HomeMy WebLinkAbout20163304.tiffCOLORADO
Office of Children,
Youth & Families
Department of Human Services
OOO00000ao®
5S -23A Agreement to Purchase
Revised 10/15
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT
SERVICES SS23A
CHILD PLACEMENT AGENCY SERVICES (CPA)
CHILD HABILITATION RESIDENTIAL PROGRAM (CHRP)
GROUP HOME/GROUP CENTER CARE
INDEPENDENT LIVING
PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF)
RESIDENTIAL CHILD CARE FACILITY (RCCF)
RESIDENTIAL DRUG/ALCOHOL PROGRAM
SHELTER CARE
SUBSIDIZED ADOPTION
TRANSITION/HOME BASED AFTER -CARE (RCCF)
OTHER (DESCRIBE):
THIS IS AN AGREEMENT, made this
day of
between Weld County Department of Social/Human Services, PO Box A, Greeley, Colorado,
80632, hereinafter called "County" and Denver Area Youth Services, 1530 W. 13th Ave, Denver, CO
80204, hereinafter called "contractor"
THIS AGREEMENT:
Shall include all children placed by Weld County Department of Social/Human Services and
placed with Denver Area Youth Services.
A child specific addendum, identifying individual service needs, must be completed and
attached to supplement this agreement for each child being served by the facility. If this
is a CPA placement, the child specific addendum should also address how administrative
services will be provided in the event the child is placed for adoption in a foster home
supervised by the CPA.
WHEREAS, the Colorado State Department of Human Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of
individuals through its agents, County Departments of Social/Human Services, and
WHEREAS, the County is authorized to purchase certain services for eligible children
under State Department rules, and
2016-3304
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director ("1 _/ •,
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WHEREAS, the County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child
Care Facility, certified Psychiatric Residential Treatment Facility, or meets the
requirements for other licensed service types.
NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings
the County and the Contractor agree as follows:
1. This Agreement shall be in force from the date of the agreement,
July 1, 2016, until the end of the Colorado fiscal year, June 30, 2017.
Any child may be removed from the facility prior to the end of the fiscal
year by the county department.
2. This Agreement may be renewed only by entering into a new written
Agreement such as this Agreement signed by the authorized
representatives of the parties. Except as otherwise provided above, either
party shall have the right to terminate this contract by giving the other
party thirty (30) days notice by registered mail, return receipt requested. If
notice is so given, this contract shall terminate on the expiration of the
thirty (30) days or until the eligible children) can 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, but the
parties shall not be released from the duty to perform their obligations up
to the date of termination.
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3. This Agreement is in lieu of and supersedes all prior agreements between
the parties hereto and relating to the care and services herein described.
SECTION I: DESCRIPTION OF SERVICES TO BE PURCHASED:
1. The total rate of payment for care and services under this Agreement shall not exceed:
the established rate for the PRTF; for CPA placements, the negotiated rate or the
approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the
negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon
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service proposal rate. The total rate of payment for care and services for other service
types will be as negotiated between the County and the Contractor. Medicaid rules shall
govern activities to be covered in the daily rate paid to PRTFs.
The amount paid for purchased care and services for less than a full month will be based
upon the daily rate.
2. Payment for a child's temporary absence from the facility, including absence due to
hospitalization, will be made in accordance with State Department rules in Staff Manual
Volume VII, 7.406.1, F (12 CCR 2509-5).
3. Transportation shall be furnished by County between the child's residence and
Contractor's facility for the initial placement and return after the treatment plan is
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
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completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County has responsibility for the decision to return the child to the facility,
with input from the Contractor.
4. All other transportation associated with the Contractor's proposed services will be
provided by Contractor. Any transportation costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and are not
subject to reimbursement under this Agreement. However, provisions for payment of
other transportation may be provided for in the Family Service Plan / Individual Plan of
Care.
5. Any transportation costs to be incurred on behalf of a child in placement, which are to
be borne by persons, or agencies, which are not a party to this contract, shall be specified
in the treatment/service plan, and those persons shall acknowledge their responsibility by
signing the treatment/service plan.
