HomeMy WebLinkAbout20181952.tiffRESOLUTION
RE: APPROVE FOUR (4) STANDARD FORMS OF AGREEMENTS FOR VARIOUS
OUT -OF -HOME PLACEMENT SERVICES, COST OF LIVING RATE INCREASE
PROVIDER LIST BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN
SERVICES AND VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN
AGREEMENTS CONSISTENT WITH SAID FORMS
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 four(4) Standard Forms of Agreements
for Various Out -of -Home Placement Services between the Weld County Department of Human
Services and various providers, and
1. Exhibit to SS23A - Additional Provisions for Purchase of
Residential Child Care Facility Services
2. Exhibit to SS23A - Additional Provisions for Purchase of Child
Placement Agency Services
3. Exhibit to SS23A - Additional Provisions for Purchase of Group
Home/Group Center Care Services
4. Individual Provider Contract for Purchase of Foster Care
Services in a Foster Care Home
5. Weld County Foster Care Providers List
WHEREAS, after review, the Board deems it advisable to approve the four (4) Standard
Forms of Agreements for Various Out -of -Home Placement Services, copies of which are attached
hereto and incorporated herein by reference, and to delegate standing authority to the Chair of
the Board of County Commissioners to execute individual agreements between the Department
of Human Services and the individuals identified on the providers list.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that these standard forms between the Weld County Department of Human
Services and various providers be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign any agreements consistent with said forms.
CC: OS O
07- 3O -I
2018-1952
HR0089
APPROVE FOUR (4) STANDARD FORMS OF AGREEMENTS FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND VARIOUS PROVIDERS
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 20th day of June, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: datiLet) uld4; (,r.
Weld County Clerk to the Board
BY:
Deputy Clerk to the Bo
AP - V ' D AS
ounty A orney
Date of signature: 07-Z7-/
Steve Moreno, Chair
arbara Kirkmeyer,
Mike Freeman
2018-1952
HR0089
MEMORANDUM
DATE: June 12, 2018
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services' Child
Welfare Request for 2018-2019 SFY Out -of -Home
Provider Contract Templates and Cost of Living
Rate Increase and OOH Provider List
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of Department's Child Welfare 2018-2019 SFY Out -of -Home
(OOH) Provider Contract Templates and Cost of Living Rate Increase and 0011 Provider
List (attachments). Listed below and attached for your reference are the proposed updates to
the Standard Form Agreements for Human Services. These updated templates have been
reviewed by Assistant County Attorney, Karin McDougal, and have been approved for our use
for the 2018-2019 contract year, at which time individual provider contracts will be submitted
through the CMS process. The updated forms are as follows:
1. Exhibit to the SS23A for the Purchase of Child Placement Agency Services
2. Exhibit to the SS23A for the Purchase of Group Home/Group Center Care Services
3. Exhibit to the SS23-A for the Purchase of Residential Child Care Facility Services
4. Exhibit A to the CWS-7A Individual Provider Contract
5. List of out -of -home providers for FY 2018-2019.
In March 2018, the Joint Budget Committee approved a one (I) percent cost of living adjustment
for OOH providers for FY 2018-2019, and this is reflected in the rate table attached to Exhibit A
of CWS-7A and the rates in the list of group home and residential child care facility providers.
SB 18-254 provides for an increase in provider reimbursement rates, but the Department has not
been notified when the rates will increase, or by how much. When that information is available,
those rate adjustments will be passed along to providers through individual provider contract
addendums.
2018-1952
Pass -Around Memorandum; June 12, 2018 — Not in CMS Page 1
I do not recommend a Work Session. I recommend approval of these Contract Templates and the
Cost of Living increase as approved by the state and OOH Providers.
Sean P. Conway
Julie A. Cozad
Mike Freeman
Approve Schedule
Recommendation Work Session
mF
Barbara Kirkmeyer, Pro -Tern \f ( emu i L
Steve Moreno, Chair
Other/Comments:
Pass -Around Memorandum; June 12, 2018 — Not in CMS Page 2
EXHIBIT to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Residential Child Care Facility Services
The following additional provisions of this Exhibit apply to the agreement entitled, "Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Human
Services," hereinafter referred to as, "County," and «Agency», hereinafter referred to as,
"Contractor."
1. County agrees to purchase and Contractor, ID# «Facility_ID», agrees to provide:
a. Child Maintenance, Administrative Maintenance and Services, which are listed in this
Agreement at a rate of $«Agency_Rate» per day unless otherwise negotiated based on
the needs of the individual child placed within the Residential Child Care Facility.
b. Additional services not covered by Medicaid or considered within the above vendor
rate. These additional services/rates may be negotiated on a child by child basis,
based on the needs of the child and in accordance with the Colorado Department of
Human Services Agency Letter C W -06-11-I dated June 8, 2006.
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.
2. County considers the agreed upon rate, outlined in the Weld County Addendum to this
contract, to be all inclusive and shall not pay for additional treatment fees; i.e.
Drug/Alcohol and Sex Offender services.
3. All bed hold authorizations and payments are subject to a seven (7) day maximum for a
child's temporary absence from a facility, including hospitalization. Bed hold requests
must have prior written authorization from County Administrator before payment will be
released to provider. Reimbursement rates for bed hold days may not exceed the state
standard rate for administrative maintenance and administrative services or may be a
reduced rate that is mutually agreed upon.
4. The services purchased under this Agreement as Child Maintenance, Administrative
Maintenance and Services for Residential Child Care Facilities include, but are not
limited to: Food, shelter, clothing, personal needs and allowance, administration,
administrative overhead, support staff, support overhead, sleep -over staff, direct child
care, transportation, therapeutic recreation, service delivery staff, parent training for
teens, independent living training, mentor/advocate, supervised visitation and all other
services as outlined in the Child Specific Addendum. The anticipated minimum
percentage for each item is as follows and will be subject to County monitoring as
outlined in Section VI of this contract:
a. Food, including meals and snacks (25%).
Exhibit to the SS23A
1 Revised 6/2018
b. Clothing (3%).
c. Shelter, including utilities and use of household furnishing and equipment and daily
supervision, including those activities that a parent would normally carry out to assure
protection, emotional support and care of the child (30%).
d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap,
combs, haircuts, and other essentials (2%).
e. Other/miscellaneous items considered usual in the care and supervision of the child,
include, but are not limited to, transportation, recreation and overhead (40%).
5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be
furnished by Contractor under this contract for facilities that provide sex offender
treatment.
6. Any additional costs for specialized services, which include, but are not limited to;
polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the
vendor rate or attached Scope of Service, will need be negotiated and authorized, in
writing by County, prior to the service being performed. Any payment for specialized
services not authorized in writing will be denied.
7. Contractor agrees to have appropriate personnel available to attend or participate in
Family Engagement, Team Decision Making meetings or court hearings. Provider shall
be notified by County staff of the dates and times attendance is requested.
8. Contractor agrees to cooperate with any vendors hired by the Weld County Department
of Human Services to shorten the duration of placement.
9. Contractor agrees to have physical examinations scheduled within 14 days and dental
examinations scheduled within eight (8) weeks of the child being placed with Contractor.
All documentation of these examinations shall be forwarded to County.
10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan
(IEP) for youth designated as a Special Education Student every three (3) years and
coordinate reviews every year. If the IEP is due while the child is in placement,
Contractor will complete or obtain a completed IEP. A copy will then be forwarded to
County.
11. Children in Residential Child Care Facilities and Child Placement Agencies are generally
not eligible to receive clothing allowances as outlined in the Weld County Department of
Human Services Policy and Procedure Manual. However, a one-time emergency
clothing allowance may be approved in limited circumstances, with prior written
authorization from County's Department Administrator required before payment will be
released to provider.
