HomeMy WebLinkAbout20190597.tiffRESOLUTION
RE: APPROVE INDIVIDUAL PROVIDER CONTRACT FOR PURCHASE OF FOSTER CARE
SERVICES IN A FOSTER CARE HOME AND AUTHORIZE CHAIR TO SIGN - TIERNEY
AND DANNY BALDWIN
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 an Individual Provider Contract for
Purchase of Foster Care Services in a Foster Care Home between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, and Tierney and Danny Baldwin, commencing September 7,
2018, and ending June 30, 2019, with further terms and conditions being as stated in said
agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and inccrporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Individual Provider Contract for Purchase of Foster Care Services in
a Foster Care Home between the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, on behalf of the Department of Human Services, and
Tierney and Danny Baldwin, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 6th day of February, A.D., 2019, nunc pro tunc September 7, 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: d...,O4,O ; ,Weld County Clerk�Ctothe Board �
BY: I
Deputy Clerk to the Bo
ED
County Attorney
Date of signature: 2-12-19
EXCUSED
Barbara Kirkmeyer, Chair
Int-1942'
Mike Freeman, Pro-Tem
C.c. NSD
2121119
2019-0597
H R0090
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PRIVILEGED AND CONFIDENTIAL.
MEMORANDUM
DATE: September 24, 2018
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services'
Individual Provider Contracts for Foster Care Services
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of the Department's Individual Provider Contracts for Purpose
of Foster Care Services. The major provisions of these agreements are:
CMS
ID
Provider/Term
Facility Type/Location
Daily Rate
_
2099
Baldwin, Tiemey
9/7/2018 - 6/30/2019
County Foster Care
Longmont, CO
Negotiated based on needs of
chil ren
2100
Aikens, Carly
9/15/2018 - 6/30/2019
County Foster Care
Greeley, CO
Negotiated based on needs of
children)
I do not recommend a Work Session. I recommend approval of these agreements.
Approve
Recommendation
Sean P. Conway
Julie A. Cozad
Mike Freeman
Barbara Kirkmeyer, Pro -Tern
Steve Moreno, Chair
MF
Schedule
Work Session
Other/Comments:
2019-0597
Pass -Around Memorandum; September 24, 2018— ID 2099 & 2100
Page 1
R_ vco
COLORADO
Office of Children,
Youth ft Families
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INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date,k) li, o"D/9, by and between the Weld County
Department of Human Services, P. O. Box A, Greeley, CO 80632, hereinafter called "County Department" and
Baldwin, Tierney and Danny, 11179 Yosemite Court, Longmont, CO 80504, hereinafter called
"Provider".
2. Thls Contractand Agreement shall be effective from September 7, 2018 and continue in force.uritil June 30, 2019
or until theiecility certificate is revoked or surrendered. This contract and agreement may be reviewed 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: ID Foster Care Home or ❑ Kinship Foster Care Home (check
applicable blank). Such,certification standards shall be maintained during the term hereof. The providerhas
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 providedto. 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 ancf 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;
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
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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 Departmenta 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;
CountyDepartment,. as recorded in the Family Service Plan. Transportation must be provided or
arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For children or youth to participate in age or developmentally appropriate: extracurricular, enrichment,
cultural, and social activities.
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
d. Any significant change in the sleeping arrangement -for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, schooUschool 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 197.3, and the ADA of 1980, 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. To annually:
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 carehome• 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 andnecessary records for audit/review purposes by state and federal personnel These, records
shall' document the type of care and dates that care is provided for each child or youth. In addition; medical,
educational andprogress 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;
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303.866.5536 www.cotorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Dicha, Executive Director
2
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The County Departmient.agrees!