SECTION II: LEGAL STATUS AND AUTHORIZATIONS:
1. Such permission as is held by the County is hereby granted to the Contractor to
authorize routine or emergency medical and dental treatment except that:
a. Medical or dental care shall be provided by personnel duly licensed by law as
required by the State of Colorado. It is mutually understood hereto that hospital
expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other
unusual expenses are not included in the monthly rate. The cost of any items not
covered by Medicaid will be negotiated between County and Contractor. Medicaid
rules shall govern activities to be covered in the daily rate paid to PRTFs.
2. County and Contractor shall insure that the child(ren) is enrolled in the Early and
Periodic Screening, Diagnosis and Treatment Program.
3. It is agreed and permission is granted for the child(ren) to participate in planned
recreational and social activities of Contractor, including supervised off grounds
excursions and extended trips within the State, provided that Contractor has written
permission from County and legal guardian for any trips out of Colorado for any reason
and any planned absence from the facility of over seven (7) days within a consecutive
30- day period. Such written permission may be in the treatment/service plan. Further,
Contractor and County will also secure, where possible, permission from parents or
guardians of the child placed with the Contractor. Any planned absence of more than 24
hours for children placed in a PRTF is not Medicaid reimbursable.
4. County and Contractor shall inform each other and the local school district of any
changes in parental residence affecting educational status which comes to their attention.
SECTION III: REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS
REPORTS:
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
1. County and Contractor agree and understand that the reasons for referral, which
necessitate purchasing services for children are specified in the attached child specific
addendum and Family Services Plan. Any other r relevant information concerning these
children that does not necessitate purchasing services is also included in the addendu
m.
2. County and Contractor shall develop an initial plan that addresses the immediate
and/or emergency needs of the child within 72 hours of admission for children in RCCFs
or group homes except PRTF. County and Contractor shall formulate an initial individual
plan of care within 14 calendar days after admission for children in RCCFs orgroup
homes except PRTF. The placement date is that
a date noted in the attached child specific
addendum included with this contract. The Child's Family Service Plan may be utilized
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as an Individual Plan of Care for this purpose for facilities. Modifications to this plan
shall be agreed to in writing on the plan supplemental or as a document
document.
3. County and Contractor shall formulate an initial individual plan of care for children nln
PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care are
must be completed by the multidisciplinary team within 14 calendar days from the
placement date. The placement date is that date noted in the attached child specific
addendum included with this contract. Modifications to this plan shall be agreed to in
writing on the plan or as a supplemental document.
4. The individual plan of care shall be goal oriented and time -limited and shall:
a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with
clinical
and other needs including the child's presenting problems,
health, emotional status, behavior,physical
support system in the community, available
resources, and discharge plan.
b. Include specific goals and measurable objectives, expected dates of
achievement, specific discharge and transitional/after-care and follow up services
treatment.
criteria to be met for termination of tr
c. Specifythe type, frequency, and duration of clinical therapy services,
rehabilitation services, medication management, emergency services, initial
assessment, documented treatment modifications, and other services determined
to be necessary to meet the child's specific goals.
d. Specify that all therapeutic services are necessary to meet the needs of the child
and to treat the child's current diagnosis.
e. Identify the provision of, or the referral for, services other than RCCF services
and shall document any court ordered treatment including identifying the agency
responsible for providing the g g y
P court ordered treatment.
f. Anticipated living arrangement for the child at the date of discharge;
g;
g. Anticipated educational arrangement for the child at the time of discharge;
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John W. Hickentooper, Governor I Reggie Bicha, Executive Director
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h. Anticipated date for discharge from treatment purchased for the child.
i. A permanency goal for the child.
5. Monthly, Child Placement Agencies, RCCFs and other contractor types other than
PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term
and long-term goals have been achieved or not achieved. These parties shall provide the
County with written reports which address changes to the child's physical condition,
psychological and social functioning, changes in the child's family situation, educational
progress, significant incidents or disciplinary actions, and progress made to achieve goals
specified in the treatment plan. Further, the Contractor agrees to sequence reports to be
received by the County 15 calendar days prior to judicial or administrative hearings or
reviews when provided with 30 calendar days advance notice of such dates by County.