12. County shall have access to Contractor's financial records as they relate to 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
Exhibit to the SS23A
2 Revised 6/2018
five years after final payment hereunder.
13. Time is of the essence in each and all of the provisions of this Agreement.
14. 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.
15. 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 above.
16. 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.
17. This Agreement is nonexclusive and County may engage or use other contractors or
persons to perform services of the same or similar nature.
18. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract
with an illegal alien who will perform work under this contract. Contractor will confirm
the employment eligibility of all employees who are newly hired for employment in the
United States to perform work under this Agreement, through participation in the E -Verify
program or the State of Colorado program established pursuant to C.R.S. §8-17.5-
102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or enter into a contract with a subcontractor that fails
to certify with Contractor that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. Contractor shall not use E -
Verify Program or State of Colorado program procedures to undertake pre -employment
screening or job applicants while this Agreement is being performed. If Contractor
obtains actual knowledge that a subcontractor performing work under the public contract
for services knowingly employs or contracts with an illegal alien Contractor shall notify
the subcontractor and County within three (3) days that Contractor has actual knowledge
that a subcontractor is employing or contracting with an illegal alien and shall terminate
the subcontract if a subcontractor does not stop employing or contracting with the illegal
alien within three (3) days of receiving notice. Contractor shall not terminate the contract
if within three (3) days the subcontractor provides information to establish that the
subcontractor has not knowingly employed or contracted with an illegal alien. Contractor
shall comply with reasonable requests made in the course of an investigation, undertaken
pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and
Employment. If Contractor participates in the State of Colorado program, Contractor
shall, within twenty days after hiring a new employee to perform work under the contract,
affirm that Contractor has examined the legal work status of such employee, retained file
copies of the documents, and not altered or falsified the identification documents for such
employees. Contractor shall deliver to 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 Contractor 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, Contractor shall be liable for actual and
consequential damages.
Exhibit to the SS23A
3 Revised 6/2018
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3),
if Contractor receives federal or state funds under the contract, Contractor must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in
the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public
benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby
swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is
otherwise lawfully present in the United States pursuant to federal law, (b) shall produce
one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall
produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the
effective date of the contract.
19. Contractor assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency;
b. Have not, within a three(3) 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 (3) year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
20. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, County may exercise the following remedial actions County find and
determine that Contractor has substantially failed to satisfy the scope of work found in the
Agreement, any Exhibit, the child specific addendum SS23B, 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 Contractor. These remedial actions include,
but are not limited to, any one or more of the following:
a. Withhold payment to Contractor 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 Contractor
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.
Exhibit to the SS23A
4 Revised 6/2018
c. Recover from Contractor any incorrect payment to Contractor due to omission,
error, fraud, and/or defalcation by deducting from subsequent payments under this
Agreement, or other agreements between County and Contractor, or as a debt to
County, or otherwise as provided by law.
21. 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.
22. No portion of this Agreement shall be deemed to constitute a waiver of any immunity
including those provided by the Colorado Governmental Immunity Act §§24-10-101 et seq.,
as applicable now or hereafter amended, that the parties or their officers or employees may
possess, nor shall any portion of this Agreement be deemed to have created a duty of care
that did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to
circumvent or replace such immunities.
23. Contractor 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. Contractor,
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 County Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
24. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
25. Financial obligations of County payable after the current fiscal year are contingent upon
funds for that purpose being appropriated, budgeted and otherwise made available.
Execution of this Agreement by County does not create an obligation on the part of
County to expend funds not otherwise appropriated in each succeeding year.
26. Contractor agrees that it is an Independent Contractor and that Contractor's officers,
agents or employees will not become employees of County, nor entitled to any employee
benefits from County as a result of the execution of this Agreement. Contractor shall
perform its duties hereunder as an Independent Contractor. Contractor shall be solely
responsible for its acts and those of its agents and employees for all acts performed
pursuant to this Agreement. Contractor, its employees and agents are not entitled to
unemployment insurance or workers' compensation benefits through County and County
shall not pay for or otherwise provide such coverage for Contractor or any of its agents or
employees.
Exhibit to the SS23A
5 Revised 6/2018
27. County reserves the right to require Contractor to provide a certificate of insurance, policy,
or other proof of insurance at its sole discretion.
Exhibit to the SS23A
6 Revised 6/2018
EXHIBIT A to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Child Placement Agency Services
The following additional provisions of this Exhibit apply to the agreement entitled, "Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Human
Services," hereinafter referred to as, "County," and «Agency», hereinafter referred to as,
"Contractor."
1. County and Contractor agree that a child specific Needs Based Care Assessment,
designated in this exhibit, shall be used to determine levels of care for each child placed
with Contractor.
2. County agrees to purchase and Contractor 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 each level of service, as
indicated by the Needs Based Care Rate Table, designated in this exhibit, for children
placed within the CPA identified as Provider ID#«Facility_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.
3. If a child is deemed eligible for the Children's Habilitation Residential Program (CHRP)
waiver, Contractor agrees to accept the assessed waiver service rate billable through the
MMIS system and the federal SSI rate billable through County.
4. All bed hold authorizations and payments are subject to a seven (7) day maximum for
a child's temporary absence from a facility, including hospitalization. Bed hold
requests must have prior written authorization from County's Department
Administrator before payment will be release to provider.
5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be
furnished by Contractor under this contract for facilities that provide sex offender
treatment.
6. Any additional costs for specialized services, which include, but are not limited to;
polygraph tests, plethysmographs, and urinalysis screens, which are not provided within
the negotiated provider rate, will need to be authorized, in writing by County, prior to the
service being performed. Any payment for specialized services not authorized in writing
will be denied.
7. Contractor agrees to have appropriate personnel available to attend or participate in
Family Engagement, Team Decision Making meetings, or court hearings. Contractor
shall be notified by County staff of the dates and times attendance is requested.
8. Contractor agrees to cooperate with any vendors hired by County to shorten the
duration of placement.
8 Exhibit to the SS23A
1 Revised 6/2018
9. Contractor agrees to have physical examinations completed within 14 days and dental
examinations completed within eight (8) weeks of the child being placed with
Contractor. All documentation of these examinations shall be forwarded to County.
10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP)
for youth designated as a Special Education Student every 3 years and coordinate reviews
every year. If the IEP is due while the child is in placement, Contractor shall complete or
obtain a completed IEP. A copy will then be forwarded to County.
11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities
and Child Placement Agencies are generally not eligible to receive clothing allowances as
outlined in the Weld County Department of Human Services Policy and Procedure
Manual. However, a one-time emergency clothing allowance may be approved in limited
circumstances, prior written authorization from County's Department Administrator is
required before payment will be released to provider.
12. County shall have access to Contractor's financial records as they relate to this Agreement
for purposes of audit. Such records shall be complete and available for audit 90 days after
final payment hereunder and shall be retained and available for audit purposes for at least
five years after final payment hereunder.
13. Time is of the essence in each and all of the provisions of this Agreement.
14. 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.
15. 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 above.
16. 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.
17. This Agreement is nonexclusive and County may engage or use other contractors or
persons to perform services of the same or similar nature.
18. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract
with an illegal alien who will perform work under this contract. Contractor will confirm
the employment eligibility of all employees who are newly hired for employment in the
United States to perform work under this Agreement, through participation in the E -
Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-
102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or enter into a contract with a subcontractor that fails
to certify with Contractor that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. Contractor shall not use E -
Verify Program or State of Colorado program procedures to undertake pre -employment
screening or job applicants while this Agreement is being performed. If Contractor obtains
actual knowledge that a subcontractor performing work under the public contract for
services knowingly employs or contracts with an illegal alien Contractor shall notify the
subcontractor and County within three (3) days that Contractor has actual
8Exhibit to the SS23A
2 Revised 6/2018
knowledge that a subcontractor is employing or contracting with an illegal alien and shall
terminate the subcontract if a subcontractor does not stop employing or contracting with
the illegal alien within three (3) days of receiving notice. Contractor shall not terminate
the contract if within three (3) days the subcontractor provides information to establish
that the subcontractor has not knowingly employed or contracted with an illegal alien.
Contractor shall comply with reasonable requests made in the course of an investigation,
undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and
Employment. If Contractor participates in the State of Colorado program, Contractor shall,
within twenty days after hiring a new employee to perform work under the contract,
affirm that Contractor has examined the legal work status of such employee, retained file
copies of the documents, and not altered or falsified the identification documents for such
employees. Contractor shall deliver to 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 Contractor 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, Contractor 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 Contractor receives federal or state funds under the contract, Contractor must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in
the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public
benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby
swears or affirms under penalty of perjury that it:
(a) is a citizen of the United States or is otherwise lawfully present in the United States
pursuant to federal law, (b) shall produce one of the forms of identification required by
C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification
required by C.R.S. § 24-76.5-103 prior to the effective date of the contract.
19. Contractor assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency;
b. Have not, within a three(3) 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 (3) year period preceding this Agreement, had one or
more public transactions (federal, state, and local) terminated for cause or
default.
8Exhibitto the SS23A
3 Revised 6/2018
20. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, County may exercise the following remedial actions if County finds
and determines that Contractor has substantially failed to satisfy the scope of work found
in the Agreement, any Exhibit, the child specific addendum SS23B, 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 Contractor. These remedial actions include,
but are not limited to, any one or more of the following:
a. Withhold payment to Contractor 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 Contractor
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 Contractor any incorrect payment to Contractor due to omission,
error, fraud, and/or defalcation by deducting from subsequent payments under this
Agreement, or other agreements between County and Contractor, or as a debt to
County, or otherwise as provided by law.
21. 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.
22. No portion of this Agreement shall be deemed to constitute a waiver of any immunity
including those provided by the Colorado Governmental Immunity Act §§24-10-101 et seq.,
as applicable now or hereafter amended, that the parties or their officers or employees may
possess, nor shall any portion of this Agreement be deemed to have created a duty of care
that did not previously exist with respect to any person not a party to this Agreement. The
parties hereto acknowledge and agree that no part of this Agreement is intended to
circumvent or replace such immunities.
23. Contractor 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. Contractor,
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 County Director. The term "litigation"
includes an assignment for the benefit of creditors, and filings in bankruptcy,
reorganizations and/or foreclosure.
24. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
25. Financial obligations of County payable after the current fiscal year are contingent upon
funds for that purpose being appropriated, budgeted and otherwise made available.
8 Exhibit to the SS23A
4 Revised 6/2018
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.
26. Contractor agrees that it is an Independent Contractor and that Contractor's officers,
agents or employees will not become employees of County, nor entitled to any employee
benefits from County as a result of the execution of this Agreement. Contractor shall
perform its duties hereunder as an Independent Contractor. Contractor shall be solely
responsible for its acts and those of its agents and employees for all acts performed
pursuant to this Agreement. Contractor, its employees and agents are not entitled to
unemployment insurance or workers' compensation benefits through County and County
shall not pay for or otherwise provide such coverage for Contractor or any of its agents or
employees.
27. County reserves the right to require Contractor to provide a certificate of insurance,
policy, or other proof of insurance at its sole discretion.
8 Exhibit to the SS23A
5 Revised 6/2018
Needs Based Care Assessment
NBC (NEEDS BASED CARE ASSESSMENT)
Answers to the following questions will determine the NBC Care Payment. For each question below
closest rating for this child. The following seven (7) questions are mutually exclusive.
please select the
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?
Select One
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
P4. How
and
monitoring
often does the child require special and extensive involvement by the provider in scheduling
Select One
of time and/or activities and/or crisis management?
P5. How much time is the provider required to assist the child because
appropriate needs with feeding, bathing, grooming, physical,
of impairments beyond age
Select One
and/or occupational therapy?
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
NBC
often are therapy services needed to address child's individual
needs per NBC assessment?
Assessment
Select One
(NEEDS BASED CARE ASSESSMENT) - Behavioral
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
Select 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", please
complete the Medically fragile NBC)
Select One
U
Emancipation
Select One
❑
Eating Problems
Select One
❑
Boundary Issues
Select One
❑
Requires Night Care
Select One
❑
Education
Select One
U
Involvement with Child's Family
Select One
Exhibit A to the SS23A 6
Revised 6/2017
Needs Based Care Assessment
WELD COUNTY DHS
Requested Services from Agency
Please indicate the services that are requested for this child.
The following information will be reflected on the child specific contract.
(Please be specific)
❑
Adoption Services
❑
Medical Services
❑
Other: NA
❑
Doctor/Dentist Appointment Coordination
❑
Provider agrees to work with family
❑
Medication Evaluation (not covered under fee for
service)
❑
Therapeutic Services funded through Medicaid Fee for
Service: (TRCCF)
❑
Medication Monitoring
❑
Individual Therapy
❑
Nursing Services/Coordination
❑
Group Therapy
❑
Physician Services/Coordination
❑
Interactive Group Therapy
❑
Occupational Therapy
❑
Family Therapy
❑
Speech Therapy
❑
Psychological Testing
❑
Child Find
❑
Pharmacological Management
❑
Other:
❑
Treatment not funded by Medicaid Fee for Service:
❑
Education:
❑
Home Based Intervention
❑
On -Grounds School
❑
MST Multi -Systemic Therapy
❑
Coordinate Assessment for Special Education
❑
Offense Specific Treatment
❑
Public School Attendance
❑
Drug and Alcohol Treatment
❑
Occupational Therapy
❑
Speech Therapy
❑
Attend Special Education Meetings
❑
Urine Analysis/Drug Screening/ Breathalyzer
❑
Other:
❑
Sexual Abuse Victimization Treatment
❑
Visitation Coordination
❑
Independent Living Skills Training
❑
Monitor phone calls and correspondence
❑
Anger Management
❑
Transportation for family/parent/child visits
❑
Behavior Modification Services
❑
Other:
❑
Behavioral Assessment
❑
Other:
❑
Recreation Services
❑
Interpreter Services
❑
Case Management
❑
Other:
❑
Attend Court Hearings
❑
Transportation: To include:
Li
Other:
Levels of Care:
Provider Level:
Case Management Level:
Therapy Level:
Date Staffed:
Participants:
Comments:
Exhibit A to the SS23A
7
Revised 6/2017
ADDENDUM 2
Needs Based Care Rate Table
Weld County Department of Human Services
(Effective 7/01/2018)
LEVEL OF '
' SERVICE
:
CHILD '
MAINTENANCE
RESPITE
ADMINISTRATIVE
MAINTENANCE .
ADMINISTRATIVE
SERVICES
MEDICAL .
NEEDS . .
' Level ' ,
Daily Rate '
Daily Rate
Daily Rate
Daily Rate -
Daily Rate
County
Basic
Maintenance
Rate
Age 0-10...$17.42
Age 11-14...$19.26
Age 15-21...$20.57
$.66
$12.64
No crisis intervention, minimal
CPA involvement, one face -to -
face visit with child per month.
$0.00
Not needed or covered
under Medicaid.
1
$21.06
$.66
$16.15
Minimal crisis intervention as
needed, one face-to-face visit per
month with child, 2-3 contacts
per month.
-'=
$5.26
Regularly Scheduled
therapy up to 4
hours/month.
