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Home My WebLink About20153273.tiffCovdroc�" DiI.e3 CONTRACT AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND A BRIGHTER DAY, INC. This Agreement Amendment, made and entered into 25th day of May, 2016, by and between the Board of Weld County Commissioners, on behalfof the Weld County Department of Human Services, hereinafter referred to as the "Department", and A Brighter Day, Inc., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement to Purchase out -of -Home Placement Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 20153273, approved on October 12, 2015. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on June 30, 2016. • The Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Contract Documents: L Exhibit A consists of additional provisions for the purchase of group home/group center care services identified as Provider ID#1678390 • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: d.� Kd14);K- BOARD OF COUNTY COMMISSIONERS Weld C' u ty lerk to the Boar WELD COUNTY, COLORADO By: Mike Freeman, Chair AUG 0 8 2.016 CONTRACTOR: A Brighter Day, Inc. 2851 S Parker Rd #600 Aurora, CO 80014 By Contractor's (or designee's) Signature and Date ce, C),(.4„...e),pko 0,01(\sw r-r- axi,5"• -37,3 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 A Brighter Day, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $165.00, per day for children placed within the Group I Iome/Group Center identified as Provider ID #1678390. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A I Revised 6/2015 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 I luman Services to shorten the duration of placement. 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 the 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. Exhibit A to the SS23A 2 Revised 6/2015 &‘ ti - 'T 03 7/ CONTRACT AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARIEL CLINICAL SERVICES This Agreement Amendment, made and entered into the 20" day of February, 2016, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Ariel Clinical Services, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement to Purchase Out -of -Home Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 20153273, approved on October 12, 2015. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on June 30, 2016. • The Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Contract Documents: 1, Exhibit A consists of additional provisions for the purchase of group home/group center services identified as Provider ID#1643047. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: dide4) `" 4j4 " o Weld C By: Clerk to the B . a (iC, COUNTY; BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair APR 2 7 2016 CONTRACTOR: Ariel Clinical Services 4660 Wadsworth Blvd Wheat Ridge, CO 80033 By: Contractor's (or designee's) Signature and Date /71(1/) 02/4"21- 9021 a a/6 -,3: 7,g Acoorl, EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Ariel Clinical Services, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $190.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1643047. 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 MMES system for Children's fIabilitation Residential Program (CE1RP) waiver eligible children and the federal SS1 rate billable to the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 �.. _ . _ _ _ CD►'L�ra�.G� �� C� ; ,�; CONTRACT AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES �-co�.�.'•,.; AND DENVER CHILDREN'S HOME This Agreement Amendment,made and entered into 1 st day of December,2015,by and between the Board of Weld County Commissioners,on behalf of the Weld County Department of Human Services,hereinafter referred to as the "Department",and Denver Children's Home,hereinafter referred to as the"Contractor". WHEREAS the parties entered into an Agreement to Purchase Out-of-Home Placement Services,(the "Original Agreement")identified by the Weld County Clerk to the Board of County Commissioners as document No. 20153273,approved on October 12,2015. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement,which is incorporated by refer�ce herein,as well as the terms provided herein. NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: • The Original Agreement will end on June 30,2016. • The Amendment,together with the Original Agreement,constitutes the entire understanding between the parties. The following change is hereby made to the Contract Documents: 1. County agrees to purchase and Contractor,m#49551,agrees to provide: a. Child Maintenance,Administrative Maintenance and Services,which are listed in this agreement at a rate of S18936 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF,the parties hereto have duly executed the Agre�nent as of the day,month,and year first above written. �ii'��1/ �I• K.f��(�G, ('�I iNTY: ATTEST: BOARD OF COLTNTY COMMISSIONERS Weld C lerk to the ar WELD COiJNTY,COLORADO gy� '��t�- . Deputy Cl k to the � /�, Mike Freeman,Chair FEg A 1 2016 �/J 1861 � `� � 9 Denver Children's Home j�g �, 1501 Albion Street �'•i Denver,C 0220 i ; By: , Contractor's (or designee's)Signat and Date I �, ��•� I1 C J�R �p��,,,,�- u��..r aoi S'�� a- � - �� +��. AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A • CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRLF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this day of �� , , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and A Brighter Day Inc., whose address is 2851 S Parker Rd #600, Aurora, CO 80014, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the of the fiscal year by the county departure t. /� �� (l SS-? Agreement to Purchase Uj. 1 eised 6!?0 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consisits of additional provisions for the purchase of Group Home/Group Center Care Services — ID#s 1621806, 1639923. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PR"I F, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 Ilealth Insurance Portability and Accountability Act (IIIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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 In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may he designated by these personnel. SS -23 A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23 A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall he recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 he construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. Any transportation costs to be incurred on behalf of a child in placement, which arc to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS': A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I . Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/201 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased wider this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to he applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and he in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 i f a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for SS -23 A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23 A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. O. 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. P. 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. Q. 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 tiled 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perfoiin 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. (�( �_ C� COUNTY: ATTEST: L/dQ�i/1/ v••ei BOARD OF COUNTY COMMISSIONERS Weld Qounty Clerk to the Bgard WELD COUNTY, COLORADO By: - Deputy Q%lerk to the Bc( i Mike Freeman, Pro-Tem APPROVED AS TO SU Ele OCT 12 Nt5 ONTRACTOR: A Brighter Day Inc. 2851 S Parker Rd #600 Aurora, CO 80014 Contra for s (or designee's) Signature and Date oZa/.,-oa,73 CI ) SS -23A Agreement to Purchase 14 Revised 6/2015 1C\ EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 A Brighter Day Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of 5102.00, per day for children placed within the Group home/Group Center identified as Provider ID #1621806. 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 the County. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 A Brighter Day, Inc., 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 $141.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1639923. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6!2015 Esther Gesick From: Sent: To: Cc: Subject: See below Esther — Cecilia Moreno Monday, September 28, 2015 2:13 PM Esther Gesick Lesley Cobb; Jacquie Higinbotham FW: contracts Cecilia Moreno Employment Services Support Specialist Employment Services 315 N 11 Ave 8 Greeley, CO 80631 970-353-3800 ext. 6756 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Judy Griego Sent: Monday, September 28, 2015 2:11 PM To: Cecilia Moreno Subject: RE: contracts I am okay with it as long we make a notation as to why we didn't go through the pass -around and who was involved in the decision making. Keeping the emails of this exchange would be good. Judy A. Griego, Director Weld County Department of Human Services 315 N 11th Avenue BLDG B Greeley, CO 80631-2014 970.352.1551, extension 6510 Fax 970.353.5215 griegoja@weldgov.com <image003.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 2015-3273 1 From: Cecilia Moreno Sent: Monday, September 28, 2015 2:09 PM To: Judy Griego Cc: Esther Gesick; Lesley Cobb; Jacquie Higinbotham Subject: RE: contracts The 43 contracts in question are Foster Care Facility Agreements CWS-7A with Exhibit A. The thought process of Esther and Child Welfare is that Legal/Finance/BOCC have already reviewed the contract template and rate approvals so there is no reason to review them again now that they are filled out with provider information; thus developing a "fast -track" within the CMS. Do you have a different take on this? Cecilia Moreno Employment Services Support Specialist Employment Services 315 N 11 Ave 8 Greeley, CO 80631 970-353-3800 ext. 6756 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Judy Griego Sent: Monday, September 28, 2015 1:55 PM To: Cecilia Moreno Subject: RE: contracts If we bypass the pass -around process, I am wondering out loud what that means. I can't tell what type of contracts you are listing. Judy A. Griego, Director Weld County Department of Human Services 315 N 11th Avenue BLDG B Greeley, CO 80631-2014 970.352.1551, extension 6510 Fax 970.353.5215 griegoia@weldgov.com <image003.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 2 From: Cecilia Moreno Sent: Monday, September 28, 2015 1:53 PM To: Frank Haug Cc: Judy Griego; Barb Connolly; Lesley Cobb; Jacquie Higinbotham; Esther Gesick Subject: RE: contracts Frank, The contracts have actually been sitting with the originator. These are the items that Esther has deemed fast -track since the form was approved and now the signed items just need to go to consent. Frank/Barb, the contracts you can move forward without review are as follows: 192, 193, 194, 195,197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 216, 217, 218, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236. Also, please note that 185, 196, 219, are still with the originator waiting for the statement of work to be uploaded but will be considered fast -track as well. Judy, I believe Esther said these can bypass pass -around as well but I am waiting for her response to be sure. Cecilia Moreno Employment Services Support Specialist Employment Services 315 N 11 Ave B Greeley, CO 80631 970-353-3800 ext. 6756 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Frank Haug Sent: Monday, September 28, 2015 11:42 AM To: Cecilia Moreno Subject: contracts I saw several contracts had been initiated, but I don't see them on my queue, just wanted to let you know. My guess is they are with accounting or something. Frank N. Haug Assistant Weld County Attorney 1150 O Street Mailing Address: P.O. Box 758, Greeley, CO 80632 tel: (970) 356-4000 x4394 fax: (970) 352-0242 3 �a �.� - 3 0218 SS -23A Agreement to Purchase 24.10.2015 01:20 PM PAGE. 2/ 25 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A 13 CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) 1] GROUP HOME/GROUP CEN'I'EK CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTh) O RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE O SUBSIDIZED ADOPTION O TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: ''/ /, �i1 _ THIS IS AN AGREEMENT, made this day of 0 /J3 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and A Kitlz Hope Homes Inc., whose address is 1401 W Colorado Ave, Colorado Springs, CO 80904, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WIIEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: 1FiRM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016, Any child may be removed from the facility prior to the end of the fiscal year by the county department. JO 4.1-19 o2ois �a73 �'�/ Revised 6/20 S Revised 6/2015 24.10.2015 01:21 PM PAGE. 3/ 25 B. 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 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 children) 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. 1. DESCRIPTION OF ERVICES tO RE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). R. The terms of this Agreement arc contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Group Horne/Group Center Care Services — ID #s 1531611, 1531612. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTP. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may he utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 24.10.2015 01:21 PM E. The Individual Plan of Care shall be goat oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. PAGE. 4/ 25 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than FRT'F, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PR'fFs shall provide 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 individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2©15 24.10.2015 01:21 PM H. 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 - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. PAGE. 5/ 25 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 (I IIPAA). 6. Maintain at all times during the term ol'this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 24.10.2015 01:22 PM PAGE. 6/ 25 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall he presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 612015 24.10.2015 01:22 PM PAGE. 7/ 25 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 he completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PMI's, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. It -Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 24.10.2015 01:23 PM II. PAYMENT TO CONTRACTOR: PAGE. 8/ 25 A. 