6. Every 14 days, PRTFs shall provide the County with written reports which address
changes to the child's physical condition, psychological and social functioning, changes
in the child's family situation, educational progress, significant incidents or disciplinary
actions, and progress made to achieve goals specified in the treatment plan.
SECTION IV: CONTRACTOR 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 Contractor and
control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State
law and rule.
3. Not charge any fees to children or families of children referred by county for any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub -contract
without the express written approval of the Director of the County Department or his/her
appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act
of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security
Act of 1975 as revised, and provide confidentiality of information concerning the child in
compliance with the Health Insurance Portability and Accountability Act (HIPAA).
6. Maintain during the term of this Agreement a liability insurance policy of at least
$25,000 for CPAs and $400,000 for PRTFs, and RCCFs for property damage liability,
$150,000 for injury and/or damage to any one person, and $600,000 for total injuries
arising from any one accident.
7. Maintain during the terms of this Agreement an insurance policy or a fidelity bond in
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.cotorado.gov/cdhs
John W. Hickentooper, Governor I Reggie Bicha, Executive Director
an amount deemed sufficient by the county, covering the activities of any of its officers,
agents, or employees responsible for the implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or any other
defalcations of the Contractor.
8. Indemnify County, Colorado Department of Human Services, Colorado Department p of
Health Care Policy & Financing, and the State of Colorado against any and loss against
all claims and actions based upon or g
p arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this
contract or by conditions created thereby, or based upon any violations of any statute,
of any such claims or actions.
or regulation and the defense
Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county
departments.
9. In regards to University of Colorado contractors only, the contractor shall be
responsible for its own wrongful or negligent acts or omissions or those of its officers,
agents, or employees while performing their professional duties to the full extent allowed
by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or
waiver of the application of the Colorado Governmental Immunity Act set forth in
§24-
10-101 to
§24-10-120, C.R.S., any claims resulting from the performance of the
University of Colorado, its employees or agents under this Agreement.
10. Maintain service program records, fiscal records, documentation and other records
,
which will sufficiently and properly reflect all direct and indirect costs of any nature
incurred in the performance of this Agreement.
The above shall be subject at all
reasonable times to inspection, review or audit by federal, Colorado Department of
Human Services, Colorado Department P
p of Health Care Policy & Financing, or county
personnel, and other persons authorized in writing by the Executive Director of the
Colorado Department of Human Services.
11. Contractor shall, in any instance of a potential adoption by fosterprovide
a parent, , the
initial home study, the SAFE study update, annual certification updates and related
materials when requested by the County within fourteen working days of the request. At
all other times the Contractor shall y q
make home studies and related materials available to
the County for review, at a location agreed upon by the County and the ,
during regular business hours.
12. Bill the County for services rendered, using the required form. This form is to be
mailed to the County by the last day of the month of care. Billings for PRTFs shall be
made to the MMIS System only. Billings for RCCF fee -for —service and CHRP shall
be
made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs sand
other contractor types shall be made to the County only. Contractor will not be paid
the county when by
billing is not received by the County within 30 calendar days following
the billing due date. y
13. Attend and participate in Administrative Reviews for children in placement with the
Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.cotorado.gov/cdhs
John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
encourage children over the age of twelve to attend their Administrative Reviews.
Participation may be in person or by teleconference.
14. The Contractor shall pay the foster parent the amount agreed upon with the county as
the child maintenance or room and board. Any payment to the foster parent in excess of
the child maintenance or room and board amount shall be treated as income to the foster
parent.
15. The Contractor shall have the on -site presence of at least one (1) official who has
received State training in how to use and apply the reasonable and prudent parent
standard and who, with respect to any child or youth placed at the Contractor's facility, is
designated to be the caregiver authorized to apply the reasonable and prudent parent
standard to decisions involving the participation of the child or youth in age or
developmentally -appropriate activities. In the case of a Foster Care Home certified by a
Child Placement Agency, Contractor agrees that each foster parent has received State
training in how to use and apply the reasonable and prudent parent standard to decisions
involving the participation of the child or youth in age or developmentally appropriate
activities.