1. To share all available information about the child or youth, 'inducting relevant social, medical and educational history,;
behavior problems, court involvement, parental,sibling and relative visitation plans, and other specific characteristics:
of the child or youth, with the provider before placement and to share,additional information.when obtained' while
the child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as, meeting 'mediae! needs,
visitation, special psychological needs, trauma and.othergrief/loss issues, and the child's or youth's:identifcation with
his/her family;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the,Family"Service Plan, as it pertains to their expectations formeeting the needs of the
child or youth•in the foster care home, at the timeOf placement or when it is completed fo!lowlrig placement
7. To giveatleast,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 toallow and permit immediate removal of a child or youth for placement elsewhere,,
or'withoutsuch 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 pt 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 authorised 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 of the payment. The Providerunderst'ands
that pursuant to the Colorado Department ofDepartment Of Human Services' Rules for the General Reimbursement for Child
Welfare Services, when,reimbursement is warranted current and (2) preceding months. .
9. To provide. of arrange through, statewide contracted training, a minimum of twelve hours of cote.pre-service
training for -fester care homes and 15 hours. of pr`.e=service training directed at the needs ofihe 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 reasonable and pruderiY,parent
c. Provide training that prepares each foster parent to' use and apply the
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.
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303.866-5932 F 303.866-5536 www,colorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
3
13. To incorporate provider information in planning for the child or youth placed in the foster care home.
14. To assure that the service described herein has been accomplished and a record made thereof on a case by case
basis.
15. To provide notice of court hearings for each child or youth placed in the foster care home.
County Department (typeor print)
Signature
Date
WHEREFORE, the parties have he - = eir hands and affixed their seals the day and date first written above.
COUNTY;
ATTEST.
Weld ' ou Jerk t• the
By:
ervie vkl dlw►til
Provider (type o print)
Provider (type or print)
D OF COUNTY COMMISSIONERS
COUNTY, COLORADO
Freeman, Pro—Tem
Signature
Signature
FEB 062019
-I S'
Date
1-14 -IT'
Date
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303.866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickentooper, Governor I Reggie Richa, Executive Director
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02.o/9...‹?7
)CHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase
Foster Care Services and Foster Care Facility Agreement
CWS-7A
The following additional provisions in this Exhibit A, and Addendum 1 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 Baldwin, Tierney and Danny, 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 purpose thereof.
4. This Amendment is intended to be applied in conjunction with attached Agreement and the Needs
Based Care Addendum as the complete integration of all understandings between the parties.
No prior or contemporaneous addition, deletion or other amendment hereto shall have any force
or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal,
addition, deletion, or other amendment hereto shall have any force or effect unless embodied as
a part of this written Agreement. This section shall not be construed as prohibiting the periodic
amending of this Agreement 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
1 Revised 5/2018
8. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to
deliver or otherwise to perform any obligation under this Agreement, where such failure is due to
any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes,
war, flood, earthquakes or Governmental actions.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or
delivered to the other party at that party's address as stated in this Agreement.
10. This Agreement is nonexclusive and County may engage or use other Providers or persons to
perform services of the same or.similar
11. Provider certifies, warrants, and agrees that it does not knowingly employ or contract with an
illegal alien who will perform work under this contract. Provider will confirm the employment
eligibility of all employees who are newly hired for employment in the United States to perform
work under this Agreement, through participation in the E -Verify program or the State of Colorado
program established pursuant to C.R.S. §8-17.5-102(5)(c). Provider shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement or enter into a contract with
a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly
employ or contract with an illegal alien to perform work under this Agreement. Provider shall not
use E -Verify Program or State of Colorado program procedures to undertake pre -employment
screening or job applicants while this Agreement is being performed. IfProvider obtains actual
knowledge that a sub -contractor performing work under the public contract for services knowingly
employs or contracts with an illegal alien Provider shall notify the sub -contractor and County
within three (3) days that Provider has actual knowledge that a sub -contractor is employing or
contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not
stop employing or contracting with the illegal alien within three (3) days of receiving notice.
