .911 �4/ 1 �
Written p�;rinis� ic�n from rhe Colorado Dep�artu��nt of I� iwn•r�n Se.rvicas. Division afChild 1�'eifi�re is required tp modify tl�is frrnu -
5 . Children/youth are � Ilowed communicatian ( including visitatron or telephone) privileges with their family ,
clergy , attorney or casewarker.
6 . If the discipline is to separate a child/youth from others or an activity , it must be brief and appropriate for age
and circumstances .
Disregard of the discipiine rules outlined in Section 7 . 708 nf Staff Manual Volume VII is graunds for deni � l of the
kinship application and/ar may result in the removal af the child ( ren )/youth from the home . Discipline or Jack of
supervision that results in physical injury or abuse to a child/youth may result in crimi nal charges and/or removal
of the child ( ren )/youth fram the home .
Ackr� r�wl�dgem � nt:
I /We have been informed of our options and their requirements , services that we may be eligible for, and
expectations of the county department of human/social services inc( uding the discipline policy . IIWe agree to
comply with any policies that the county department of human/social services requires and all laws of the State of
Colorado .
Additianal Agreement(s) or Requirements fram the Caunty Department of Human/Social Services :
Requirements may be outlined below or entered on an addendum and attached ta this agreement.
Provider
Provider Date
Witnessed by Caseworker (or other placing party named above) :
�t�
1�1'- I (h; inst�ip PrUr,r<zin- fCinslai�7 Cue Ar,re��cna�nf)
Rev . �l.%I �4% 18
\Vritten �eirriissic�n fron�i the Colorado Deparunent ofHiuri•cin Se�rvice�s. Uivis�ou ofCl� ilci Weltkre is requirecl Yo n�odify this Y'orm-
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