16. Contractor shall ensure that each foster parent or caregiver authorized to apply the
reasonable and prudent parent standard receives sufficient, ongoing training to continue
to use and apply the reasonable and prudent parent standard for each child or youth
placed in the foster home or facility.
SECTION V: COUNTY SHALL:
1. Determine eligibility of the children under this Agreement for placement and medical
coverage. Medicaid rules and regulations shall govern determination of Medicaid
eligibility.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Human Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate when billing is submitted as described in Section IV, Number 10
(above).
4. Abide by all the rules and regulations of the Colorado Department of Human Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. If this agreement covers an initial placement for a child, the Contractor may receive a
clothing allowance in accordance with State Department rules.
6. Monitor children's progress in accordance with the treatment/family services plan and
the requirements of Colorado Department of Human Services rules and provide
1575 Sherman Street, 2nd Floor, Denver, Co 80203 P 303-866-5932 F 303-866-5536 www.co(orado.gov/cdhs
John W. Hickentooper, Governor 1 Reggie Bicha, Executive Director
consultation to Contractor in relation to the services purchased under this Agreement.
7. Invite Contractor to Administrative Reviews at least 2 weeksprior to the scheduled • u ed
review.
8. Involve Contractor in planning for the child and give the Contractor a copy of the
Family Services Plan at time of placement or as soon as completed and when updated P p ed or
revised.
9. The County shall seek recovery from the RCCF, CPA or other contractor type fo
r or any
non -Medicaid payment amounts that have been misused as defined in rules. The County u ty
may withhold subsequent payments to recover any funds misused by the RCCF, CPA PA or
other contractor type. The County shall seek recovery of any remaining funds as a
debt
due the County for the benefit of the state. The RCCF or CPA may appeal thedecision
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recover or withhold subsequent payments as defined in rules.
10. The County shall identify the amount agreed upon with the Contractor to be pai
d id to
the foster parent for the child's room and board. Such amount will be the same as shown
in Trails for the child's maintenance.
11. Reimbursement rates that are negotiated between the County and the Contract
be for allowable or shall
costs in one or more of four primary components: child maintenance,
administrative services, administrative maintenance, and treatment. Contractor type will
determine which of these four components will be included in the reimbursement
rate.
12. The County shall provide the Contractor with a copy of thepolicy that identifies
activities that providers trained in the reasonable and prudent parent standard may
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approve, and identifies activities that require County department approval.
13. The County shall require that the person(s) authorized to apply the reasonable an
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prudent parent standard, including each foster parent, will standard complete State training
specific to the reasonable and prudent
parent and will receive ongoing training
as necessary in order., to meet the needs of each child or youth, and to use and apply the
reasonable and prudent parent standard. pp y
SECTION VI: GENERAL PROVISIONS:
1. The Parties to this Agreement intend that the relationship between them, contemplated
1 t ed
by this Agreement is that of employer independent contractor. No agent, employee,
g or
servant of Contractor shall be deemed to be an employee, agent, or servant of the County.
Contractor will be solely and entirely responsible for its acts or of any a employee, agent,
servants and sub -contractors during the performance of this Agreement.
2. Payment pursuant to this Agreement, if in State of Colorado, coup or federal
whether in whole or in county, funds,
part, is subject to and contingent upon the continuing availability
of State of Colorado, coup and
county, federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that reasonable care was given to
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John W. Hickenlooper, Governor 1 Reggie Bicha, Executive Director
guard and protect personal items brought to Contractor by the children, Contractor will be
released from responsibility for loss or damage to such personal items.
4. This Agreement is intended to be applied in conjunction with the child specific
addendum and family services plan 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 either prohibiting the periodic amending of the family services plan
or appending a county designed addendum to this agreement.
5. The contract shall permit the State Department to monitor 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 client. Monitoring may occur through review of
program reports, on -site visits where applicable and other contracts as deemed necessary.
The Contractor understands that the State Department may provide consultation to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
a. All reimbursement requests shall be submitted to and approved by the
appropriate County staff. Reimbursement for placement services shall be paid
from the date of admission up to, but not including, the day of discharge.