$3.54
1 '/2 .
$24.56
$.66
$17.90
2
$28.08
$.66
$19.66
Occasional crisis intervention as
needed, two face-to-face visits
with child, 2-3 contacts per
month.
_
$10.52
Weekly scheduled
therapy 5-8 hours a
month with 4 hours of
group therapy.
_
$5.09
2 %:
$31.59
$.66
$21.41
3
$35.10
$.66
$23.17
Ongoing crisis intervention as
needed, weekly face-to-face
visits with child, and intensive
coordination of multiple
services.
$15.79
Regularly scheduled
weekly, multiple
sessions, can include
more than I person,
i.e. family therapy, for
9-12 hours/monthly.
$6.66
3 1/2
$38.60
$.66
$24.93
4
Congregate
Care
Drop Down
$42.12
$.66
$26.67
Ongoing crisis intervention as
needed, which includes high
level of case management and
CPA involvement with child and
provider and 2-3 face -to face
contacts per week minimum.
Negotiated
i
Negotiated
Assessment/
Emergency
Level Rate
$28.08
•
$.66
$19.66
..
EXHIBIT to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Group Home/Group Center Care Services
The following additional provisions of this Exhibit apply to the agreement entitled, "Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between the
Board of County Commissioners of Weld County, on behalf of the Weld County
Department of Human Services," hereinafter referred to as, "County," and «Agency»,
hereinafter referred to as, "Contractor."
I. County agrees to purchase and Contractor agrees to provide the care and services, which
are listed in this Agreement at a rate of $«Agency_Rate», per day for children placed
within the Group Home/Group Center identified as Provider ID #«Facility_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.
2. Contractor agrees to accept the assessed waiver service rate billable through the MMIS
system for Children's Habilitation Residential Program (CHRP) waiver eligible children
and the federal SSI rate billable to County.
3. All bed hold authorizations and payments are subject to a seven (7) day maximum for a
child's temporary absence from a facility, including hospitalization. Bed hold requests
must have prior written authorization from the Weld County Department Administrator
before payment will be release to Contractor.
4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be
furnished under this contract for facilities that provide sex offender treatment.
5. Any additional costs for specialized services, which include, but are not limited to;
polygraph tests, plethysmographs, and urinalysis screens, which are not provided within
the negotiated provider rate, will need to be authorized, in writing by County, prior to the
service being performed. Any payment for specialized services not authorized in writing
will be denied.
6. The services purchased under this Agreement for Group Home/Center services may
include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter,
clothing, educational supplies and allowance), direct child care, transportation,
administrative overhead, support overhead, service delivery staff, which may include but
are not limited to: Parent training for teens, independent living training, and
mentor/advocate services.
7. Contractor agrees to have appropriate personnel available to attend or participate in
Family Engagement, Team Decision Making meetings, or court hearings. Contractor
shallbe notified by County staff of the dates and times attendance is requested.
Exhibit to the SS23A
1 Revised 6/2018
8. Contractor agrees to actively participate in achieving the child's Permanency Goal and
cooperate with any vendors hired by the Weld County Department of Human Services to
shorten the duration of placement.
9. Contractor agrees to have physical examinations completed within 14 days and dental
examinations completed within eight (8) weeks of the child being placed with Contractor.
All documentation of these examinations shall be forwarded to County.
10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP)
for youth designated as a Special Education Student every three (3) years and coordinate
reviews every year. If the IEP is due while the child is in placement, Contractor shall
complete or obtain a completed IEP. A copy will then be forwarded to County.
11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities
and Child Placement Agencies are generally not eligible to receive clothing allowances as
outlined in the Weld County Department of Human Services Policy and Procedure
Manual. However, a one-time emergency clothing allowance may be approved in limited
circumstances, with prior written authorization from County's Department Administrator
required before payment will be released to provider.
12. County shall have access to Contractor's financial records as they relate to this Agreement
for purposes of audit. Such records shall be complete and available for audit 90 days after
final payment hereunder and shall be retained and available for audit purposes for at least
five years after final payment hereunder.
13. Time is of the essence in each and all of the provisions of this Agreement.
14. 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.
15. 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 above.
16. 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.
17. This Agreement is nonexclusive and County may engage or use other contractors or
persons to perform services of the same or similar nature.
18. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract
with an illegal alien who will perform work under this contract. Contractor will confirm
the employment eligibility of all employees who are newly hired for employment in the
United States to perform work under this Agreement, through participation in the E -Verify
program or the State of Colorado program established pursuant to C.R.S. §8-17.5-
102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or enter into a contract with a subcontractor that fails
to certify with Contractor that the subcontractor shall not knowingly employ or contract
Exhibit to the SS23A
2 Revised 6/2018
with an illegal alien to perform work under this Agreement. Contractor shall not use E -
Verify Program or State of Colorado program procedures to undertake pre -employment
screening or job applicants while this Agreement is being performed. If Contractor
obtains actual knowledge that a subcontractor performing work under the public contract
for services knowingly employs or contracts with an illegal alien Contractor shall notify
the subcontractor and County within three (3) days that Contractor has actual knowledge
that a subcontractor is employing or contracting with an illegal alien and shall terminate
the subcontract if a subcontractor does not stop employing or contracting with the illegal
alien within three (3) days of receiving notice. Contractor shall not terminate the contract
if within three (3) days the subcontractor provides information to establish that the
subcontractor has not knowingly employed or contracted with an illegal alien. Contractor
shall comply with reasonable requests made in the course of an investigation, undertaken
pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and
Employment. If Contractor participates in the State of Colorado program, Contractor
shall, within twenty days after hiring a new employee to perform work under the contract,
affirm that Contractor has examined the legal work status of such employee, retained file
copies of the documents, and not altered or falsified the identification documents for such
employees. Contractor shall deliver to 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 Contractor 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, Contractor 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 Contractor receives federal or state funds under the contract, Contractor must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in
the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public
benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby
swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is
otherwise lawfully present in the United States pursuant to federal law, (b) shall produce
one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall
produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the
effective date of the contract.
19. Contractor assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency;
b. Have not, within a three (3) 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;
Exhibit to the SS23A
3 Revised 6/2018
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 (3) year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
20. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, County may exercise the following remedial actions if County finds
and determines that Contractor has substantially failed to satisfy the scope of work found
in the Agreement, any Exhibit, the child specific addendum SS23B, 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 Contractor. These remedial actions include,
but are not limited to, any one or more of the following:
a. Withhold payment to Contractor 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 Contractor
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 Contractor any incorrect payment to Contractor due to omission,
error, fraud, and/or defalcation by deducting from subsequent payments under this
Agreement, or other agreements between County and Contractor, or as a debt to
County, or otherwise as provided by law.
21 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.
22. No portion of this Agreement shall be deemed to constitute a waiver of any immunity
including those provided by the Colorado Governmental Immunity Act §§24-10-10l et
seq., as applicable now or hereafter amended, that the parties or their officers or
employees may possess, nor shall any portion of this Agreement be deemed to have
created a duty of care that did not previously exist with respect to any person not a party
to this Agreement. The parties hereto acknowledge and agree that no part of this
Agreement is intended to circumvent or replace such immunities.
23. Contractor 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. Contractor,
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
Exhibit to the SS23A
4 Revised 6/2018
deliver copies of such document(s) to County's Director. The term "litigation" includes
an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations
and/or foreclosure.
24. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
25. Financial obligations of County payable after the current fiscal year are contingent upon
funds for that purpose being appropriated, budgeted and otherwise made available.
Execution of this Agreement by County does not create an obligation on the part of
County to expend funds not otherwise appropriated in each succeeding year.