Provider shall not terminate the contract if within three days the sub -contractor provides
information to establish that the sub -contractor has not knowingly employed or contracted with an
illegal alien. Provider shall comply with reasonable requests made in the course of an
investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of
Labor and Employment. If Provider participates in the State of Colorado program, Contract
Professional shall, within twenty days after hiring a new employee to perform work under the
contract, affirm that Provider has examined the legal work status of such employee, retained file
copies of the documents, and not altered or falsified the identification documents for such
employees. Provider shall deliver to County, a written notarized affirmation that it has examined
the legal work status of such employee, and shall comply with all of the other requirements of the
State of Colorado program. If Provider fails to comply with any requirement of this provision or of
C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so
terminated, Provider shall be liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5 103(3), if
Provider receives federal or state funds under the contract, Provider must confirm that any
individual natural person eighteen (18) years of age or older is lawfully present in the United
States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided
under the contract. If Provider operates as a sole proprietor, it hereby swears or affirms under
penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the
United States pursuant to federal law, (b) shall produce one of the forms of identification required
by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required
by C.R.S. § 24-76.5-103 prior to the effective date of the contract.
12. Provider assures and certifies that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, and declared ineligible
or voluntarily excluded from covered transactions by a federal department or agency.
Exhibit A to the CWS-7A
2 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 a government
entity (federal, state, or local) with commission of any of the offenses enumerated in
paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause ordefault.
13. In addition to terminating this Agreement in accordance with the provisions herein, County
may exercise the following remedial actions if the County finds and determines that the
Provider has substantially failed to satisfy the duties found in this Agreement, 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 corrections in
performance are satisfactorily completed.
B. Deny payment or recover reimbursement for those services or deliverables which have
not been performed and which due to circumstances caused by Provider cannot be
performed or if performed would be of no value to County. Denial of the amount of
payment shall be reasonably related to the amount of work or deliverables lost to County.
C. Recover from Provider any incorrect payment to Provider due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement, or
other agreements between County and Provider, or as a debt to County, or otherwise as
provided by law.
14. It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties or their assignees, and nothing contained in this Agreement shall give or
allow any claim or right of action whatsoever by any other person not included in this Agreement.
It is the express intention of the undersigned parties that any entity other than the undersigned
parties or their assignees receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
15. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties
or their officers or employees may possess, nor shall any portion of this Agreement be 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/or foreclosure.
17. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado
and be in accordance with the policies, procedures, and practices of County. Provider shall
strictly comply with all applicable federal and State laws, rules and regulations in effect or
hereafter established.
18. Financial obligations of the County payable after the current fiscal year are contingent upon funds
Exhibit A to the CWS-7A
3 Revised 5/2018
for that:purpose being appropriated, budgeted and otherwise made available. Execution of this
Agreement by County does not create an obligation on the part of County to expend funds not
otherwise appropriated in each succeeding year.
19. County and Provider agree that 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 payment 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 Certified Foster Care Home identified as Provider ID# «Agency_ID».
These services will be for children who have been deemed eligible for social services
under the statutes, rules and regulations of the State of Colorado.
21. All bed hold authorizations and payments are subject to a 7 -day maximum for a child's temporary
absence from a facility, including hospitalization. Bed hold requests must have prior written
authorization from the Department Administrator before payment will be release to Provider.
22. Any additional costs for specialized services, which may include but are not limited to; Co -pays,
deductibles, or services not covered by Medicaid, will need to be authorized, in writing by the
Department Administrator, prior to the service being performed. Any payment for specialized
services not authorized in writing may be denied.
23. All reimbursement requests shall:
A. Be submitted in a format approved by the County. If submitted in an unapproved format
or inadequate documentation is provided, the County reserves the right to deny payment.
B. Be submitted by the 4th of each month following the month of service. If the
reimbursement request is not submitted within twenty-five (25) calendar days ofthe
month following service, it may result in forfeiture ofpayment.
C. Placement service reimbursement shall be paid from the date of placement up to, but not
including the day of discharge.
D. Transportation reimbursement shall be for visitation purposes only. If medical
transportation is needed, Provider will arrange reimbursement through Medicaid. Any
other special requests for transportation reimbursement shall require prior approval by
the Resource Manager or the DepartmentAdministrator.
E. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the
clothing allowance form accessed through the Foster Parents Database On-line System
(FIDOS).
24. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and
protect personal items brought to Provider by the children, Provider shall be released from
responsibility for loss or damage to such personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human
Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State
of Colorado and any applicable federal laws and regulations, as such, which may be amended
from time to time, and shall be binding on Provider and control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services
provided under this Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the
Exhibit A to the CWS-7A.
4 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
attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations.
These requests shall be made through the child's caseworker and/or the Provider's Foster Care
Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors
hired by the Weld County Department of Human Services to preserve placement in the least
restrictive placement appropriate, comply with the treatment plan of the child, and attendcourt
hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completed within
8 weeks of the child being placed with Provider. All documentation of these examinations will be
placed in the foster child's placement binder.
10. Attend all necessary school meetings and support any plan that is developed regarding the child
in order to promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set forth in Section 19-3-304,C.R.S.
12. Maintain, access and review information weekly onFIDOS.
13. Maintain/update information in the foster child's binder. The binder will be reviewed on amonthly
basis and signed off by child's caseworker and/or the Provider's Foster Care Coordinator.
14. Maintain/update medication logs on a daily basis, if child is taking medications.
15. 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 manual.
Exhibit A to the CWS-7A
5 Revised 5/2018
ADDENDUM 1
Needs Based Care Assessment
NBC (NEEDS BASED CARE ASSESSMENT)
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
following:
Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as
outlined in the treatment plan?
Select One
P2. How often is the foster care provider required to participate in child's therapy or
counseling sessions?
P3. How much time is the provider required to intervene at home and/or at school with the
child in conjunction with a regular or special education plan?
Select One
Select One
P4. How often does the child require special and extensive involvement by the provider in
scheduling and monitoring of time and/or activities and/or crisis management? -
Select One
P5. How much time is the provider required to assist the child because of impairments
beyond age appropriate needs with feeding, bathing, grooming, physical, and/or
occupational therapy?
Select One
Al. How often is CPA/County case management required? (Does not include therapy)
**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.
Select One
T1. How often are therapy services needed to address child's individual needs per NBC
assessment?
NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment
Select One
Assessment Areas:
Comment:
Rating:
❑
Aggression/Cruelty to Animals
Select One
❑
Verbal or Physical Threatening
Select One
Destructive of Property/Fire Setting
Stealin
Select One
Select One
❑
Self -injurious Behavior
Select One
❑
Substance Abuse
Select One
❑
Presence of Psychiatric Symptoms/Conditions
Select One
Enuresis/Encopresis
Runaway
Sexual Offenses
Inappropriate Sexual Behavior
Disruptive Behavior
Delinquent Behavior
Depressive -like Behavior
Select One
Select One
Select One
Select One
Select One
Select One
Select One
Medical Needs - (If condition is rated "severe",
please complete the Medically fragile NBC)
Select One
Emancipation
Select One
Eating Problems
Boundary Issues
Requires Night Care
Education
Select One
Select One
Select One
Select One
y
Involvement with Child's Family
Select One
Addendum 1
10 Revised 5/2018
ADDENDUM 2
Needs Based Care Rate Table
Weld County Department of Human Services
(Effective 7/01/2018)
LEVEL OF
SERVICE
CHILD
• MAINTENANCE
RESPITE
MEDICAL
NEEDS
Level
Daily Rate
Daily Rate
_
Daily Rate
County
Basic
Maintenance
Rate
$35.70
$.66
I
$35.70
$.66
$3.54
1 '/2
$35.70
$.66
2
$35.70
$.66
' .
$5.09
2 1/2
$38.99
$.66
3
$42.28
5.66
. -
$6.66
3 1/2
$45.57
$.66
4
Congregate
Care
Drop Down
r
$48.86
$.66
Negotiated
Assessment/
Emergency
Level Rate
$35.70
-
$.66
-
Addendum 2
11
Revised 8/2018
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