Furthermore, Medicaid payments for PRTF and CHRP placements are permitted
on the day of discharge in compliance with regulations promulgated by the
Colorado Department of Health Care Policy and Finance. Fee for Service will be
reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to
funds encumbered in this contract and shall also include Medicaid funds for
PRTF and RCCF therapeutic services and CHRP services paid by the
Department of Health Care Policy and Financing. Payment for placement
services will not be provided for clients on "runaway" status unless the County
has previously approved it. Reimbursement requests for therapy costs for clients
enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the
Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal
Agent. The Contractor shall forward copies of such billings to the County on a
monthly basis.
In the event that a Contractor receives payment for a per diem discharge day,
regardless of funding source, the Contractor shall refund those dollars forthwith.
b.The purpose of these requirements is to provide minimum assurance that the
Contractor has adequate accounting and budgeting information available to allow
management to maintain a financially viable enterprise and to demonstrate
financial accountability to the county departments of human/social services and
Colorado Department of Human Services for the use of public funds.
(1) The Contractor must have in place a double entry accounting system and all
financial transactions must be posted to this system. Financial statements,
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
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prepared from information provided by this system, shall be presented in
conformity with U.S. generally accepted accounting (GAAP). principles The
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Contractor must also have adequate time keeping and cost allocation systems to
allocate salary cost and indirect cost to appropriate opriate cost centers. Books and
records of the Contractor shall be subject, at any reasonable time, to inspection,
p,
audit or copying by appropriate Federal, State or county personnel, or such
independent auditors or accountants as may be designated by these personnel.
(2) All billing by the contractor must be in a format approved by the fiscal agent
or county. Contractors must bill the
fiscal agent and county at least once a
month. Contractors may bill twice a month, on the 15th and last day of the
month, for services rendered. Bills will
be returned unpaid if the bills do not
conform to the approved format or the documentation is inadequate.
(3) All Contractors whose total annual expenditures are $100,000 or more shall
submit an annual audit of their financial statements by an independent certified
public accountant. Contractors with p
total annual expenditures less than $100,000
may submit an audit as described above or may submit compiled or reviewed
financial statements, prepared in accordance with generally accepted accounting
p
principles. If the Contractor is a government agency that has an independent audit
done by another agency of that p
Y government, its audited financial statements,
prepared in accordance with generally accepted accounting principles for state
and local governments meet this requirement. The audited, compiled or reviewed
financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy
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provided to the Colorado Department of Human Services (Attn: Administrator
for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180
days after the y contractor's fiscal year end. The audited financial statements and
supplementary information defined in regulation for various agencies shall be
presented as described in Section VI, B (1), above and must contain sufficient
detail to provide evidence of financial accountability under the terms of this
contract and controlling state regulations. Contractors that are a subsidiary of a
parent organization must submit separate finan
cial ancial statements for the subsidiary
that detail each of the Contractor's facilities and/or programs that provide services
for the Colorado Department of Human
p Services and also must provide a
reconciliation of these financial statements to the consolidated financial
statements of the organization as a whole. When applicable, the Contractor must
comply with the audit requirements found in the Single Audit Act of 1984 and the
Single Audit Act Amendments of 1996 and U. S. Office of Management Bement and
Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -
Profit Organizations including subsequent revisions, and appropriate audit and
financial reporting requirements as defined in State laws, rules, and regulations.
gu . s
(4) If Contractors do not submit their annual audit or refuse to disclose financial
information regarding the operation of the program in a timely manner, the Fiscal
Agent may withhold payment ca
g p y until the audit and/or requested information is
submitted. If the contractor is a CPA, then sanctions of the contractor may occur
for failure to submit.
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303-866-5536 www.colorado.gov/cdhs
John W. Hickenlooper, Governor Reggie Bicha, Executive Director
10
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(5) In cases where documentation does not exist to support audit information or
services provided, contractor will be required to repay all funds received for
which documentation does not exist.
(6) In cases where audit deficiencies are noted, a plan of corrective action shall
be submitted to the State Department's Audit Division for approval within 4
months of the date of the audit.
(7) Failure to comply with any of these requirements, including items on the
addendum is justification for the County to impose fiscal sanctions, penalties, or
cancel the contract.