26. Contractor agrees that it is an Independent Contractor and that Contractor's officers,
agents or employees will not become employees of County, nor entitled to any employee
benefits from County as a result of the execution of this Agreement. Contractor shall
perform its duties hereunder as an Independent Contractor. Contractor shall be solely
responsible for its acts and those of its agents and employees for all acts performed
pursuant to this Agreement. Contractor, its employees and agents are not entitled to
unemployment insurance or workers' compensation benefits through County and County
shall not pay for or otherwise provide such coverage for Contractor or any of its agents or
employees.
27. County reserves the right to require Contractor to provide a certificate of insurance, policy,
or other proof of insurance at its sole discretion.
Exhibit to the SS23A
5 Revised 6/2018
ICOLORADO
; Office of Children,
Youth 8 Families
new.o%Human Services
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date, by and between theWeld County
Department of Human Services, P. O. Box A, Greeley, CO 80632, hereinafter called "County Department" and
«Agency», «Agency_MailingAddress», «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 is renewed;
3. To accept a child or youth, only with the approval of the certifying agency;
4. To cooperate fully with the County Department or its representatives, and participate in the
development of the Family Service Plans -for a child or youth in placement, including visits with their
parents, siblings, relatives, or to transition to another foster care facility;
5. To maintain approved standards of care as set by the Colorado Department of Human Services;
6. To maintain the confidentiality of information shared about the child or youth and his/her family;
7. Not to accept money from parents or guardians;
8. Not to make any independent agreement with parents or guardians;
c
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
1
9. Not to release the child or youth to anyone without prior authorization from the County Department;
10. To allow representatives of the County Department to visit the foster care home and to meet with the
child or youth at any reasonable time, including scheduled and unscheduled visits; and,
11. To give the County Department a 30 -day notice, except in an emergency, to remove a child or youth
for placement elsewhere, and to work with the County Department as requested to prepare the child or
youth for another placement.
12. To provide transportation to the child or youth. The amount of transportation to be provided will be
agreed upon at placement and may be changed upon mutual agreement of the provider and the
County Department, as recorded in the Family Service Plan. Transportation must be provided or
arranged:
a. For professional services and/or for school attendance when necessary; and,
b. For children or youth to participate in age or developmentally appropriate extracurricular, enrichment,
cultural, and social activities.
13. To report promptly to the County Department:
a. Any unplanned absence of the child or youth from provider's care;
b. Any major illness of the child or youth;
c. Any serious injury to the child or youth;
d. Any significant change in the sleeping arrangement for the child or youth;
e. Any contemplated change of address or change of household members;
f. Any conflict the child or youth may have with law enforcement, school/school district staff, or other persons
in authority;
g. Any emergency;
h. Any pertinent discussion with parents or guardians about the child or youth or supervising agency; and,
i. Any information received regarding a change of address of the parents or guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of 1973, and the ADA of 1990, concerning
discrimination on the basis of race, color, sex, age, sexual orientation, expression, or identity, religion, political beliefs,
national origin, or handicapping condition.
15. To complete pre -service training prior to the placement of a child or youth.
16. 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 care home as required by the Colorado Department of Human
Services regulations; and,
c. Obtain certification to use and apply the reasonable and prudent parent standard for each child or youth served
in the foster care home.
17. To attend semi-annual Administrative Reviews for a child or youth in placement.
18. To be knowledgeable of, and comply with the "Rules Regulating Foster Care Homes" and the "General Rules for
Child Care Facilities;
19. Not to enter into any subordinate subcontract hereunder;
20. To keep required and necessary records for audit/review purposes by state and federal personnel. These records
shall document the type of care and dates that care is provided for each child or youth. In addition, medical,
educational, and progress summary records shall be maintained for each child or youth as required pursuant to the
Colorado Department of Human Services' Rules Regulating Family Foster Care Homes.
21. To complete or schedule a medical examination for the child or youth within 14 days after initial placement and a
dental examination within eight weeks of initial placement;
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
2
The County Department agrees:
1. To share all available information about the child or youth, including relevant social, medical and educational history,
behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics
of the child or youth, with the provider before placement and to share additional information when obtained while
the child or youth is in placement.
2. To inform the provider of expectations regarding the care of the child or youth, such as meeting medical needs,
visitation, special psychological needs, trauma and other grief/loss issues, and the child's or youth's identification with
his/her family;
3. To give the provider the written admission record of the child or youth to the foster care home at the time of placement;
4. To give the provider a written procedure or authorization for obtaining medical care for the child or youth;
5. To involve the provider in family service planning for the child or youth as a member of treatment team;
6. To give the provider a copy of the Family Service Plan, as it pertains to their expectations for meeting the needs of the
child or youth in the foster care home, at the time of placement or when it is completed following placement;
7. To give at least a 30 -day notice of plans to remove a child or youth from the foster care home. The 30 -day notice may
be waived by mutual consent to allow and permit immediate removal of a child or youth for placement elsewhere,
or without such waiver in the event of an emergency. An emergency is defined as any situation in which a provider's
inability to provide services threatens the health, safety or welfare of a child or youth.
8. To pay the provider at the rates established by the Colorado Department of Human Services or as authorized and
negotiated between the provider and the County Department:
a. Payment shall be made by electronic banking transfers (EBT) drawn by the duly authorized county officer; and,
b. Provider shall notify the County Department of any payment or billing dispute within 60 days of the month
when service was provided. Failure to do so will result in forfeiture of the payment. The Provider understands
that, pursuant to the Colorado Department of Human Services' Rules for the General Reimbursement for Child
Welfare Services, when reimbursement is warranted current and (2) preceding months.
9. To provide or arrange through statewide contracted training, a minimum of twelve hours of core pre -service
training for foster care homes and 15 hours of pre -service training directed at the needs of the child or youth to be
served in the foster care home.
10. To annually complete the following:
a. Update the Training Development Plan with the provider;
b. Provide or make available quality and relevant training for each foster parent that will build competencies to
meet the needs of the children and youth served in the foster care home;
c. Provide training that prepares each foster parent to use and apply the reasonable and prudent parent
standard; and,
d. Pursuant to the Colorado Department of Human Services' Rules Regulating Family Foster Care Homes,
document that the provider is trained in, and can use and apply the reasonable and prudent parent standard
for each child or youth placed in the foster care home.
11. The County Department is responsible for providing information on county specific procedures.
12. To invite the provider to Administrative Reviews for each child or youth in placement.
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 (type or print)
Signature Date
WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above.
COUNTY;
ATTEST: BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Clerk to the Board Steve Moreno, Chair
PROVIDER:
Provider (type or print)
Signature Date
Provider (type or print)
Signature Date
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
4 8
7
EXHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase
Foster Care Services and Foster Care Facility Agreement
CWS-7A
The following additional provisions in this Exhibit A, and Addendum 1 and Addendum 2, apply to the
agreement entitled, "Individual Provider Contract for Purpose of Foster Care Services and Foster Care
Facility Agreement," by and between the Weld County Department of Human Services, hereinafter
referred to as, "County," and «Agency», 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 emergency situation.
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 County
for any purpose. Provider shall have no authorization, express or implied, to bind 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 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 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 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 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 personsto
perform services of the same or similar nature.