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 CIIRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid R r purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County stain. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CI IRP 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. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CARP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. if this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. O. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 24.10.2015 01:23 PM PAGE. 9/ 25 wilt determine which of these tour components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County, County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL, STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State or Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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, B. County and Contractor shall insure that the ehiid(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 4/2015 24.10.2015 01:24 PM PAGE. 10/ 25 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 Contractor, Any planned absence of more than 24 hours for children placed in a PR'l'h is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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 I lumen 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 24.10.2015 01:24 PM PAGE. 11/ 25 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9, Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS; A. 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 shalt be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 24.10.2015 01:24 PM F. 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 eller final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. PAGE. 12/ 25 1I. 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. 1. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. i.. 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 the illegal alien within three (3) clays of receiving notice. Contract Professional 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. Contract Professional shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.S-102(5), by the Colorado Department of Labor and Employment. If Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for SS -23A Agreement to Purchase 11 Revised 6/2015 24.10.2015 01:25 PM PAGE. 13/ 25 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional must confirm thatany 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 i'or public benefits provided under the contract. If Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3, 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 olionscs enumerated in paragraph (B) above. 4. ltave not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase l2 Revised 6/2015 24.10.2015 01:25 PM PAGE. 14/ 25 2. 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. 3. 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. U. 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. P. 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. Q. 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 (S) 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. R. Any amendments or modifications to this agreement shall be hi writing signed by both parties. S. 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 arty cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 24.10.2015 01:26 PM PAGE. 15/ 25 WH1 RI}OR1?, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld By: APPROVED AS TO S I let dOriot COUNTY: • L BOARD OF COUNTY COMMISSIONERS I3t�ai WELD COUNTY, COLORADO Deput 4 lerk to th•f: ,�, Mike Freeman, Pro—Tem Otj 12 Z015 CO1�TRACTOR: A Kidz Hope Homes Inc. 1401 W Colorado Ave Colorado Springs, CO 80904 By: 4.19 ontractor's (or desig ee's Signature and Date SS -23A Agreement to Purchase 14 Revised 6/2015 ` .30273(.2) �LA1 24.10.2015 01:26 PM PAGE. 16/ 25 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 A Kidz Hope Homes Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $95.00, per day for children placed within the Group Home/Group Center identified as Provider Ill #1531611. 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 the County. 3. 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. 4. A minimum ofone 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 the County, prior to the service being performed. Any payment for specialized services not authorized in writin will be denied. 6. The services purchased under this Agreement for Group Ilome/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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 24.10.2015 01:26 PM PAGE. 17/ 25 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 M.P. 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. Exhibit A to the SS23A 2 Revised 6/2015 24.10.2015 01:26 PM EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group .Homc/Group Center Care Services PAGE. 18/ 25 The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -I Placement Services SS23A, 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 A Kidz Hope Homes Inc., hereinafter referred to as, "Contractor." 1 County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $95.09, per day for children placed within the Group Horne/Group Center identified as Provider ID #1531612. 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 SST rate billable to the County. 3. 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. 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 the County, prior to the service being performed. Any payment for specialized services not authorized its 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 or Team Decision making meetings. Contractor shall he notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 24.10.2015 01:27 PM PAGE. 19/ 25 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑x CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE Cl 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: THIS IS AN AGREEMENT, made this ? day of ,, , 20 � , by and between the Board of County Commissioners of Weld County, on b half of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Adoption Options, whose address is 13900 East Harvard Ave, Suite 200, Aurora, CO 80014, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WFIEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. SS -23A Agreement to Purchase �.Ci- TsI c/P o -/02-lam Revised 6/2015 5-3021 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PR"I'Fs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of'Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: SS -23A Agreement to Purchase Revised 6/2015 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. H, Contractor shall: I . 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 SS -23A Agreement to Purchase 3 Revised 6(2015 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. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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-I0-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 MM1S 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, 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 Contractor must he 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 SS -23A Agreement to Purchase Revised 6/2015 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 provided to the Colorado Department of Human Services (Ann: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of' Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of' the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated. final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Agreement to Purchase 7 Revised 6/2015 III. TRANSPORTATION: A. Transportation shall he furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportationmay include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3, 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. F. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. RESPONSIBILITIES OF COUNTY: A. County shall: I. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any SS -23A Agreement to Purchase Revised 6/2015 remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of I Iuman Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. SS -23A Agreement to Purchase ► 0 Revised 6/2015 G. Time is of the essence in each and all of the provisions of this Agreement. H. 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, tires, strikes, war, flood, earthquakes or Governmental actions. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 F -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if SS -23A Agreement to Purchase it Revised 6/2015 so terminated, Contract Professional 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). it' Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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: 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. 4. 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. N. In addition to terminating this Agreement. in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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. SS -23A Agreement to Purchase l2 Revised 6,'2015 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established I`. Financial obligations ot'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. SS -23A Agreement to Purchase 13 Revised 6/'2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: der/ JelJel"";41 BOARD OF COUNTY COMMISSIONERS Weld . o my Clerk to the ►oard WELD COUNTY, COLORADO By Depu Clerk to the ►/i/ rd Mike Freeman, Pro—Tem APPROVED AS TO S Elc Oflie'31 or Dep OCT 12 2015 CONTRACTOR: Adoption Options 13900 East Harvard Ave, Suite 200 Aurora, CO 80014 By: tfil/W Contractor's (or designee's) Signature and Date 7, g7 ,S — SS -23A Agreement to Purchase 14 Revised 6/2015 c90/i 31273 (3 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Adoption Options, 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#45078. 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 (C HRP) waiver, Contractor agrees to accept the assessed waiver service rate billable through the MMIS system and the federal SSI rate billable through the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A Revised 5/2015 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. PI. 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 andror at school with the child in conjunction with a regular or special education plan? 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 andi'or crisis management'? P5. How much time is the provider required to assist the child because of impairments beyond age Select One appropriate needs with feeding, bathing, grooming, physical. 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 TL How of n are them+ services needed to address a:,:�' individual needs • NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: Aggression/Cruelty to Animals Select One Verbal or Physical Threatening Select One Destructive of Property/Fire Setting 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 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 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 he reflected on the child specific contract. (Please be specific) ❑ Adoption Services H Medical Services 0 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 RSpeech 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 R 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 E 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 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) $12.35 County Basic Age 0-10...517.01 $0.00 Maintenance Age 1 1-14,..$18.81 $•66 No crisis intervention, Minimal CPA involvement, one face -to - Not needed or cover Rate Age 15-21 . 520.09 face visit with child per month. under Medicaid. $15.77 $5.14 Minimal crisis intervention as Regularly Scheduled 1 $20.56 $.66 needed. one face-to-face visit per month with child, 2-3 contacts per month 4 therapy up to hoursimonth. $3.45 1 ''/ $23.99 $.66 $17.48 $19.20 $10.28 Occasional crisis intervention as Weekly scheduled 2 $27.42 $.66 needed, two face-to-face visits with child, 2-3 contacts per month therapy 5-8 hours a month with 4 hours of group therapy. $4.97 2 '/ $30.85 5.66 $20.91 $2_2.62 $15.42 Ongoing crisis intervention as Regularly scheduled weekly, multiple 3 4 534.27 $.66 needed, weekly face-to-face visits with child, and intensive coordination of multiple services. sessions, can include more than I person. i.e. family therapy, for 9-12 hours/monthly. 56.50 31/2 r: $37.69 $.66 $24.34 $26.05 4 Ongoing crisis intervention as needed. which includes high Congregate $41.13 $.66 level and Negotiated Negotiated Care of case management Drop Down frx Xr 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 Exhibit A to the SS23A 5 Revised 6/2014 Me/1 ib AGREEMENT TO PURCIIASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this '' day of , 20 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Alternative Homes For Youth, whose address is 1110 M Street, Greeley, CO 80631, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department /,w,v/ �v,r�/ 3°275- 6-0 SS -23A Agreement to Purchase `"' • 1r' Revised 6/2015 /p /02 -- /� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 2016. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must he completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care, SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/20 f 5 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. County shall: I. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E, The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. IIave not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: I. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. O. 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. P. No portion of this Agreement shall he 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: „a'ei BOARD OF COUNTY COMMISSIONERS Weld .o ty Clerk to the Board WELD COUNTY, COLORADO By: Deput Clerk to the jig and APPROVED AS TO SUSS Ele ; d Officia or Dep SS -23A Agreement to Purchase Mike Freeman, Pro—Tem ONTRACTOR: Alternative Homes For Youth 1110 M Street Greeley, CO 80631 By: OCT 12 2015 ontrctor's (or designee's) Signature and Date o2%3x73 61) 14 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Alternative Homes For Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 2016, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.34 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 CW-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 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. 