6. In the event this contract is terminated, final payment to the Contractor may be
withheld at the discretion of the County until final audit. Incorrect payments to the
Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the
Contractor either by deduction from subsequent payments under this contract or other
contracts between the County and the Contractor or by the County, as a debt due to both
the State of Colorado, the Colorado Department of Human Services and the County. The
waiver of any violation shall not be construed as a waiver of any other or subsequent
violation of this contract or appropriate statutes and regulations.
WHEREFORE, the parties have herein set their hands and affixed their seals the day and
date first written above.
ATTEST:
Weld C
By:
COUNTY:
�/,�+�/ �• 'el BOARD OF COUNTY COMMISSIONERS
ty Clerk to the Bo rd WELD COUNTY, COLORADO
Deputy Cl;. to t �I' :t� 'J 1 . / \ ike Freeman, Chair
NTRACTOR:
OCT 2 4 21;6
enver Area Youth Services
1530 W. 13th Ave
Denver, CO 80204
By:
Contractor's (or designeeSignatu
and Date
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F 303866.5536 www.colorado.gov/cdhs
John W. Hickentooper, Governor Reggie Bicha, Executive Director
11
pp cof
w off.
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
Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and
of County Commissioners of between the Board
Weld County, on behalf of the Weld County Department of Human
Services," hereinafter referred to as, "County," and Denver Area Youth Services, hereinafter
referred to as, "Contractor."
1. County and Contractor agree that a child specific Needs Based Care Assessmen
t,
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,
indicated by the Needs Based Care Rate designatedTableas
in this exhibit, for children
placed within the CPA identified as Provider ID#45069. These services will be for
children who have been deemed eligible for social services under the statutes, rul
es and
regulations of the State of Colorado.
3. If a child is deemed eligible for the Children's Habilitation Residential Program
gr (CHRP)
waiver, Contractor agrees to accept the assessed waiver service rate billable through the
MMIS system and the federal SSI rate billable through the County.
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4. All bed hold authorizations and payments are subject to a 7 day maximum for a child's
child s
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from Count
y'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,
furnished by the Contractor under • • . will be
this contract for facilities that provide sex offender
treatment.
6. Any additional costs for specialized services, which include, but are not limited to;
tests, plethysmographs, and urinalysis screens, which are not provided within
hin
the negotiated provider rate, will need to be authorized, in writing b y Count y, prior to the
service being performed. Any payment for specialized services not authorized in writing
will be denied.
i
7. Contractor agrees to have appropriate personnel available to attend or i participate n
Family Engagement, Team Decision Making meetings, or court hearings. Contractor
or
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 County to shorten the
duration of placement.
Exhibit to the SS23A 1
Revised 6/2016
9. Contractor agrees to 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 shall be forward 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, the Contractor shall
complete or obtain a completed IEP. A copy will then be forwarded to the County.
11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities
and Child Placement Agencies are not eligible to receive clothing allowances as outlined
in the Weld County Department of Human Services Policy and Procedure Manual.
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. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or
contract with an illegal alien who will perform work under this contract. Contract
Professional 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). Contract Professional 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 Contract Professional that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform
work under this Agreement. Contract Professional 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 Contract Professional obtains actual
knowledge that a subcontractor performing work under the public contract for services
knowingly employs or contracts with an illegal alien Contract Professional shall notify the
subcontractor and County within three (3) days that Contract Professional 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
Exhibit to the SS23A
2 Revised 6/2016
the illegal alien within three (3) days of receiving notice. Contract Professional shal
l 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. Contract Professional shall comply with reasonable requests made in the course urse of
an investigation, undertaken pursuant to C.R.S.