11. Provider certifies, warrants, and agrees that it does not knowingly employ or contract with an
illegal alien who will perform work under this contract. Provider will confirm the employment
eligibility of all employees who are newly hired for employment in the United States to perform
work under this Agreement, through participation in the E -Verify program or the State of Colorado
program established pursuant to C.R.S. §8-17.5-102(5)(c). Provider shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement or enter into a contract with
a sub -contractor that fails to certify with Provider that the sub -contractor shall not knowingly
employ or contract with an illegal alien to perform work under this Agreement. Provider shall not
use E -Verify Program or State of Colorado program procedures to undertake pre -employment
screening or job applicants while this Agreement is being performed. If Provider obtains actual
knowledge that a sub -contractor performing work under the public contract for services knowingly
employs or contracts with an illegal alien Provider shall notify the sub -contractor and County
within three (3) days that Provider has actual knowledge that a sub -contractor is employing or
contracting with an illegal alien and shall terminate the subcontract if a sub -contractor does not
stop employing or contracting with the illegal alien within three (3) days of receiving notice.
Provider shall not terminate the contract if within three (3) 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
6 Revised 5/2018
B. Have not, within a three (3) 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 (3) 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 County finds and determines that 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 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 deemed to
have created a duty of care that did not previously exist with respect to any person not a party to
this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is
intended to circumvent or replace such immunities.
16. Provider shall promptly notify County in the event in which it is a party defendant or respondent in
a case, which involves services provided under the agreement. 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
County's Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
17. This Agreement and the provision of services hereunder shall be subject to the laws ofColorado
and be in accordance with the policies, procedures, and practices of County. Provider shall
strictly comply with all applicable federal and State laws, rules and regulations in effect or
hereafter established.
Exhibit A to the CWS-7A
7 Revised 5/2018
18. Financial obligations of County payable after the current fiscal year are contingent upon funds for
that purpose being appropriated, budgeted and otherwise made available. Execution of this
Agreement by County does not create an obligation on the part of County to expend funds not
otherwise appropriated in each succeeding year.
19. County and Provider agree that 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 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 County. If submitted in an unapproved format or
inadequate documentation is provided, 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.
Exhibit A to the CWS-7A
8 Revised 5/2018
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the
express written approval of the Director of 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 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 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 County'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
eight (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 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 Fl DOS.
13. Maintain/update information in the foster child's binder. The binder will be reviewed on a monthly
basis and signed off by child's caseworker and/or County'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
9 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:
Select One
Aggression/Cruelty to Animals
Verbal or Physical Threatening
Destructive of Property/Fire Setting
Stealing
Self -injurious Behavior
Substance Abuse
Select One
Select One
Select One
Select One
Select One
Presence of Psychiatric Symptoms/Conditions
Select One
❑
Enuresis/Encopresis
Select One
❑
Runaway
Select One
❑
Sexual Offenses
Select One
Inappropriate Sexual Behavior
Disruptive Behavior
Delinquent Behavior
Depressive -like Behavior
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
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
ADMINISTRATIVE
MAINTENANCE
ADMINISTRATIVE
SERVICES
MEDICAL
NEEDS
Level
Daily Rate
Daily Rate,
Daily Rate
Daily Rate
•
Daily Rate
County
Basic
Maintenance
Rate
Age 0-10...$17.42
Age 11-14...$19.26
Age 15-21...$20.57
$.66
$12.64
No crisis intervention, minimal
CPA involvement, one face -to -
face visit with child per month.
$0.00
Not needed or covered
under Medicaid.
I
—
'_—
$21.06
$.66
$ 16.15
Minimal crisis intervention as
needed, one face-to-face visit per-
month with child, 2-3 contacts
per month.
—
$5.26
Regularly Scheduled
therapy up to 4
hours/month.
'
$3.54
I 1/2
$24.56
$.66
$17.90
2
_
_
--
$28.08
$.66
$19.66
Occasional crisis intervention as
needed, two face-to-face visits
with child, 2-3 contacts per
month.
$10.52
Weekly scheduled
therapy 5-8 hours a
month with 4 hours of
group therapy.
$5.09
2 %:
$31.59
$.66
$21.41
3
---
$35.10
$.66
.
$23.17
Ongoing crisis intervention as
needed, weekly face-to-face
visits with child, and intensive
coordination of multiple
services.
$15.79
Regularly scheduled
weekly, multiple
sessions, can include
more than I person,
i.e. family therapy, for
9-12 hours/monthly.
$6.66
3 1/2
$38.60
$.66
$24.93
4
Congregate
Care
Drop Down
=
$42.12
$.66
$26.67
Ongoing crisis intervention as
needed, which includes high
level of case management and
CPA involvement with child and
provider and 2-3 face -to face
contacts per week minimum.
Negotiated
Negotiated
Assessment/
Emergency
Level Rate
$28.08
$.66
$19.66
Addendum 2
11
Revised 5/2018
WELD COUNTY FOSTER CARE PROVIDERS
July 1, 2018 to June 30, 2019
Agone, Talia and Emore, Lansing
Bass, Kayci and Jonathan
Moore, Jay and Candice
Bishop, Leilani
Brown, Rachel and Williford, Julie
Castaneda, Natalie and Freddy
Davidson, Stacey A.
Dennis, Esther and Grigsby, Michael
Easley, Allison and William Eric
Garcia, Fernando and Aracely
Heimer, Sara
Korby, Stephanie and Trenton
Lind, Patricia and Dalby, Katherine
Long, Kiley and Cole, Andrew
Marin, Gilbert and Lazuick-Marin, Justine
Maronek, Dennis and Patricia
Marinez, Stacey and Jeremy
Radi, Tera
Roderick, Douglas and Kelli
Salazar, Clara and Michael
Sanchez, Tracy and Isidro
Scheer, James L. and Elizabeth
Schmelz, Pamela and Romero, Shane
Schulz, Lindsey
Schweitzer, Shyanna and Nevin
Seader, Erin and Ryan
Wright, Jon and Nicole
Tavita, Jacquelyn and Bruce
Thaden-Fidjeland, Amanda
Van Den Elzen, Dawn
Walker, Kayla and Renae
Walker, Kurt and Jennifer
Westra, Michael and Geneva
Williams, Allison and Buddy
Wurtz, Drew and Workman-Wurtz, Kathryn
Carruth, Ashlee B.
Mann, Kristin and Russell
Miller, Pamela
Bingley, Anja and Richard
1694421 833 Columbine Drive
1687306 2130 72nd Ave. Ct.
1692443 7075 19th St., Apt. 5
1694008 2620 9th Ave.
1640956 7920 West 12th St.
1678403 6337 W. 28th St.
1694419 520 Marquiss Ct.
1687385 40818 Jade Drive
1674424 488 Stonebrook Dr.
1561879 3919 28th Ave.
1547292 3000 W. 19th St.
1659973 3105 70th Ave.
1658999 1611 15th Ave.
1687316 1883 Sunset Circle
1661206 25000 CR 69
1520627 2929 56th Ave.
1649838 1149 Northview Dr.
1683320 501 28th Ave.
10994 3110 57th Ave.
1663774 1269 49th Ave. Ct.
1687293 423 28th Ave.
1666078 37700 Co. Rd. 23
1694423 411 Pinyon St.
1665608 5121 W. 11th St., Apt. 409
1686185 1117 Alpine Ct.
1694425 420 Cottonwood Ave.
1639129 3919 W. 22nd Street
1680800 6906 23rd Street
1676040 537 36th Ave. Ct.
44282 5819 W. 16th St. Ln.
1693525 37077 Northwest Dr.
1546248 7681 Carlson Court
1696891 1460 Frontier Road
1687324 1202 42nd Ave.
1633330 1901 15th Street
1678635 3306 San Marco Ave.
1674765 420 Bobcat Dr.
1587465 5151 W. 29th St., Unit 2004
1700655 418 30th Ave. Ct.