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 A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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: THIS IS AN AGREEMENT, made this day of / �..�20 � , by � and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Arapahoe House, whose address is 8801 Lipan St, Thornton, CO 80260, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent. County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. SS -23A Agreement to Purchase Revised 6/2015 &O/5"' 3273 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 88692. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6:'2015 . The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G, Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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. 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 - Agreement without the express written approval of the Director of the County Department or hisiher appointed designee. 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 All billing by 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. 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 provided to the Colorado Department of Human Services (Attn: Administrator for PR I"hs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after 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 (I), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase $ Revised 6,2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of I luman Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/�2O15 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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 C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. Fl. 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. 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. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 1I Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract. Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section l., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: G/idv•'41 BOARD OF COUNTY COMMISSIONERS Weld u y Clerk to the Board WELD COUNTY, COLORADO By: Deputy Sri ler to the APPROVED AS TO SU El r c ed Offic al or Depa Arapahoe House 8801 Lipan St Thornton, CO 80260 Mike Freeman, Pro-Tem OCT 12 ME NTRACTOR: By: kaay.e. 1 1 C E -o l-24-Zol s Contractor's (or designee's) Signature and Date SS -23A Agreement to Purchase 14 Revised 6/2015 --4,273P EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Arapahoe House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 88692, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.34 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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. Othermiscellaneous 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 the 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 writin by the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 ,614A,W p/6 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A 0 CHILD PLACEMENT AGENCY SERVICES (CPA) 0 CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING El 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: THIS IS AN AGREEMENT, made this day of , 20 , • by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Ariel Clinical Services, whose address is 4660 Wadsworth Blvd, Wheat Ridge, CO 80033, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS. 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department.�� (6) SS-23A Agreement to Purchase ' 1T' " {' C / Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. 1. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. I). County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: SS -23A Agreement to Purchase Revised 6/2015 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly. Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. II. 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 SS -23A Agreement to Purchase 3 Revised 6;2015 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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. SS -23A Agreement to Purchase 4 Revised 6/2015 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 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 In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I . Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. ?. All billing by 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 1 5th and last day of the month, for SS -23A Agreement to Purchase 5 Revised 6/2015 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of I996 and U. S. Office of Management 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -?3A Agreement to Purchase 6 Revised 6i?015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Agreement to Purchase 7 Revised 6/2015 III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan. and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1 Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF. CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF. CPA or other Contractor type. The County shall seek recovery of any SS -23A Agreement to Purchase 9 Revised 6/2015 remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. SS -23A Agreement to Purchase 10 Revised 6/2015 G. Time is of the essence in each and all of the provisions of this Agreement. IL 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. 1. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if SS -23A Agreement to Purchase Revised 6/2015 so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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: 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: I . Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 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 die amount of payment shall be reasonably related to the amount of work or deliverables lost to County. SS -23.A Agreement to Purchase 12 Revised 6/2015 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -21A Agreement to Purchase 1 3 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: di: ) to,„k. BOARD OF COUNTY COMMISSIONERS Weld C,tt Clerk to the Bgard WELD COUNTY, COLORADO By: Deputy lerk to the B APPROVED AS TO S B ial or Di Mike Freeman, Pro-Tem CONTRACTOR: Ariel Clinical Services 4660 Wadsworth Blvd Wheat Ridge, CO 80033 .ti. By: . Contractor's ( designee's) Signature pf-toX12 and Date J /) S\ X12, —.and OCT 12 2415 - 1O olo,_30273 (G) SS -23A Agreement to Purchase 14 Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Ariel Clinical Services, hereinafter referred to as, "Contractor." I. 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#90205. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A Revised 5/2015 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. 1 1 . 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. Exhibit A to the SS23A Revised 5/2015 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? Select One 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? 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? 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 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 grou p or more than one County foster child is with the same provider. T1 How often are theraservices needed to address child's individual needs •er 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 Select One Select One Select One Select One Select One Select One Select One Select One Select One Select One Select One Li complete Needs - (If condition is rated "severe", please complete the Medically fragile NBC) Select One ❑ Emancipation Select One Eating Problems Select One Boundary Issues Requires Night Care Education Select One Select One Select One Involvement with Child's Family Select One Exhibit A to the SS23A 3 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 Appointment Coordination ❑ Provider agrees to work with family Medication Evaluation (not covered under fee for service) in ❑ 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) LEVEL OF SERVICE CHILD MAINTENANCE RESPITE ADMINISTRATIVE MAINTENANCE ADMINISTRATIVE,' SERVICES MEDICAL NEEDS Level Daily Rate Dai1y Rate Daily Rate Daily Rate R I e County Basic Maintenance Rateunder Age 0-10...$17.01 Age 11-14...$18.81 Age 15-21...$20.09 $.66 $12 35 No crisis intervention, Minimal CPA involvement. one face-to- face visit with child per month. $0.00 Not needed or cover Medicaid. ---------- $20.56 $.66 515 77 Minimal crisis intervention as needed. one face-to-face visit per month with child. 2-3 contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month. $3.45 I ''A $23.99 $.66 $17.48 2 $27 42 $.66 $19.20 Occasional crisis intervention as needed. two face-to-face visits with child. 2-3 contacts per month $10.28 Wee.<ly scheduled therapy 5-8 hours a month with 4 hours of group therapy. $4.97 2 ''A $30.85 — $.66 S20.91 1 3 $3427 $.6b $22.62 Ongoing crisis intervention as needed. weekly face-to-face visits with child. and intensive coordination of multiple services $15.42 Regularly scheduled weekly. multiple sessions. can include more than I person, i.e. family therapy, for 9-12 hours/monthly. $6.50 3 1/2 $37.69 $.66 $24 34 4 Congregate Care Drop Down $41 13 $.66 $26.05 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 $2742 $.66 S19.20 Exhibit A to the SS23A 5 Revised 6/2014 001,6A/a /6001Akp AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A O CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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: THIS IS AN AGREEMENT, made this � day of , 20 /5, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Bethany Christian Services, whose address is 3000 S. Race St., Denver, CO 80210, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. SS -23A Agreement to Purchase /p ,. 4.2 Revised 6/ 5 o24/-- �? 7 B. 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 Agreement by giving the other party written notice received at :east 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 chiid(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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and B, each of which forms an integral part of this agreement. Exhibit A and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consists of additional provisions for the purchase of Group Home/Group Center Care Services — ID# 74864. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall; 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities andor programs :hat provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable. Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and L. S. Office of Management 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/2015 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 excursions and extended trips within the State, provided that Contractor has v, -r ;en 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 Contractor. Any planned absence of more than 24 hours for children placed in a PR 1`r is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Depaitnrent of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for and non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this SS -23A Agreement to Purchase 10 Revised 6/2015 Agreement for purposes of audit. Such records shat be C07:17,e'e c '' •e audit 90 days after final payment hereunder and shall hero 3 ned and aN audit purposes for at least five years after final payment hereunder er G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I, 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional participates in the State of Colorado program, Contract Professional shall, within ':wert. dais after hiring an new employee to perfoiui work under the contract, affirm that Contract Professional has examined the legal work status of such employee. rea.ned file copies of the documents, and not altered or falsified the identifica'.cr dccu_rnents for such employees. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such empioice. and shall SS -23A Agreement to Purchase Revised 5 2015 comply with all of the other requirements of the State of Colorado nrograrn If Contract Professional 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, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor SS -23A Agreement to Purchase 12 Revised 612015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S, 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U, 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. �/►�"�cl COUNTY: ATTEST: ddrillsAi '�' "�'BOARD OF COUNTY COMMISSIONERS Weld ?o t Clerk to the Bard WELD COUNTY, COLORADO y By: / ,� , ' `^ L eputy Crk to the BMike Freeman, Pro-Tem APPROVED AS TO SUBST Ele or Depart TRACTOR: Bethany Christian Services 3000 S. Race St. Denver„i0210 By OCT 12 2015 Contrctor's (or designee's) Signature and ate SS -23A Agreement to Purchase 14 Re'30175 (t) vised 6/2015 s�yl.0 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Bethany Christian Services, 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#45514. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 TI. How often are thera• services needed to address child's individual needs .-r 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 ❑ Stealing Select One ■ Self -injurious Behavior Select One C Substance Abuse Select One E. 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 ❑ 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 3 Revised 6/2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency Please indicate the services chat are requested for this child. The following information will be reflected on the child specific contract. (Please be specific) ❑ Adoption Services ❑ j Medical Services • Other: NA ❑ I Doctor Dentist Appointment Coordination ❑ Provider agrees to work with family ❑ Medication Evaluation (not covered under fee for serv:ce) • Therapeutic Services funded through Medicaid Fee for Service: (TRCCF) ❑ % Me iication Monitoring ❑ Individual Therapy L Nursing Services -Coordination ❑ Group Therapy [] ' Physician Services;Coordination Interactive Group Therapy ❑ r Occupational Therapy Family Therapy ❑ I Speech Therapy ❑ Psychological Testing ❑ ` Child Find ❑ Pharmacological Management L # 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 El Offense Specific Treatment ❑ Public School Attendance ❑ Drug and Alcohol Treatment ❑ Occupational Therapy 0 : Speech Therapy ❑ Attend Special Education Meetings Urine Analysis/Drug Screening/ Breathalyzer ❑ Other: El Sexual Abuse Victimization Treatment ❑ Visitation Coordination • Independent Living Skills Training ❑ Monitor phone calls and correspondence • Anger Management ❑ Transportation for m ly;"aarent child visits ■ Behavior Modification Services ❑ Other: ❑ Behavioral Assessment ❑ Other: ❑ Recreation Services ❑ Interpreter Services • Case Management 0 Other: ❑ Attend Court Hearings El Transportation: To include: 0 Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service� (Effecti��e 7f012015) � LEVEL OF CHI1.D � ! _�D'�il�"I�"IRaTt�`E ' �D�iL�IcTRATIVE AILDICAI, � KESPI7E � � � SERVICE 11AL�'TE��'vCE t �L�L'�:�E'ti.4��E ; ; 5ERVICES N�EDS . Levei Da?