§8-17.5-102(5), by the Colorado
Department of Labor and Employment. If Contract Professional t in the St
participates ate of
Colorado program, Contract Professional shall, within twenty days after
Y hiring an new
employee to perform work under the contract, affirm that Contract Professional has
examined the legal work status of such employee, retained file copies of the documents,
nts
and not altered or falsified the identification documents for such employees. Contract
Professional 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 Contract Professional fails to comply
with any requirement of this provision or of C.R.S.§8-17.5-101p Y
et seq., County, may
terminate this Agreement for breach, and if so terminated, Contract Professional sha
ll be
liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.R.S. .§ 24-765-
103 (3),
if Contract Professional receives federal or state funds under the contract, Contract
Professional must confirm that any individual natural person ei hteen(18) years of age or
older is lawfully g
present in the United States pursuant to C.R.S. § 24-76.5-103(4),if such
individual applies for .
pp public benefits provided under the contract. If Contract Professional
operates as a sole proprietor, it hereby swears or affirms under penalty ofperjury 'u that it:
(a) is a citizen of the United States or is otherwisep � �
lawfully present in the United States
pursuant to federal law, (b) shall produce one of the forms of identification required b
C.R.S. § 24-76.5-101, et se and(c)shall r � •q -Y
q 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-year period of preceding this Agreement, been convicted
judgment rendered against �
of or had a civil
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 ofrecords, making false
statements, or receiving stolen property;
•
c. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above;
d. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
.
20. In addition to terminating this Agreement, in accordance with the provisions of the
attached Agreement, the County may exercise the following remedial actions County . find
and determine that Contractor has substantially failed to satisfy the scope of work found and in
Exhibit to the SS23A 3
Revised 6/2016
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 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.
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. 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.
24. Any amendments or modifications to this agreement shall be in writing signed by both
parties.
25. 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.
Exhibit to the SS23A
4 Revised 6/2016
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
shall not pay for or otherwise provide g County
such coverage for Contractor or any of its agents or
employees.
27. County reserves the right to require the Contractor to provide a certificate of insurance
,
policy, or other proof of insurance at its sole discretion.
Exhibit to the SS23A 5
Revised 6/2016
Needs Based Care Assessment
NBC
Answers
closest
(NEEDS
to
rating
the
BASED
for
following
this
child.
CARE
questions
The
ASSESSMENT)
following
will
determine
seven
(7)
the
questions
NBC
Care Payment.
are mutually
For
exclusive.
each
question
below
please
select
the
Pl.
Therapy;
in
How
the
often
treatment
does
Medical
the
plan?
Treatment;
child
require
transportation
Family
Visitation;
by
the
Extraordinary
foster
care
Educational
provider
for
Needs;
the
following:
etc.,
as outlined
Select
One
P2.
sessions?
How
often
is the
foster
care
provider
required
to
participate
in child's
therapy
or counseling
Select
One
P3.
conjunction
How
much
time
with
is
the
a regular
provider
or
required
special
education
to intervene
plan?
at
home and/or
at school
with
the
child
in
Select
One
P4.
How
often
does
the
child
require
special
and
extensive
involvement
by the
provider
in scheduling
Select
One
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
age
Select
One
feeding,
appropriate
needs
with
bathing, grooming, physical,
and/or occupational
therapy?
Al.
How
**Please
or
more
often
group
than
Note:
is
CPA/County
one
The
County
Case
case
Management
foster
management
child
level
is
required?
with
may
the same
(Does
be
assessed
not
provider.
include
on
a combined
therapy)
basis if a sibling
Select
One
T1.
How
often
are
thera
services needed
to address
child's
individual
needs
.er NBC assessment?