Windsor, CO 80550
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80631
Greeley, CO 80634
Greeley, CO 80634
Dacono,CO 80514
Ault, CO 80610
Windsor, CO 80550
Evans, CO 80620
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80631
Milliken, CO 80543
Kersey, CO 80644
Greeley, CO 80634
Erie, CO 80516
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Severance, CO 80550
Frederick, CO 80530
Greeley, CO 80634
Windsor, CO 80550
Eaton, CO 80615
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Windsor, CO 80550
Ft. Collins, CO 80524
Eaton, CO 80615
Greeley, CO 80634
Greeley, CO 80634
Evans, CO 80620
Milliken, CO 80543
Greeley, CO 80634
Greeley, CO 80634
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
WELD COUNTY FOSTER CARE PROVIDERS
July 1, 2018 to June 30, 2019
Blank, Matthew and Emily
Callaway, Christopher and Lisa
Dunn, James and Gari
Erickson, Joshuah and Tessa
Gillette, Michael and Alisyn
Gomez, Maira and lbarra, Eric
Haines, Ryan and Kara
Haynes, Donna
Klaus, Dawn
Long, Joshua and Jennifer
Matzke, Michael and Sara
Menzel, Kathrina and Jared
Purtell, Nicole and Christopher
Ritter, Thomas and Deborah
Shenk, Christopher and Diaz, Xioma
Smith, Elizabeth Ann and Sean Michael
Taylor, Jeff and Silva, Alexander
Tucker, Tasha and Thomas
Vance, Morgan and Kindvall, Brandon
Villa, Jacob and Kati
Visser, Ryan and Amanda
White, Kristen
Winterfeld, Rachel
Hernandez, Keyano and Michael
Jeffery, Jamie
Olson, Stacey
Schultz, Alisha
WestHolmes, Liesl and Corey
Braunagel, Karen
Schmidt, Constance and Donald II
Schumaker, Russel and Colleen
Wipf, Keith and Bethany
Kidd, Roger and Michelle
Johnston, Loyd and Trisha
1669654 1251 Vail Ln.
1655848 3204 39th Ave.
1714413 413 Ash St.
1716237 2057 26th St. Rd.
1716936 5527 Wilderness Loop
1707673 200 N. 35th Ave., #219
1714134 2737 W. 14th St.
1688399 2343 W. 11th St. Rd.
1710929 348 Valley Ave.
1712147 2548 Palmer Ave.
1716250 1949 Cataluna Dr.
1707638 6025 Lynx Creek Circle
1708813 2391 Tate Ave.
1554009 10151 Devonshire St.
1715961 709 Keensburg Ct.
1679422 2912 McIntosh Dr.
1712176 4943 W. C Street
1702726 2317 44th Ave.
1703052 500 Campbell St.
1712716 14 Rose Ct.
1673369 3212 68th Ave. Ct.
1711814 1651 Kelmsley Ct.
1712735 1516 44th Ave. Ct.
1702702 5796 E. 129th PI.
1708865 339 Valley Ave.
1698259 1297 Midland Street
1698304 812 North 6th Street
1667110 2530 Sunstone Dr.
1714402 1775 Laurus Ln.
1511343 17900 CR 5
1713457 10428 Cherry Vale St.
1706601 3266 Cramer Ave.
1715791 15182 Oak Knoll
1685257 2817 E. Aloma Ct.
Longmont, CO 80503
Evans, CO 80620
Kersey, CO 80644
Greeley, CO 80631
Marysville, CA 95901
Greeley, CO 80634
Greeley, CO 80634
Greeley, CO 80634
Lochbuie, CO 80603
Mead, CO 80542
Windsor, CO 80550
Frederick, CO 80530
Ft. Lupton, CO 80620
Firestone, CO 80504
Ft. Collins, CO 80525
Longmont, CO 80503
Greeley, CO 80634
Greeley, CO 80634
Kersey, CO 80644
Windsor, CO 80550
Greelen., CO 80634
Windsor, CO 80550
Greeley, CO 80634
Thornton, CO 80602
Lochbuie, CO 80603
Brighton, CO 80601
Manitowoc, WI 54220
Ft. Collins, CO 80525
Johnstown, CO 80534
Berthoud, CO 80513
Firestone, CO 80504
Evans, CO 80620
Monroe, MI 48161
Wichita, KS 67211
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
Dependant upon child needs - Refer to Needs Based Care Rate Table
CPA FOSTER CARE PROVIDERS
July 1, 2018 to June 30, 2019
Adoption Options
Ariel Clinical Services
Bethany Christian Services
Denver Area Youth Services
Dungarvin Colorado LLC
Family Resource Network
Hope & Home
Imagine!
Kids Crossing
Lutheran Family Services Rocky Mountains
Maple Star Colorado
Nightlight Christian Adoptions
Parker Personal Care Homes Inc.
Quality Life Services LLC
Sample Supports
Savio House
Smith Agency Inc.
Special Kids Special Families
Specialized Alternatives for Families and Youth
Strong Foundations, LLC
Top of the Trail Inc.
Whimspire CPA
Griffith Centeres for Children, Inc.
45078 1355 S. Colorado Blvd., Suite 501
90205 4660 Wadsworth Blvd.
45514 3000 S. Race St.
45069 1530 W. 13th Ave.
1547661 4704 Harlan St., Suite 550
1508602 5360 N. Academy Blvd., Suite 130
29867 4945 N. 30th Street, Suite 300
21369 1400 Dixon Ave.
79752 1440 E. Fountain Blvd.
45080 363 S. Harlan Street, Suite 200
90967' 2250 S. Oneida Street, Suite 200
1590226 150 E. 29th Street
1512100 1597 Cole Blvd., Suite 250
32066 11975 Reed Street
16864561620 Kimbark St.
37330 325 King St.
44882_14364 E. Evans Ave.
431841424 W. Pikes Peak Ave.
1662183 1600 Specht Point Road
1594056 1702 68th Ave.
28112 301 N. Cascade
19562 9540 E. Jewell Ave.
1510565 17 N. Farragut
Denver, CO 80222
Wheat Ridge, CO 80033
Denver, CO 80210
Denver, CO 80204
Denver, CO 80212
Colorado Springs, CO 80918
Colorado Springs, CO 80919-3152
Lafayette, CO 80026
Colorado Springs, CO 80910-3502
Denver, CO 80226
Denver, CO 80224-2557
Loveland, CO 80538
Lakewood, CO 80401-3417
Broomfield, CO 80020
Longmont, CO 80501
Denver, CO 80219
Aurora, CO 80014-1408
Colorado Springs, CO 80905
Ft. Collins, CO 80525
Greeley, CO 80634
Montrose, CO 81401
Denver, CO 80247
Colorado Springs, CO 80909
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
'Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
Dependent upon child needs -- Refer to Needs Based Care Rate Table
CPA GROUP HOME/CENTER PROVIDERS
July 1, 2018 to June 30, 2019
Ariel Clinical Services
Bethany Christian Services
CGL-CPA, LLC
Griffith Center for Children
Kids Crossing
90205
Ariel Sprite House
Kismet House
45514
Cortinez Field of Dreams
1615382
LGC I - Vine
LGC II - Marion St.
LGC III - Williams ST.