��,Ra?� ' � L, . '��._ � s _�_:=-�'_ � i:;Rate Daity Rate • '.` I i � � � � SIZ35 County Basic �� Age0-10...$17.01 � �� . ��_IIi� ` ,_ �p.L}0 � Maintenance �- Age 11-14...$18.81 � „ �iot nezeled or cover ' --------- LPA L�rn�;emaM,srae�ace-to- Rate Age 15-21...$20.09 under'vledicaid. � =�c��,sit w:�-��i}d�z�r`-� � I _— _ �+4 I �;n SI.'— �= � 55.14 � �'�'��`�� t�egularly Scheduled ( i $20.56 �.66 e�:�e,ont face-to-�aae,r�sa; �z� u to 4 �3.45 � �aa Qy a , `�' �"'��''�''-= 7aurvmonth. � � �oarscss pa c�±=^ •� I 1 %: � $23.99 �, $.66 S 1'48 �-�= = ��" 519.� `'� S'.U.28 ; � Occasional crisis int�vrm�oc ts '� '�� scheduled =� = 2 ' �27.42 �� $.66 _.� 4�; �eeded,iwo 5xx-cn-facr•.s� �-'ae� �-8 hours a $4.97 I ., � �' r*xx:�w:ch d hou�s of ; �, with c�iJd,2-3 �a-s'�U aer ��;; _: �4: �' �nan� � �xx:p u'�er�� - ' , - 2'/z $30.85 �� $.66 S2(�9 i � --------- � � � 522.62 � � �:�� S!�.4? '�`` � On oin crisis intervention as � Rz�ular(y schedufed � �= � � g g � weekly,muhiple 3 f_ 534.27 �" $.66 � ` needed,weekly face-taface -�� _ � '�, sessions,can inc(ude $6.50 �: visits with child,and iniensive �: more than I person, � K= Y . � ``' coordination of multiple _ �' = i.e.family therapy,for "� "`'� �rv��' 9-l2 hours/monthiv. ± - i _ , _ 31/2 � $37.69 ' �.66 �; $2434 �- ----------- --------- -�b+ �' $2b.05 4 Ongoing crisis intervention as Congregate �.; � needeci,which includes high $4 L.13 $.66 � _ "` � level of case management and Negotiated Negotiaied Care . ; Drop Down '' �'- ' CPA involvement with child and " provider and 2-3 face-to face contacts per week minimum. �.,: ��: - � - E - .�rr.�-�,.,-^_:� . � AssessmenU . • c-:: Emergency �` $27.42 �_ $.66 ' $19.20 `'� ' z� � :�„. ----------- ---------- R Level Rate � � t r � � Exhibit A to the SS23A 5 Revised 6/2014 �� S EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Bethany Christian Services, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $83.87, per day for children placed within the Group Home/Group Center identified as Provider ID #74864. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluaon 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 w11 tiler be forwarded to the County. 11. Children in Psychiatric Residential Treatment Faculties, Residential Child Care Facilities and Child Placement Agencies are not eligible to rive cotring allowances as outlined in the Weld County Department of Hilmar Services Po:icy ar,± Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CI CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) El GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) O RESIDENTIAL CHILD CARE FACILITY (RCCF) O RESIDENTIAL DRUG/ALCOHOL PROGRAM O SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this 30'''`' day of 3 t 1 , 20 lc- , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and CGL - CPA, LLC, whose address is 1420 Kenton Street, Aurora, CO 80010, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. If this is a CPA placement, the child specific addendum should also address how administrative services will he 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the CO/s end of the fiscal year by the county de artment. 90/5�,�.7go> SS -23A Agreement to Purchase �' Revised 6/2015 1 /0 .— /02 --- /� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Group Home/Group Center Care Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall he agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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 ( l 2 CCR 2509-5) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS. A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. The cost of any items not covered by Medicaid will he negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. Any notice required to be given under this Agreement shall be in writing and shall he mailed or delivered to the other party at that party's address as stated above. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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 hut not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 612015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Ater .4,4) ..dp;e1 BOARD OF COUNTY COMMISSIONERS Weld Clerk to the Board WELD COUNTY, COLORADO � By: Deputy flerk to the B APPROVED AS TO SUBS Elec Departni N Mike Freeman, Pro-Tem OCT 1 2 2015 RACTOR: CGL - CPA, LLC 1420 Kenton Street Aurora, CO 80010 By: Q e& @-vtio LCL Contractor's (or designee's) Signature and Date SS -23A Agreement to Purchase 14 (>2/614.5‘27.5(6F) Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 CGL - CPA, LLC, 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 $128.08, per day for children placed within the Group Home/Group Center identified as Provider ID #1620076. These services will he 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 CGL - CPA, LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services_ which are listed in this Agreement at a rate of $128.08, per day for children placed within the Group Horne/Group Center identified as Provider ID #1620241. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 CGL - CPA, LLC, 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 $137.19, per day for children placed within the Group Home/Group Center identified as Provider ID #1619053. 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 (CI-IRP) waiver eligible children and the federal SSI rate billable to the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 eematAtv d 3HN AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A El CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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: THIS IS AN AGREEMENT, made this day of , 20/b , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Denver Area Youth Services, whose address is 1530 W. 13th Ave, Denver, CO 80204, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 IIuman Services, hereinafter referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the count department. 3021N 23A Agreement to Purchase W �v Revised 6/2015 /D- /O2-/� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services, C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. Contractor shall: I. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of I Iuman Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. F. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Agreement to Purchase 7 Revised 6/2015 III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF. CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any SS -23A Agreement to Purchase 9 Revised 6/2015 remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. SS -23A Agreement to Purchase 10 Revised 6/2015 G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if SS -23A Agreement to Purchase 11 Revised 6/2015 so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 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. SS -23A Agreement to Purchase 12 Revised 6/2015 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above, COUNTY: ATTEST: ddrifivt,) JejapitA Weld 9qunty Clerk to the Board By: Deputy (CJlerk to the B APPROVED AS TO SUB ANCE: Ele•.: d Officia or Departm SS -23A Agreement to Purchase BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Pro-Tem CTOR: er Area Youth Services 1530 W. 13th Ave Denver. CO 80204 By: OCT 12 2015 7/3/15- Contractor's (or designee's) Signature and Date 024/bl-2-5g-too) 14 Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Denver Area Youth Services, 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#45069. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? Select One 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? 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? 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 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 theraservices needed to address child's individual needs .er 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 Properry.'Fire Setting Select One Stealing Self -injurious Behavior Substance Abuse Select One Select One Select One Presence of Psychiatric Symptoms/Conditions Enuresis/Encopresis Runaway Select One Select One 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 O Eating Problems Boundary Issues Requires Night Care Education Select One Select One Select One Select One Involvement with Child's Family Select One Exhibit A to the SS23A 3 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 he reflected on the child specific contract. (Please be specific) ❑ Adoption Services ❑ Medical Services Other: NA ❑ Doctor/Dentist Appointment Coordination O 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 El Pharmacological Management ❑ Other: ❑ Treatment not funded by Medicaid Fee for Service: O Education: O Home Based Intervention O On -Grounds School • MST Multi -Systemic Therapy El Coordinate Assessment for Special Education O Offense Specific Treatment ❑ Public School Attendance O Drug and Alcohol Treatment ❑ Occupational Therapy O Speech Therapy O Attend Special Education Meetings ❑ Urine Analysis/Drug Screening/ Breathalyzer ❑ Other: ❑ Sexual Abuse Victimization Treatment O Visitation Coordination O Independent Living Skills Training ❑ Monitor phone calls and correspondence al Anger Management ■ Transportation for family/parent/child visits ❑ Behavior Modification Services ❑ Other: O Behavioral Assessment ❑ Other: ❑ Recreation Services O Interpreter Services ❑ Case Management O Other: ■ Attend Court Hearings O Transportation: To include: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) County Basic Age 0-10...$17.01 F Maintenance Age 11-14...$18.81 j Rate Age 15-21...$20.09 2.4 3 3 1/2 4 Congregate Care Drop Down Assess ment/ Emergency Level Rate $20.56 $30.85 $.66 $.66 $12.35 No crisis intervention, Minimal CPA involvement, one face-to- face visit with child per month. $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $.66 $17.48 $.66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $.66 $20.91 $34.27 $.66 $37.69 $41.13 $27.42 $22.62 Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $.66 $24.34 $.66 $.66 $26.05 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. $19.20 $0.00 Not needed or cover under Medicaid. $5.14 Regularly Scheduled therapy up to 4 hours/month. $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. $15.42 Regularly scheduled weekly, multiple sessions, can include more than I person, i.e. family therapy, for 9-12 hours/monthly. Negotiated $3.45 $4.97 $6.50 Negotiated Exhibit A to the SS23A 5 Revised 6/2014 e,ii,w f1J ahi9 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) I RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOFIOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: 1)1-A THIS IS AN AGREEMENT, made this /oday of 0 �� / , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, `'County," and Denver Children's Home, whose address is 1501 Albion Street, Denver, COdfa 80220, hereinafter referred to as, "Contractor.' THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the l end of the fiscal year by the county department. /.�73 (1OJ SS -23A Agreement to Purchase t " G,w Revised 6,'2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 49551. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 612015 E. The Inclividual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 SS -23A Agreement to Purchase H. 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 he 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado. 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 4 Revised 6%2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 612015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will he 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 four (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 possible fiscal sanctions, penalties. or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6'2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion ot'the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services. administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 SS -23A Agreement to Purchase 8 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I . Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 Revised 612015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6.2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6'2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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, tires, strikes, war, flood, earthquakes or Governmental actions. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 it' a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. Revised 6/2015 SS -23A Agreement to Purchase 12 2. 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. 3. 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. O. 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. P. 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. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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, tires, strikes, war, flood, earthquakes or Governmental actions. Q. l . Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. 13 Revised 6/2015 SS -23A Agreement to Purchase WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. CC� ,,// �C COUNTY: ATTEST: do:0 1V "®' 'BOARD OF COUNTY COMMISSIONERS Weld nt Clerk to the Boa d WELD COUNTY, COLORADO B Deputy It1 erk to the Bo APPROVED AS TO SUB Departm ike Freeman, Pro—Tem NTRACTOR: Denver Children's Home 1501 Albion Street Denver, COdfa 80220 By: OCT 12 2015 Contractors (or designee's) Signatu and Date SS -23A Agreement to Purchase 14 Revised 6;2015 oZvio-?3 65) EXHIBIT A 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 apply to the agreement entitled, `'Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Denver Children's Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 49551, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $147.71 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 CW-06-1 1-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. I i. Children in 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. Exhibit A to the SS23A 2 Revised 612015 119/1-14,W asa AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) 0 RESIDENTIAL CHILD CARE FACILITY (RCCF) • RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: ejr4 THIS IS AN AGREEMENT, made this Ic2 day of , 20J by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and El Pueblo Boys' and Girls' Ranch, whose address is One El Pueblo Ranch Way, Pueblo, CO 81006, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Iluman Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: c.IV7 D J'''_ 2 "'25 A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. SS -23A Areernent to Purchase Q� �.2,-/g Revised 6/2015 /�-- =361 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. 1. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 45146. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. RECEIVED JT 2 727 SS -23A Agreement to Purchase 2 Revised 6!2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. n SS -23A Agreement to Purchase Revised 6/2015 SS -23A Agreement to Purchase H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado. 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 4 D i i s&d Governmental Immunity Act set forth in §24-10-101 to X24-10-120. 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 Iluman Services, Colorado Department 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall he presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall he subject. at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase j vised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will he 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. RECE+t�E D ;,i 2 LVL L JV lrl4 5 SS -23A Agreement to Purchase 6 Revised 6/2015 SS -23A Agreement to Purchase 7 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CIIRP 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall he recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type 0'AI33B i Revised 6%2015 will determine which of these four components will be included in the reimbursement rate. SS -23A Agreement to Purchase III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 PECEIV7D 8 i �� Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. RESPONSIBILITIES OF COUNTY: A. 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 he amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. V`D SS -23A Agreement to Purchase 9 Revised 6.2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. It is agreed that it', 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. D SS -_'3A Agreement to Purchase 10 Revised 6;2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 1 1 Revised 6/2015 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. It' Contract Professional 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 it' so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. R - ^Er cD SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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 he an incidental beneficiary only. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. 7r`cIVCf") ct" SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTE : /�, p.(A.13OARD OF COUNTY COMMISSIONERS Wel Co t 4y Clerk to the Bgard WELD COUNTY, COLORADO 3 Deputy fllerk to the 13d Mike Freeman, Pro—Tem APPROVED AS TO SUBST, Electe. )fficial o Depart OCT 12 2015 RACTOR: El Pueblo Boys' and Girls' Ranch One El Pueblo Ranch Way Pueblo, CO 81006 By. Contr(ctor's (or designee') Signature and Date (1£1. M1Li. ti Y S �Y1� x(1,11 I01",7eluli I (.,EL) SS -23A Agreement to Purchase 14 RECEIVED Itl 2 ~ 2'n Revised 6/2015 oZb/�- 3 6( EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 El Pueblo Boys' and Girls' Ranch, hereinafter referred to as. "Contractor." 1. County agrees to purchase and Contractor, ID# 45146, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.36 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 CW-06-11-1 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 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. 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 A to the SS23A Revised 6/2015 lIFO tsts 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. I I. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 Gritei /A 01/ AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A • CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) El GROUP HOME/GROUP CENTER CARE CINDEPENDENT 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: THIS IS AN AGREEMENT, made this 31 day of , 20lS—, by and between the Board of County Commissioners of Weld County, on be ,:If of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Evergreen Child Placement Agency, whose address is 1436 Hilltop Dr., Longmont, CO 80501, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 5 13 6."2) SS -23A Agreement to Purchase ' rJ l Revised 6/2015 /0-/02-/� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Group Home/Group Center Care Services ID# 61317 C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. if Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 and Budget (OMB) Circular A -I 33, 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 612015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreemcnt_ SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: di:MeV Go.. ,Lo'cek Weld ' o ty Clerk to the Beard WELD COUNTY, COLORADO By: Deputy Jerk to the B APPROVED AS TO SUBS N Elec - Official e r epartm BOARD OF COUNTY COMMISSIONERS Mike Freeman, Pro-Tem 0CT 12 2695 RACTOR: Evergreen Child Placement Agency 1436 Hilltop Dr. Longmont, CO 8050 By Contracto and Date - 302 7,5 00 SS -23A Agreement to Purchase 14 Revised 6/2015 — E ' EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Evergreen Child Placement Agency, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $131.77, per day for children placed within the Group Home/Group Center identified as Provider ID #61317. 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 the County. 3. 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. 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 the 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 Horne/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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A t Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 SS -23A Agreement to Purchase AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) 0 RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME. BASED AFTER -CARE (RCCF) ❑ OTHER: T� THIS IS AN AGREEMENT, made thisJo2 day of 0/ , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Family Crisis Center, whose address is 2929 W 10th Ave, Denver, CO 80204, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as. "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 4-""(- /D <5017 Revised 6/2015 B. 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 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 he 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 45204. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: I. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. . Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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. Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts. omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A ,agreement to Purchase 4 Revised 6!2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 CIIRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of I luman Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 All billing by 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 total annual expenditures less than $1.00,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. It Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. F. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 612015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/'_015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6=`2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Aereement to Purchase 10 Revised 6/2015 F. 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. Time is of the essence in each and all of the provisions of this Agreement. H. 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. 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. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 I -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained tile copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County. a written notarized SS -23A Agreement to Purchase 11 Revised 6,2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. I lave not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: dQ; f G: •aCiellfeik BOARD OF COUNTY COMMISSIONERS Weld Clerk to the Boar WELD COUNTY, COLORADO By: Deputy f/erk to the Boar APPROVED AS TO SUBSTA Electe.Alfficial or eparttnen Mike Freeman, Pro-Tem Isis Center 2929 W 10th Ave Denver, CO 80204 ontrafor's (or designee's) Signature and Date OCT 12 2015 SS -2311 Agreement to Purchase 14 Revised 6!2015 -.3x27 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Family Crisis Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 45204, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.35 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 CW-06-1 1-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 lEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 1 I . Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 DEPARTMENT OF HUMAN SERVICES PO BOX A GREELEY, CO 80632 WEBSITE: www.co.weld.co.us Administration and Public Assistance (970) 352-1551 Child Support (970) 352-6933 July 22, 2015 Family Crisis Center 2929 W 10th Ave Denver, CO 80204 Dear Provider, As directed by the Colorado Department of Human Services in Agency Letter CW-04-15-A, dated May 17, 2004, the Weld County Department of Human Services is submitting the following forms for your review and signature: l) State prescribed SS -23A, Agreement to Purchase contract with Exhibit. 2) State prescribed SS -23B, Child Specific Addendum - One for each child currently placed with provider. In order to be in compliance with Volume 7.304.61(G) and 7.304.661(A), which requires county departments to contract with providers for specific services using the state prescribed contract, we are requesting that these forms be signed and returned by August 7, 2015. For your convenience, I can accept completed contracts via e-mail at hieinbiinweldeov.com. If you choose to mail your contracts, please be sure to mail them to the address listed above Attention: Jacquie Higinbotham. Once all forms have been received, they will be presented to the Board of County Commissioners for final approval and signatures. We look forward to working with you in the upcoming year. If you have any questions regarding the enclosed forms or the contract process, please feel free to call me at (970) 352-1551 Ext. 6603 or email at higinbjjit weldgov.com. Sincerely, Jacquie J. Higinbotham J.D. Placement Contract Coordinator Weld County DHS Enclosure .7'Air,3 Lesley Cobb Child Welfare Financial Supervisor Weld County DHS AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A © CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) O RESIDENTIAL DRUG/ALCOHOL PROGRAM O SHELTER CARE ❑ SUBSIDIZED ADOPTION O TRANSITION/HOME BASED AFTER -CARE (RCCF) O OTHER: 41/ THIS IS AN AGREEMENT, made this / ' day of 20 Jby and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Family Resource Network, whose address is 6285 Leham Dr., Suite 101, Colorado Springs, CO 80918, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: 66; Iki-11"- SS -23A Agreement to Purchase Revised 6/2015 oZp 5-30213 /4- TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must he completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific SS -23A Agreement to Purchase Revised 6%2015 Addendum (SS23B) included with this contract. Modifications to the individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency sery ices, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies. RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers. agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services. Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. 1 l . In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 CFIRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 (I), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 612015 II. PAYMENT TO CONTRACTOR: A. 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 CIIRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these tour components will he included in the reimbursement rate. Ill. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. "transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses. surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6-2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours. weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 62015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. F. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall he 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: I . Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2, Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6r""'_015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: W.Aide$,) G .. i...4 'A Weld Clerk to the Beard By: uJ, Deputy erk to the B d Mike Freeman, Pro-Tem OCT 1 2 2015 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO APPROVED AS TO SUBS Ele :. Official or Departme ACTOR: Family Resource Network 6285 Leham Dr., Suite 101 ColoradgSprings, CO 80918 s (or designee's) Signature and Date SS -23A Agreement to Purchase 14 Revised 6/2015 O2o/ — ,2 �3 ( I 4:(7.0). 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 Sen ices The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Family Resource Network, hereinafter referred to as, "Contractor," I. 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 ol'service, as indicated by the Needs Based Care Rate Table, designated in this exhibit, for children placed within the CPA identified as Provider ID#1508602. 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 SS1 rate billable through the County 4. 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 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 the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, hut arc not limited to; polygraph tests, plethysmographs, and urinalysis screens, which arc 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 or Team Decision making meetings. Contractor shall be notified by County statTof'the dates and times attendance is requested. R Contractor agrees to cooperate with any vendors hired by the County to shorten the duration of placement. Exhibit A to the SS23A Revised 5%2015 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. Exhibit A to the SS23A Revised 5%2015 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. Pl. 