HomeMy WebLinkAbout20174093.tiffRESOLUTION
RE: APPROVE AGREEMENT FOR INDIVIDUAL PROVIDER CONTRACT FOR PURCHASE
OF FOSTER CARE SERVICES IN A FOSTER CARE HOME AND AUTHORIZE CHAIR
TO SIGN - DAWN KLAUS
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement for Individual Provider
Contract for Purchase of Foster Care Services in a Foster Care Home between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services, and Dawn Klaus, commencing October 24, 2017,
and ending June 30, 2018, with further terms and conditions being as stated in said agreement,
and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Agreement for Individual Provider Contract for Purchase of Foster
Care Services in a Foster Care Home between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Human Services, and Dawn Klaus, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 4th day of December, A.D., 2017, nunc pro tunc October 24, 2017.
ATTEST: die,L)< 4�C+•
Weld County Clerk to the Board
BY:
APPROVED AS
County Attorney
Date of signature: (/3(I7
ac, HS (J
a t r oDi t8'
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Cja1,424-122/
ie A. Cozad, Chair
Steve Moreno, Pro-Tem
arbara Kirkmeyer
2017-4093
HR0088
Ne4r
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: November 14, 2017
TO: Board of County Commissioners — Pass -Around
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services'
Individual Provider Contracts for Foster Care Services
Please review and indicate if you would like a work session prior to placing this item on the Board's
agenda.
Request Board Approval of the Department's Individual Provider Contracts for Purpose
of Foster Care Services. The major provisions of this agreement are:
CMS
ID
Provider/Term
Facility Type/Location
Daily Rate
1535
Klaus, Dawn
October 24, 2017 -June 30, 2018
County Foster Care
Lochbuie, CO 80603
Negotiated based
on needs of
child(ren)
1536
Gomez, Maria and Ibarra, Eric
October 13, 2017 -June 30, 2018
County Foster Care
Greeley, CO 80634
Negotiated based
on needs of
child(ren)
I do not recommend a Work Session. I recommend approval of these Agreements.
Sean P. Conway
Julie A. Cozad, Chair
Mike Freeman
Barbara Kirkmeyer
Steve Moreno, Pro -Tern
jajm
Approve Schedule
Recommendation Work Session
Other/Comments:
Pass -Around Memorandum; November 14, 2017 — CMS 1535, 1536 Page 1
eJnikroJJ 04f
(COLORADO
Office of Children,
Youth b Families
INDIVIDUAL PROVIDER CONTRACT
FOR PURCHASE OF FOSTER CARE SERVICES IN A FOSTER CARE HOME
1. THIS CONTRACT AND AGREEMENT, made this date, 677O/7 by and between the Weld County
Department of Human Services, P. O. Box A, Greeley, CO 80632, hereinafter called "County Department" and Klaus,
Dawn," 348 Valley Ave., Lochbuie, CO 80603 hereinafter called "Provider.
2. This Contract and Agreement shall be effective from October 24, 2017 and continue in force until June 30, 2018 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 certificate as 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;
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.
2017-4093
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1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cehs
John W. Hickentooper, Governor I Reggie Bicha, Executive Director
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 in accordance with Volume 7
requirements.
21. To complete or schedule a medical examination for the child or youth within 14 days after initial placement and a
dental the County Department;
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;
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1575 Sherman Street, 2nd Fioor, Denver. CO 80203 P 303-866-5932 F 303-866 5536 www.colorado.govicdhs
John W. Hickentooper, Governor I Reggie Bicha, Executive Director
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.
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.
Shanon Staires
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:
ATTE
Wel
By
Deput
PROVIDER:
Dawn Klaus
Provider (type or print)
Provider (type or print)
OARD OF COUNTY COMMISSIONERS
LD CO; TY, COLOR O
—69
a l,. A. Cozad, Chair
awn
Signature
10/24/2017
Date
Signature
Date
3
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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 apply to the agreement entitled, "Individual Contractor Contract for
Purpose of Foster Care Services and Foster Care Facility Agreement," hereinafter referred to as,
"County," and Klaus, Dawn, hereinafter referred to as, "Contractor."
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. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor
Contractor's agents or employees are, or shall be deemed to be, agents or employees of the
County for any purpose. Contractor shall have no authorization, express or implied, to bind the
County to any agreement, liability, or understanding. The parties agree that Contractor will not
become an employee of County, nor is Contractor entitled to any employee benefits from County
as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible
for its acts or of any agent, employee, servants and sub -contractors during the performance of
this Agreement.
3, Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in
whole or in part, is subject to and contingent upon the continuing availability of State of Colorado,
county, and federal funds for the purpose thereof.
4, This Amendment is intended to be applied in conjunction with attached Agreement and the Needs
Based Care Addendum as the complete integration of all understandings between the parties.
No prior or contemporaneous addition, deletion or other amendment hereto shall have any force
or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal,
addition, deletion, or other amendment hereto shall have any force or effect unless embodied as
a part of this written Agreement. This section shall not be construed as prohibiting the periodic
amending of this Agreement or the Needs Based Care Addendum in writing, if agreed to by both
parties. The Agreement, this Exhibit A and the Needs Based Care Addendum are intended to be
in lieu of and supersede all prior agreements between the parties hereto and relating to the care
and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is
permitted to monitor the service program, fiscal and other records sufficiently to assure the
purchase of services in this Agreement are carried out for the benefit of the aforementioned child
or youth. Monitoring may occur through review of program reports, on -site visits where
applicable and other Agreements as deemed necessary. Contractor understands that the State
Department and the County may provide consultation to Contractor to assure satisfactory
performance in the provision of purchased services under this Agreement.
6. County shall have access to Contractor's service program, financial and other records, which will
sufficiently and properly reflect all direct and indirect costs of any nature incurred in the
performance of this Agreement for purposes of audit. Such records shall be complete and
available for audit 90 days after final payment hereunder and shall be retained and available for
audit purposes for at least five years after final payment hereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
8. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to
Exhibit A o the CWS-7A
4 Revised 6/2016
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 contractors or persons to
perform services of the same or similar nature.
11, 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 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, Contract Professional shall, within twenty days after hiring an 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.
12. 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-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.
Exhibit A o the CWS-7A
5 Revised 6/2016
D. Have not within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
13. In addition to terminating this Agreement, in accordance with the provisions of this Agreement
and Exhibit A, County may exercise the following remedial actions if the County finds and
determines that the Contractor has substantially failed to satisfy the duties found in this
Agreement, Exhibit A or the Needs Based Care Addendum. Substantial failure to satisfy the
scope of work shall be defined to mean incorrect or improper activities or inaction by the
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.
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. 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. The 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 the County Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganizations and/or foreclosure.
17. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado
and be in accordance with the policies, procedures, and practices of County. Contractor shall
strictly comply with all applicable federal and State laws, rules and regulations in effect or
hereafter established.
18, Financial obligations of the County payable after the current fiscal year are contingent upon funds
for that purpose being appropriated, budgeted and otherwise made available. Execution of this
Agreement by County does not create an obligation on the part of County to expend funds not
otherwise appropriated in each succeeding year.
19. County and Contractor 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 Contractor unless otherwise negotiated and approved by the County.
20. 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 the Child Maintenance level of service, as indicated by
the Needs Based Care Rate Table, designated as Addendum 2, for children placed within the
Exhibit A o the CWS-7A
6 Revised 6/2016
Weld County Certified Foster Care Home identified as Provider ID# 1710929. 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 Contractor.
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, jn writing by the
Department Administrator, prior to the service being performed. Any payment for specialized
services not authorized in writing may be denied.
23. All reimbursement requests shall:
A. Be submitted in a format approved by the County. If submitted in an unapproved format
or inadequate documentation is provided, the County reserves the right to deny payment.
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 of the
month following service, it may result in forfeiture of payment.
C. Placement service reimbursement shall be paid from the date of placement up to, but not
including the day of discharge.
D. Transportation reimbursement shall be for visitation purposes only. If medical
transportation is needed, Contractor will arrange reimbursement through Medicaid. Any
other special requests for transportation reimbursement shall require prior approval by
the Resource Manager or the Department Administrator.
E. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the
clothing allowance form 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 Contractor by the children, Contractor shall be released from
responsibility for loss or damage to such personal items.
CONTRACTOR SHALL:
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 Contractor and control any disputes in this Agreement.
2. Not charge any fees to children or families of children referred by County for any services
provided under this Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub -Agreement without the
express written approval of the Director of the County Department or his/her appointed
designee.
4. Maintain at all times during the term of this Agreement a liability insurance policy of at least
$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. Contractor shall provide a certificate of
insurance provided by its insurer upon request by County.