1510565
Prospect Youth Home
79752
A Better Way
Helping Hands Group Home
Hudson Group Home
LaMar Place
Reggie's House
Safe Landing
Second Chance
Robinson
Open Arms
Evergreen
Voices of Empowerment
Parker Personal Care Homes Inc. 1512100
Orion House
Saiph Group Center
Rocky Mountain Kids 1593378
Savio House
Drew's Place
Future Bound
Jeremiah 29
Nevada House
37330
Bridgeway Group Home
Carr Group Center for Girls
2938 North Ave., Suite G
861 N. Sable Blvd.
6137 Kearney St.
2836 Vine Street
3659 Marion Street
3025 Williams Street
28 Farragut Ave.
14202 E 24th Ave
21622 E Alamo Place
2060 Bula Dr.
3590 LaMar PI.
785 Revere St.
1365 Langness Circle
12799 Exposition Dr.
5082 Tucson Way
2501 Norman Lane
1436 Hilltop Dr.
794 Memphis St.
1399 S. Chambers Circle
1493 S. Wheeling Circle
65 Diamond Road E
3101 Palmer Park Blvd.
4841 Sand Ripples Lane
2129 N. Nevada Ave.
9820 W. 21st Ave.
3297 Jasmine Street
Grand Junction, CO 81504
Aurora, CO 80011
Commerce City, CO 80022
Denver, CO 80205
Denver, CO 80205
Denver, CO 80205
Colorado Springs, CO 80909
Aurora, CO 80011
Centennial, CO 80015
Colorado Springs, CO 80915
Colorado Springs, CO 80911
Aurora, CO 80011
Ellicott, CO 80808
Aurora, CO 80012
Denver, CO 80239
Pueblo, CO 81005
Longmont, CO 80504
Aurora, CO 80011
Aurora, CO 80012
Aurora, CO 80012
Fountain, CO 80817
Colorado Springs, CO 80909
Colorado Springs, CO 80922
Colorado Springs, CO 80907
Lakewood, CO 80215
Denver, CO 80207
1643047 $194.58
1630179 $147.56
74864 $85.89
1620241 $131.16
1619053 $140.50
1620076 $131.16
1543863 $149.93
1621890 $121.22
1551132 $97.63
1623469 $94.27
1534441 $94.27
1625620 $97.77
1541496 $94.27
1552984 $97.63
1538302 $101.80
1590619 $98.49
61317 $155.82
1667442 $103.23
1654684 $146.45
1666303 $155.05
1613088 $117.77
1599810 $117.77
1619041 $117.77
1599808 $117.77
1644205 $114.19
1548445 $114.19
Strong Foundations, LLC 1594056
A New World
1621990
Carradine Center II
C & M Group Home
Marie Alirez Group Home
Michael Alirez Group Home
All Hands In
Ascend
Brighter Pathways
Brighter Pathways II
Candi's House
Gems and Jewels
House of Healing
Rocky Mountain Group Home
Turning Lights Group Center
Cornerstone Specialized G.C.
14101 E. 46th Ave.
1920 81st Ave.
1405 26th Street
1709 37th Ave.
4291 S. Fundy Way
17905 E. Bails Place
4006 S. Mission Parkway
1697 S. Kenton St.
1170 Norfolk St.
5376 S. Truckee Court
1036 S. Ouray St.
16621 E. 107th Ave.
1365 S. Lewiston St.
3070 S. Quintero Way
Denver, CO 80239
Greeley, CO 80634
Greeley, CO 80631
Greeley, CO 80634
Aurora, CO 80013
Aurora, CO 80017
Aurora, CO 80013
Aurora, CO 80012
Aurora, CO 80011
Centennial, CO 80015
Aurora, CO 80017
Commerce City, CO 80022
Aurora, CO 80017
Aurora, CO 80013
1621801 $114.19
9875 $94.22
70335 $84.51
54150 $82.83
1686513 $222.20
1705635 $222.20
1649791 $146.45
1693759 $146.45
1652108 $146.45
1639923 $146.45
1709708 $222.20
1701369 $146.45
1621806 $146.45
1707380 $222.20
RESIDENTIAL CHILD CARE FACILITY PROVIDERS
July 1, 2018 to June 30, 2019
Agency
Alternative Homes for Youth
Attention Homes Chase House
Avanti House
Denver Children's Home
Devereux Cleo Wallace
Families First Children's Treatment Center
Griffith Centers for Children Inc.
Hilltop Residential Youth Services
Jefferson Hills Aurora
Midway Youth Services, Inc.
Mount St. Vincent Home
Regents of the University of Colorado (Synergy)
Roundup Fellowship IV
Roundup Fellowship V
Savio House
Shiloh House for Youth -- Thornton
Shiloh House -- Adams Campus
Shiloh House -- Longmont
Shiloh House -- Estes
Shiloh House -- Portland
Shiloh House -- Yarrow
Smith Agency Inc. -- Serenity Chidlren's Home
Southern Peaks Regional Treatment Center
Tennyson Center for Children
Third Way Center -- Bannock
Third Way Center -- Lincoln
Third Way Center -- Lowry
Third Way Center -- Pontiac
Third Way Center -- York
Turning Point Center for Youth -- Matthews
Turning Point Center for Youth -- Prospect
Dale House Project 24
Dale House Project 802
Jefferson Hills Lakewood
Shiloh House -- Sheridan
Smith Agency Inc. -- Serenity Chidlren's Home II
Springbrook Behavioral Health
Facility ID Agency Mailing Address
2016 1110 M St.
11679 1443 Spruce Street
1695623 P. O. Box 1938
49551 1501 Albion Street
39794 8405 Church Ranch Blvd.
57632 2163 S. Yosemite St.
39212 1724 Gilpin Street
96474 1331 Hermosa Ave.
12284 421 Zang St.
44002 729 Remington
45174 4159 Lowell Blvd.
49488 3738 W. Princeton Cir.
45211 3443 South Galena St., Suite 310
45212 3443 South Galena St., Suite 310
48170 325 King St.
1588986 6588 W. Ottawa Ave.
1528492 6588 W. Ottawa Ave.
1539982 6588 W. Ottawa Ave.
20335 6588 W. Ottawa Ave.
54169 6588 W. Ottawa Ave.
70967 6588 W. Ottawa Ave.
96482 15001 E. Tufts Place
1526789 700 Four Mile Parkway
1529814 2950 Tennyson St.
1507881 P. O. Box 61385
77810 P. O. Box 61385
1547437 P. O. Box 61385
65346 P. O. Box 61385
49487 P. O. Box 61385
45179 1644 South College Ave.
1616504 1644 South College Ave.
1502911 24 E. Dale St.
1502990 802 N. Tejon St.
88459 421 Zang St.
62291 7201 S. Sheridan Ct.
6566 14364 E. Evans Ave.
1714091 1 Havenwood Lane
Agency City State Zip
Greeley, CO 80631
Boulder, CO 80301
Broomfield, CO 80023
Denver, CO 80220
Westminster, CO 80021
Denver, CO 80231
Denver, CO 80218
Grand Junction, CO 81506
Lakewood, CO 80228
Fort Collins, CO 80524
Denver, CO 80211
Denver, CO 80236
Denver, CO 80231
Denver, CO 80231
Denver, CO 80219
Littleton, CO 80128
Littleton, CO 80128
Littleton, CO 80128
Littleton, CO 80128
Littleton, CO 80128
Littleton, CO 80128
Aurora, CO 80014
Canon City, CO 81212
Denver, CO 80212-3029
Denver, CO 80206
Denver, CO 80206
Denver, CO 80206
Denver, CO 80206
Denver, CO 80206
Fort Collins, CO 80525
Fort Collins, CO 80525
Colorado Springs, CO 80903
Colorado Springs, CO 80903
Lakewood, CO 80228
Littleton, CO 80123
Aurora, CO 80014
Travelers Rest, SC 29690
Facility Daily Rate
$193.91
$138.16
$182.18
$193.93
$193.93
$164.04
$193.94
$190.15
$188.92
$156.75
$193.92
$161.82
$90.65
$95.73
$193.92
$188.96
$188.37
$188.37
$188.37
$188.37
$188.37
$87.65
$193.93
$193.92
$192.29
$192.29
$192.29
$192.29
$192.29
$190.98
$190.98
$120.10
$120.10
$183.77
$188.37
$163.80
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