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 often a th . • services needed to address . z ,'.. individual needs •er NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: Aggression/Cruelty to Animals Select One Verbal or Physical Threatening Select One Destructive of Property/Fire Setting 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 ET Needs - (If condition is rated "severe", please complete the Medically fragile NBC) complete Select One ❑ 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 3 Revised 6/2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency Please indicate the services that are requested fur this child. The following information will he reflected on the child specific contract. (Please he specific) Services • Medical Services RAdoption 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 Therapy Nursing Services/Coordination RIndividual Group Therapy Physician Services/Coordination ❑ Interactive Group Therapy Occupational Therapy 0 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 0 Interpreter Services Case Management 0 Other: Attend Court Hearings Transportation: To include: 0 Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Graf 11) a5M AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A O CHILD PLACEMENT AGENCY SERVICES (CPA) E CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) O GROUP HOME/GROUP CENTER CARE INDEPENDENT LIVING PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) O RESIDENTIAL CHILD CARE FACILITY (RCCF) R• ESIDENTIAL DRUG/ALCOHOL PROGRAM • SHELTER CARE El SUBSIDIZED ADOPTION El T• RANSITION/HOME BASED AFTER -CARE (RCCF) El OTHER: Tl� THIS IS AN AGREEMENT, made this fps' day of %'( 20 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of human Services whose address is P.O. Box A, Greeley, CO. 80632, hereinafter referred to as, "County," and Griffith Center for Children, whose address is 1724 Gilpin Street, Denver, CO 80218, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as. "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: fI RM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may he removed from the facility prior to the end of the fiscal year by the county department. ",c, i?- 3z15 65 SS 5A Aereement to Purchase 66: /415 /4Revised 6"2015 /o -a- /5- E3. 'fhis 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 Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. It 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children. are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, and B, each of which forms an integral part of this agreement. Exhibit A. and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists ofadditional provisions for the purchase of Group Etome/Group Center Care Services -- ID# 1543863. Exhibit B consists of additional provisions for the purchase of Residential Child Care Facility Services. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child.Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -'_3A ereernent to Purchase Revised 62_01 The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitionallafter-care and follow up services criteria to be met for termination of treatment. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. [very fourteen (14) days. PRTFs shall provide 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 Individual Plan of Care. I L Contractor shall: SS -23,\ A:4reement to Purchase ; R,2\ ised 6:2015 I. 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. 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. 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. 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least 525.000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of I luman Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23 A Agreement to Purchase 4 Revised 6:20i 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 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 In any instance of a potential adoption by a foster parent. provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor. during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23 X Agreement to Purchase 5 Revised 6'201; ?. All billing by 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. All Contractors whose total annual expenditures are S100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23.4 A reeinent to Purchase 6 Revised 6'_015 11. PAYMENT 1O CON i RACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to.be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall he paid from the date of admission up to, but not including, the day of discharge. 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 Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHIRP 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source. Contractor shall refund those dollars forthwith. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud. or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -2,A A:treeinent to Purchase 7 Revised 6 2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility. with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AL I HORf7.AT'IONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. 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 he covered in the daily rate paid to PRT Es. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23.1 ;A,reernent to Purchase 8 Revised 6:201 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours. weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. 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. Monitor children's progress in accordance with the treatment'family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family' Services Plan at time of placement or as soon as completed and when updated or revised. Aereernent to Purchase q Revised 6'2015 8. Seek recovery from the RCCF. CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. Vi, GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS --'3.1 Ak,,reement to Purchase 10 Revised 6'2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. 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 F -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -'3A Agreement to Purchase 1 1 Revised 6:20'5 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23.1 Agreement to Purchase 12 Revised 6i20I 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 he of no value to County. Denial of the amount of payment shall he reasonably related to the amount of work or deliverables lost to Count‘. . 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established. U. 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. SS -13A Agreement to Purchase 1 3 Revised 6 ?t)1; WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: dj„d;t/ J uC,GtDft.i BOARD OF COUNTY COMMISSIONERS Weld Co tv Clerk to the Bard WELD COUNTY, COLORADO By: eputy Crk to the B APPROVED AS TO SUBST N I:leeteOfficial o Depar Mike Freeman, Pro—Tem OCT 12 2015 RACTOR: riffith Center for Children 1724 Gilpin Street Denver, CO 80218 By: Co t ractor's (or designee's) Signature and Date o2o/5 -373 SS -23A Agreement to Purchase 1 r} Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of \Veld County, on behalf of the Weld County Department of Human Services." hereinafter referred to as, "County," and Griffith Center for Children, hereinafter referred to as. "Contractor.' 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of S146.40, per day for children placed within the Group Home/Group Center identified as Provider lD #1543863. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. :1 to the SS2 3;\ Revised 6'2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. I I . 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. Exhibit A to the SS23.A '_ Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Griffith Centers for Children Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 39212, agrees to provide: a. Child Maintenance. Administrative Maintenance and Services. which are listed in this Agreement at a rate of S189.37 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 CW-06-1 I -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 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. 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 A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6::2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ID CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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) LI OTHER: THIS IS AN AGREEMENT, made this :_ day of , 201<- , by and between the Board of County Commissioners of Weld County, on 'behalf of the Weld County Department of I-Iuman Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Hope & Home, whose address is 4945 N 30th Street, Suite 300, Colorado Springs, CO 80919-3152, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. SS -23A Agreement to Purchase Revised 6:2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate andior 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County' and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 6/2015 F. The Individual Plan of Care shall he goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly' review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. Contractor shall: Conform with and abide by all rules and regulations of the Colorado Department of f luman 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. 1. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 Il. PAYMENT TO CONTRACTOR: A. 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 CIIRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 .Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. In the event this Agreement is terminated. final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 he construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Aueement to Purchase 7 Revised 6,2015 III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase x Revised 6%2015 from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. RESPONSIBILITIES OF COUNTY: A. County shall: I. 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. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 SS -23A Agreement to Purchase 9 Revised 6/2015 or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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'. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. F. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. SS -23A Agreement to Purchase 10 Revised 6;2015 G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. 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. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. 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 F. -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if SS -23A Agreement to Purchase 1I Revised 6/2015 so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (18) years ot'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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 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. SS -23A Agreement to Purchase 12 Revised 612015 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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, tires, strikes, war, flood, earthquakes or Governmental actions. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. Financial obligations of the County payable after the current fiscal year arc 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. SS -23A Agreement to Purchase 13 Revised 6/201 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Weld ' *Fun By v e�he Bo Deputy ( lerk to the Boa APPROVED AS TI SUBST Ele'' d Official or Depa BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Pro-Tem OCT 12 2015 1 NTRACTOR: Hope & Home 4945 N 30th Street, Suite 300 Colorado Springs, CO 80919-3152 By: Con tor (or designee's) Signature a gate SS -23A Agreement to Purchase 14 Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Hope & Home, 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#29867. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A Revised 5'015 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. Exhibit A to the SS�3A 2 Revised 5/2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 often are theca' services needed to address ' individual needs . -r NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) - Behavioral Assessment Select One Assessment Areas: Comment: Rating: 0 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 ❑ Emancipation Select One ❑ Eating Problems Select One ❑ Boundary Issues Select One Requires Night Care Select One C Education Select One ❑ Involvement with Child's Family Select One Exhibit A to the SS23A Revised 6/2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency ('lease indicate the services that are requested for this child. The following information will he reflected on the child specific contract. (Please he specific) i Adoption Services Medical Services Other: NA R 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 Tran portation 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 612014 �;� . •, Needs Based Care Rate Table Weld County Department of Fiuman Service 1Effccti�c ' 0I ZI)1�! � � LE�'EL(.)t� Cfl]L.D � �I7:1IrrlSTR�ITf�'E .4U�Ilti(Sl'It�TIVE �1H:I)I('.�1L SER�'[CE �11.�1V'I'Etix�ti(.'1•: REtiPITE �I:11\TE�.��CE SER1"1<:ES 1t'.F.1)S I,t�cl �� C)ail}�Itate �I.)aily R�ii� llail}�C2ate Dail}�Rate � I)a�l��izati $12.35 County Basic Age 0-10...$17.01 $0.00 ; �.66 No crisis intervention,;vlinimal r Maintenance Age II-14...a18.8( Notneededorcover ---------- �€ CPA involrement,one face-to- " Rate Age I S-21 ..S?0.09 under!viedicaid. � face visit with child per month. � 9. � ��.�7 �5.�� Minimal crisis intervention as Regularly Scheduled l $20.56 $.66 needed.one face-to-face visit $�;5 therapy up to 4 per mnnth with child.2-3 haurs/month. contacts per month I '/: $23.� $.66 $17.48 --------- ----------- �I 9.20 $I 0.?8 Occasional crisis intervention as Weekly scheduled 2 527.42 $.66 needed,two face-to-face�isits therapy 5-8 hours a $-3.9% with child,2-3 contacts pe;r month with d hours of month group therapy. 2 Yz 530.85 $.66 $20.91 ----------- ---------- $22.62 $15.42 � Ongoing crisis intervention as Regularly scheduled weekly,multiplr � 3 $34.21 5.66 needed,weekly face-to-face sessiuns,can includr $6.50 � visits with child,and intensive more than 1 person_ coordination of multiple i.e. f'amily therap}. tur � scr�ices. 9-�?hours/monthl� 31!2 $37.69 $.66 S�4.3�3 ----------- ---------- _ ____ -- $26.05 ;� Ongoing crisis intervention ss Con re Ste needed,which indudes high ?