5. Indemnify the County against any and loss against all claims and actions based upon or arising
out of damage or injury, including death, to persons or property caused or sustained in
connection with the performance of this Agreement or by conditions created thereby, or based
upon any violations of any statute, ordinance, or regulation and the defense of any such claims or
actions.
Exhibit A o the CWS-7A
7 Revised 6/2016
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings, if
requested by the Department. County staff shall notify the Contractor of the dates and times
attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency situations.
These requests shall be made through the child's caseworker and/or the Contractor's Foster Care
Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors
hired by the Weld County Department of Human Services to preserve placement in the least
restrictive placement appropriate, comply with the treatment plan of the child, and attend court
hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completed within
8 weeks of the child being placed with Contractor. All documentation of these examinations will
be placed in the foster child's placement binder.
10, Attend all necessary school meetings and support any plan that is developed regarding the child
in order to promote educational success.
11. Immediately report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set forth in Section 19-3-304, C.R.S.
12, Maintain, access and review information weekly on 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 the Contractor'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 o the CWS-7A
8 Revised 6/2016
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?
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?
P4. How often does the child require special and extensive involvement t7Y the provider in
scheduling and
monitoring of time and/or activities and/or crisis management?
P5. How much time is the provider required to assist the child because of impairments
beyond aoe
appropriate needs with feeding, bathing, grooming, physical, and/or occupational
therapy?
Select One
Select One
Select One
Select One
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.
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
Select One
Assessment Areas:
Comment:
Rating:
Aggression/Cruelty to Animals
Select One
Verbal or Physical Threatening
Select One
Destructive of Property/Fire Setting
Select One
Stealing
Self -injurious Behavior
Substance Abuse
Presence of Psychiatric Symptoms/Conditions
Enuresis/Encopresis
Runaway
Sexual Offenses
inappropriate Sexual Behavior
Disruptive Behavior
Delinquent Behavior
Depressive -like Behavior
elect une
Select One
Select One
Select One
Select One
Select One
Select One
Select One
Select One
Select One
Select One
Medical Needs - (If condition is rated "severe",
please complete the Medically fragile NBC)
Select One
Emancipation
Select One
Eating Problems
Boundary Issues
Requires Night Care
Education
Select One
Select One
Select One
Select One
O
Involvement with Child's Family
Select One
Addendum 1
9 Revised 6/2016
Department` of Human-Services'Ptit cies
2.322 Needs Based Care Rate Table (Effective 7/01/2015)
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Age 0-10.:.$17.25
r
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t
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$12.52
--crisis-inter-vention,-minimal
' CPA involvement, one face -to-
face visit with child per month.
$0.00 !
-Maintenance
Rate
r Age I I•=14-:$19:07
Age 15-21...$20.37
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o ded or coverer'
under Medicaid.
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$20.85
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,
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$.66
I
;;
$15.99
! Minimal crisis intervention as
needed, one face-to-face visitper
month with child, 2-3 contacts
per month.
.r.:.
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t.;!
i
! $5.21
!
Regularly Scheduled
therapy up to 4
hours/month.
!'
$3.50
1 'A
..
$23.99
$.66
$17.48
2
i
, $27.80
": r
$-66
!
$19.47
Occasional crisis intervention as
needed, two face-to-face visits
j with child, 2-3 contacts per
month.
i. C
-
1
$10.42
Weekly scheduled
therapy 5-8 hours a
month with 4 hours of
group therapy.
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$5.04
2 'A
-_.
`
$31.28
.q.,
$•66
w
$21.20
r
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3
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' $34.75
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- r
a
1w
$.66
r
'1
;
$22.94
Ongoing crisis intervention as
needed, weekly face-to-facevisits
with child, and intensive
; coordination of multiple services.
Ft
'
r -
r
;t•
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$15.63
Regularly scheduled
weekly, multiple
sessions, can include
more than 1 person, i.e.
; p
family therapy, for 9-12
hours/monthly-
•
•
I ,t
t
• $6.50
3 1/2
$38.22
,.
1 +!
$.66
$24.68
; -S
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—
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4
Congregate
Care
Drop Down
`f
-
1
$41.70
`.^.,
$.66
'
li
,' .
t
,
i ,
I $26.41
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.
I '
,
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- -
Negotiated
r
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Negotiated
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Assessment/
Emergency
Level Rate
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$27.80
$.66
' •
$19.47
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