Select
One
NBC
(NEEDS
BASED
CARE
ASSESSMENT)
— Behavioral
Assessment
Assessment
Areas:
Comment:
Rating:
Aggression/Cruelty
to Animals
Select
One
❑
Verbal
or
Physical
Threatening
Select
One
Destructive
of
Property/Fire
Setting
Select
One
I
Stealing
Select
One
Self
-injurious
Behavior
Select
One
❑
Substance
Abuse
Select
One
1
❑
Presence
of
Psychiatric
Symptoms/Conditions
Select
One
Enuresis/Encopresis
Select
One
❑
Runaway
_
Select
One
❑
Sexual
Offenses
Select
One
Inappropriate
Sexual
Behavior
Select
One
❑
Disruptive
Behavior
Select
One
Delinquent
Behavior
Select
One
❑
Depressive
-like
Behavior
Select
One
Medical
Needs
- (If
condition is rated
"severe",
Select
Medically
fragile
please
One
complete
the
NBC)
❑
Emancipation
Select
One
Eating
Problems
Select
One
❑
Boundary
Issues
Select
One
❑
Requires Night
Care
Select
One
❑
Education
Select
One
❑
Involvement
with
Child's
Family
Select
One
Exhibit A to the SS23A 6
Revised 6/2014
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
ordination
Appointment Coordination
Provider
❑
agrees to work
with
family
Medication
Evaluation
(not covered
under
fee
for
❑
service)
Therapeutic
❑
Services
funded
through
Medicaid
Fee
for
Medication
Monitoring
Service:
(TRCCF)
❑
❑
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
❑
a
MST
Multi
-Systemic
Therapy
❑
Coordinate
Assessment
for Special
p
Education
❑
Offense
Specific
Treatment
❑
Public
School
Attendance
.
❑
Occupational
Therapy
'
❑
Drug
Alcohol
and
Treatment
❑
Speech
Therapy
❑
Attend
Special
Education
Meetings
Urine Analysis/Drug
Screening/
Breathalyzer
❑
Other:
l
❑
Sexual
Abuse
Victimization Treatment
❑
Visitation
Coordination
❑
Independent
Living Skills
Training
❑
Monitor
calls
phone
and
correspondence
and
once
❑
p
Anger
Management
❑
Transportation
for family/parent/child
visits
❑
Behavior
Modification
Services
❑
Other:
❑
Behavioral
Assessment
❑
Other:
❑
Recreation
Services
il
Interpreter
Services
❑
Case Management
❑
Other:
Attend
Court
Hearings
❑
Transportation:
To include:
❑
Other:
Levels of Care:
Provider Level:
Case Management Level:
Therapy Level:
Date Staffed:
Participants:
Comments:
Exhibit A to the SS23A
7 Revised 6/2014
Needs Based Care Rate Table
Weld County Department of Human Service
(Effective 7/01/2015)
,._.
1
LEVEL
OF
CHILD
RESPITE
ADMINISTRATIVE
ADM
1INI✓ Rai 1
IVE
MEDICAL
SERVICE
MAINTENANCE
MAINTENANCE
SERVICES
NEEDS
Level
Daily
Rate
Daily
Rate
Daily
Rate
Daily
Rate
Daily
Rate
1
County Basic
Age 0-10...$17.01
$ 66
$12.35
$0.00
Maintenance
Rate
Age 11-14...$18.81
Age 15-21...$20.09
No
CPA
face
crisis intervention,
involvement
visit with
child
Minimal
one face -to-
per month.
Not needed
under
or cover
Medicaid.
$15.77
$5.14
1
$20.56
$.66
Minimal
needed,
crisis intervention
one face-to-face
as
visit
Regularly
therapy
Scheduled
up
to 4
$3.45
per month with
child,
2-3
hours/month.
contacts per month
1 %:
$23.99
$.66
$17.48
-
a
---------
$19.20
$10.28
Occasional crisis intervention as
Weekly
scheduled
2
$27.42
$.66
needed,
two face-to-face visits
therapy 5-8
hours a
$4.97
with child, 2-3 contacts per
month
with 4 hours of
month
group therapy.
2 'A
$30.85
$.66
$20.91
$22.62
$15.42
Regularly
scheduled
i
Ongoing crisis intervention as
weekly, multiple
3
$34.27
$ ,66
needed, weekly
face-to-face
sessions, can include
$6.50
visits with
child,
and
intensive
more than 1 person,
coordination
of
i.e. family
therapy, for
multiple
services.
=
9-12
hours/monthly.
3 1/2
$37.69
$.66
$24.34
--------
$26.05
4
Ongoing crisis intervention as
Congregate
needed,
which
includes
high
Care
$41.13
$.66
level of case management and
Negotiated
Negotiated
Drop Down
CPA involvement with child
and
provider and 2-3 face -to face
contacts per week
minimum.
Assessment/
Emergency
$27.42
$.66
$19.20
Level Rate
a
Exhibit A to the SS23A
8
Revised 6/2014
Hello