` g 8 $di.l3 5.66 � • �,r,.��.�i �:��",��.e�,.! Care level ofcase management and Drop Down CPA invulvcment with child and proaid�r and 2-3 face-to facc ,�,�ii.�ru p�r«,rk minimw�: �'��: Assessmcnt , Emergency ,r. $27 a� $.66 '" $ly?0 ,.s= Level Rate Exhibit A to the SS2:iA 5 Revised 6/2014 Con AnW /6 */,Z6. AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CI CHILD PLACEMENT AGENCY SERVICES (CPA) O CHILDREN'S 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: 'r THIS IS AN AGREEMENT, made this 104 day of 20 /j , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Imagine!, whose address is 1400 Dixon Ave, Lafayette, CO 80026, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. /6f73 (n) SS -23A Agreement to Purchase Ce- f Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: I. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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, VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damaiges. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5- 103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: ,,A.''ti BOARD OF COUNTY COMMISSIONERS Weld my Clerk to the Board WELD COUNTY, COLORADO By: APPR Elect Official o Departure ike Freeman, Pro-Tem NTRACTOR: Imagine! 1400 Dixon Ave Lafayette, CO 80026 By: OCT 12 2015 Contr tor's (or designee' �f Signature and Date SS -23A Agreement to Purchase 14 „2,/,•....302136-1) Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Imagine!, 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#21369. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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 followingseven (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? Select One 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? 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? 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 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 theraservices needed to address child's individual needs .er NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Select One Assessment Areas: Comment: Rating: El Aggression/Cruelty to Animals Select One ❑ Verbal or Physical Threatening Select One Destructive of Property/Fire Setting Stealin Select One Select One ❑ Self -injurious Behavior Select One ❑ Substance Abuse Select One El Presence of Psychiatric Symptoms/Conditions Select One Enuresis/Encopresis Runaway Sexual Offenses Select One Select One Select One Select One Select One Inappropriate Sexual Behavior Disruptive Behavior Delinquent Behavior Depressive -like Behavior El Select One Select One CI Medical Needs - (If condition is rated "severe", please complete the Medically fragile NBC) Select One Emancipation Select One ❑ El Eating Problems Boundary Issues Requires Night Care Education Select One Select One Select One Select One Involvement with Child's Family Select One Exhibit A to the SS23A 3 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 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 0 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 El Attend Special Education Meetings El Urine Analysis/Drug Screening/ Breathalyzer ❑ Other: ❑ Sexual Abuse Victimization Treatment 0 Visitation Coordination ❑ Independent Living Skills Training ❑ Monitor phone calls and correspondence III Anger Management El Transportation for family/parent/child visits ❑ Behavior Modification Services ❑ Other: ❑ Behavioral Assessment 0 Other: ❑ Recreation Services ■ 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 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) County Basic Maintenance Rate Age 0-10...$17.01 Age 11-14...$18.81 Age 15-21...$20.09 $.66 $12.35 No crisis intervention, Minimal CPA involvement, one face-to- face visit with child per month. $0.00 Not needed or cover under Medicaid. 1 $20.56 $.66 $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month. 53.45 $23.99 $.66 $17.48 2 $27.42 $.66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. $4.97 2''/ $30.85 $.66 $20.91 3 $34.27 $.66 $22.62 Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $15.42 Regularly scheduled weekly, multiple sessions, can include more than I person, i.e. family therapy, for 9-12 hours/monthly. $6.50 3 1/2 $37.69 5.66 $24.34 4 Congregate Care Drop Down $41.13 5.66 $26.05 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 Assess ment/ Emergency Level Rate $27.42 $.66 $19.20 Exhibit A to the SS23A 5 Revised 6/2014 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑x RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this day of , 20 /5:by by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Jefferson Hills, whose address is 421 Zang St, Lakewood, CO 80228, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 027 3 (I SS -23A Agreement to Purchase da��jC� A Revised 6/2015 /O B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID#s 12284. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 Governmental Immunity Act set forth in §24-I0-101 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is peimitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: u,./ti1 X1togei BOARD OF COUNTY COMMISSIONERS Weld C. y Clerk to the Board, WELD COUNTY, COLORADO By: Deputy C rk to the Boar APPROVED AS TO SUBSTANCE: Ele ed Official •r Departme SS -23A Agreement to Purchase Mike Freeman, Pro—Tem OCT 1 t J11 OR: Hills Zang St Lakewood, CO 80228 By: auc. -717,2V/ C ntractor's (o design 's) S. nature and Date ao3a93 1) 14 Revised 6/2015 ��1 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Jefferson Hills, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 12284, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $184.46 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A t Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 LJW/a �5 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ID CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL. PROGRAM (CIIRP) ❑ 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: 7 THIS IS AN AGREEMENT, made this/' day of , 20 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Maple Star Colorado, whose address is 2250 S Oneida Street, Suite 200, Denver, CO 80224-2557, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county' department. SS -'_3A Agreement to Purchase 11$G/1A-2 Revised 6/2015 o2oi6-(3x,73 ►9 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and B, each of which forms an integral part of this agreement. Exhibit A and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consists of additional provisions for the purchase of Group Home/Group Center care services lD# 13416. C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCM or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days. PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase Revised 61201 i H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Iiuman Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. I I . In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 CFIRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be SS -23A Agreement to Purchase 5 Revised 6/2015 subject, at any reasonable time, to inspection, 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 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (4) months of the date of the audit. SS -23A Agreement to Purchase 6 Revised 6/2015 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. II, PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CIIRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/2015 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening. Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6/2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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 he amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 612015 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will he the same as shown in Trails for the child's maintenance. VI. GENERAL PROVISIONS: A. 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. B. 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'. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to SS -23A Agreement to Purchase 10 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. 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. Time is of the essence in each and all of the provisions of this Agreement. II. 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, tires, strikes, war, flood, earthquakes or Governmental actions. Any notice required to be given under this Agreement shall be in writing and shall he mailed or delivered to the other party at that party's address as stated above. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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-IO2(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 F -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract SS -23A Agreement to Purchase 11 Revised 6/2015 Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: Withhold payment to Contractor until the necessary services or corrections in SS -23A Agreement to Purchase 12 Revised 6/2015 performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ,,; COUNTY: ATTEST: fJ.dsi`W/ v'• '� BOARD OF COUNTY COMMISSIONERS Weld C;eiunty Clerk to the Board WELD COUNTY, COLORADO By: Deputy] lerk to the Bo jf +� � Freeman, Pro—Tem APPROVED AS TO SUBSTA Elects]: Official or liepartment CTOR: Maple Star Colorado 2250 S Oneida Street, Suite 200 Denver, CO 80224-2557 By: OCT 12 2015 tractor's gnee's) Signature and Date 01- %-1S SS -23A Agreement to Purchase 14 Revised 6/2015 o20/i' 30Z 73 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Maple Star Colorado, 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#90967. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A Revised 5/2015 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. 1 1. 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. Exhibit A to the SS23A Revised 5/2015 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. PI. 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 edycatign plan? 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 appropriate needs with feeding, bathing, grooming, physical, 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 often are then services needed to address individual needs r NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: Aggression/Cruelty to Animals Select One Verbal or Physical Threatening Select One Destructive of Property/Fire Setting 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 ❑ Emancipation Select One ❑ Eating Problems Select One Issues Select One RBoundary Requires Night Care Select One El Education Select One ❑ Involvement with Child's Family Select One Exhibit A to the SS23A 3 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 he reflected on the child specific contract. (Please he specific) S Adoption Services Other: NA Provider agrees to work with family Therapeutic Services funded through Medicaid Fee for • Medical Services Doctor/Dentist Appointment Coordination Medication Evaluation (not covered under fee for service) ❑ Medication Monitoring Individual Therapy 0 Nursing Services/Coordination Group Therapy Physician Services/Coordination Interactive Group Therapy Occupational Therapy Family Therapy Psychological Testing Pharmacological Management Treatment not funded by Medicaid Fee for Service: Home Based Intervention MST Multi -Systemic Therapy Offense Specific Treatment Drug and Alcohol Treatment Urine Analysis/Drug Screening/ Breathalyzer Sexual Abuse Victimization Treatment Independent Living Skills Training Anger Management Behavior Modification Services 8 B S peecn Inerapy Child Find Other: Education: On -Grounds School Coordinate Assessment for Special Education Public School Attendance Occupational Therapy Speech Therapy Attend Special Education Meetings Other: Visitation Coordination Monitor phone calls and correspondence Transportation for family/parentichild visits Other: Behavioral Assessment Other: Recreation Services Case Management Attend Court Hearings Transportation: To include: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Interpreter Services Other: Other: Comments: Exhibit A to the SS23A 4 Revised 6/2014 I . . Needs Based Care Rate Table ' Weld Coun[y Departmen[of Human Service fEffecti�c ^�'01'?Q15) � " I,F"1'Fl�t)F � (.'HILI) � � :tU111\ISTR��"Il�'E � AD1lItiISTR.�`CI��E M1�CEI)[C.1L � RE:tiPITE j SF�RVICl�: �1.ai\7��.NA�C1�: i�l 1tV"I"[:A�tiCE � SER�'10E5 NEEDS I.�vcl � �� <��1�Ctate� fa�ilv Rat'c I�ail� Ra�te � n��il��I2atc: I)ail}�Ratc p County Basic Age0-10...y17.01 ��j� S0A0 � $.66 No crisis intervention,Minimal � Maintenance .Age 11-14...$18.81 Notneede�iur:,�..; ---------- � Rate Age 15-21.-.S20 09 CPA involvement.one face-to- under Medi�.uJ � face visit with child per month. ! -- _.__ ! S I�.?7 $5.I d { Minimal crisis intervention as Regularly Sch«ful��; � 1 $2Q�6 �•6� needed.one face-to-face visit '" j� � therapy up<<� t iper month with child,2-3 hours/muni:, � contact�ti per month ', 1 Y� $23.99 �.66 S17.d8 ----------- ---------- $I 9.20 $10.28 -. Occasional crisis interventiun� W'eekly schedule�i 2 $2Z42 �.66 needed,two face-ro-face visits therapy 5-8 hours., `+� '��' � with child.?-3 contacts per munth with�hours, month group therapy. � --________-- 2'h 530.85 5.66 $20.91 ----------- --------- j 322.62 $I 5.4� _-- + Regulariy schedult•��. aOngoing crisis intervention as weekly,multiple ! 3 $34.27 $.Ci6 needed,weekly face-to-face szti�ions,can inclu�ir �� visits with child,and intensive more than I person. � coordination of multiple �.�. Camily[herap�. t� � d sercices. 9-I2 hours/monthl�. ' 31/2 $37.69 �.66 $�4.3-t ---------- --------- ; $�6.05 ; ? ; Ongoing crisis intervention�s Cangregate needed,which includes hi�h '� $41 13 �.66 lev�l ofcase management and ` ' � . �, -`� Care '' Drop Down CPA invohement with child and � �rnviJer<�rni?-1 I��ce-to fa�� _.�,nia�t�., . �,��ch minimun: . .. .. . . .. � . ltiscti�mcn[� � Emergency $?7.4? � '" $.6b '`sIN.'_U ----- ---.__. Levei Rate `�*��. i � � i I � i . j Exhibit A tn the SS?.iA 5 Revised 6/2014 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Maple Star Colorado, hereinafter referred to as, "Contractor." 1 County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $86.00, per day for children placed within the Group !tome/Group Center identified as Provider ID #13416. 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 MM1S system for Children's Habilitation Residential Program (CHRP) waiver eligible children and the federal SSI rate billable to the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 [EP 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. Exhibit A to the SS23A 2 Revised 6/2015 Confh001 lQ a�9 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL, TREATMENT FACILITY (PRTF) I] RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM E SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: 71 THIS IS AN AGREEMENT, made this f day of , 20 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Midway Youth Services, Inc., whose address is 729 Remington, Fort Collins, CO 80524, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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. WIIEREAS, the Colorado State Department of I luman Services, hereinafter referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. `�"' ' I cs o2e ,,---,5a-73 6,10) SS -23A Agreement to Purchase l Revised 6/2015 /0_/�-/� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 44002. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/20 I5 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (I 5) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6:'2015 II. Contractor shall: I. Conform with and abide by all rules and regulations of the Colorado Department of I[uman 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 - Agreement 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 I [eaath Insurance Portability and Accountability Act (IIIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Ann: Audit Division Director for CPAs) within 180 days after 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 CI IRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements arc 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 Agreement 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. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CI IRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child. Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. Ilowever, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. 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 Agreement, shall be specified in the treatment/service plan. and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. 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. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6%2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this SS -23A Agreement to Purchase 10 Revised 6/2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained tile copies of the documents, 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 SS -23A Agreement to Purchase 1 1 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential damac.es. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5- 103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor SS -23A .Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. SS -23A Agreement to Purchase 13 Revised 6/2015 dittrAN) COUNTY: ATTEST: v• 'ti BOARD OF COUNTY COMMISSIONERS Weld . t Clerk to the Bo. rd WELD COUNTY, COLORADO By: Deputy 4 erk to the Bo APPROVED AS TO SUBSTANCE. Ele e d Official or P epartment Trtsz Mike Freeman, Pro-Tem CTOR: Midway Youth Services, Inc. 729 Remington Fort Collins, CO 80524 By: 0CT 12 2015 Cont ; tor's (or designee Signature and Date SS -23A Agreement to Purchase 14 o2Di-302 73(27) Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Midway Youth Services, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 44002, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of S153.05 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 CW-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 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. 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 A to the SS23A 1 Revised 6/2015 b. Clothing (3%). w 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/20I5 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A SS -23A Agreement to Purchase ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PROF) O RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this day day of , 20 A7 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Mount St Vincents Home, whose address is 4159 Lowell Blvd, Denver, CO 80211, hereinafter referred to as. "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS. 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county dea%men: � 1..r /4- cam/"`-' / D /02- /i' Revised 6/2015 Cis-v/✓ 59210 B. 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 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 he 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A. defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services - ID# 45174. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes. except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF. a comprehensive Individual Plan of Care must he completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6 2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives. expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23 A Agreement to Purchase 3 Revised 6/2015 II. Contractor shall: I. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 he 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. 1. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of I luman Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. It' Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6;2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of'payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of I lealth 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child. Contractor may receive a clothing allowance in accordance with State Department rules. O. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 62015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/20 T 5 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRFF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. 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. Monitor children's progress in accordance with the treatmentfamily services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6:'2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. Any notice required to be given under this Agreement shall be in writing and shall he mailed or delivered to the other party at that party's address as stated above. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained tile copies of the documents, and not altered or falsified the identification documents for such employees. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase II Revised 6;2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach. and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit, the child specitic 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6%2015 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6;`2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTES ' �•/.�@rAtAi 't1 BOARD OF COUNTY COMMISSIONERS Weld o n Clerk to the Board WELD COUNTY, COLORADO By: ' 4, it- 1 _ APP Ele 1 or Dept Mike Freeman, Pro—Tem ACTOR: Mount St Vincents Home 4159 Lowell Blvd Denver, CO 80211 By: 0CT 12 2015 !L( tz71t '" Contra or's (or designed's) Signature and Date SS -23A Agreement to Purchase 14 Revised 6/2015 7 330213 tmvigagogal EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Mount St Vincents Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 45174, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.3.5 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A Revised 6/201 5 SS -23A Agreement to Purchase AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CHILD PLACEMENT AGENCY SERVICES (CPA) CI CHILDREN'S 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: THIS IS AN AGREEMENT, made thisl� day of , 20 /5, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Quality Life Services LLC, whose address is 11975 Reed Street, Broomfield, CO 80020, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county idppaent. Revised 6,20 15 Q 02 cag B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may he utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRI'Fs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6!2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 10. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 11. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 12. Specify the 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. 13. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 14. 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 court ordered treatment. 15. Specify the anticipated living arrangement for the child at the date of discharge. 16. Specify the anticipated educational arrangement for the child at the time of discharge. 17. Specify the anticipated date for discharge from treatment purchased for the child. 18. Specify a permanency goal for the child. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 El. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 ot'the application of the Colorado SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. 1 1 . In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase Revised 6'2015 2. All billing by 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. 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6,2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. F. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/2015 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6.2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educationalstatus which comes to their attention. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of I luman Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 6/2015 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon us completed and when updated or revised. 8. Seek recovery from the RCCF. CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF. CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will he the same as shown in Trails fur the child's maintenance. VI. CiENERAL PROVISIONS: A. 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 panics 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 B. 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 C. 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 he released from responsibility for loss or damage to such personal items. D This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of I luman Services shall he and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to SS -21A Agreement to Purchase 0 Revised 6=?015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. II. 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. 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. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract SS -23A Agreement to Purchase 1I Revised 612015 Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable tier actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5- 103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I,, above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in SS -23A Agreement to Purchase 12 Revised 6/2015 performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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 tiled 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: EST: w, t/LA,J BOARD OF COUNTY COMMISSIONERS Weld .tnty Clerk to the soar WELD COUNTY, COLORADO El e• e+ Official rr Departm ke Freeman, Pro —Tern Quality Life Services LLC 11975 Reed Street Broomfield, CO 80020 By: OCT 1 2 2015 r ontractor's or designee's) Signature and Date 1/: "1 SS -23A Agreement to Purchase 14 Revised 6/2015 026/O— W73(209 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase or Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Hoard of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, '`County," and Quality Life Services LLC, hereinafter referred to as. -Contractor.- I. 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#32066. 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. Ira 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 NEVUS system and the federal SSI rate billable through the County. 4. 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 County's Department Administrator before payment will he release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. G. 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 he authorized, in writing by County. prior to the service being performed. Any payment for specialized services not authorized in writing will he denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall he 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 A to the SS23A t Revised 5:2015 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. Exhibit A to the SS23A 2 Revised 5!2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 often are there services needed to address individual needs r NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: ■ Aggression/Cruelty to Animals Select One • Verbal or Physical Threatening Select One ■ Destructive of Property/Fire Setting Select One ■ Stealing Select One ■ Self -injurious Behavior Select One li 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 El Needs - (If condition is rated "severe", please complete the Medically fragile NBC) complete Select One ❑ 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 Revised 6/2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency Phase 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 R Medical Services C 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 . � �'. Needs Based Care Rate Table Weld County Department of Human Service (F:.ffcctivc'?UI/?015? LEV'F_L OF �� C:IIIL,D � � � r�D�lt'\IS'1 F2A77�'E .AU!�l[NISTRATI�'E �7Ell1('Ai,� RESPITE SE[2�'lCE M11.(I:ti't E\A;lC'E �IAfN'?`E:'Y,1'V("F. SER!'10E5 VE�;US Ler�el �� Daxly Rate � � I)aily Rate I)ail}�Et�te I�aily IZate Uail}� Rate = County Basic ;1ge 0-10...$17.01 $12.3� $0�� ,5" -' 5±,r, �u crisis in[ervention.Minimal ' :Naintenance Age I I-14...$18.81 Not needrd or cover ---------- f �.1'A involvemen[.one face-to- Rate Age I S-21...$20.�1�1 under!�ledicaid. :,��e visit with child per month. $15.77 $� I� �iinimal crisis intervention as Regularly Scheduled }�� 1 $20.56 w�,�� ,�.�_I�J,one face-to-face visit $3'�� therapy up to 4 ,: month with child.?-3 hourslmonth. �untacis per month t '/: $2.3.99 w nr, S 17.48 ----------- ----------- � __ $19.20 �]U.28 �>�casional crisis intervention as W'eekly scheduled 1 $�7.4� "''' nrrded.twa fac;e-to-face visits therapy 5-8 hours a $4.9' ��ith ehild.2-3 contacts per month with 4 hours of ,P month gtoup therapy. , ,� _ __ _.. ' 530.85 �'� ti�,r, �?�1 91 ----------- ---------- 2h _ — -- y„�� $15.42 Regularly scheduled �' � . _ �:. ,intervention as weekly,multipie 3 ��2, , �� ncedcJ.weekly face-to-Pace sessions,can include $650 ��:it.«ith child,and intensive more than I person, .. . ;.: nation of multiple i.e. family therapy, fc�r <rrvices. 9-12 hours/monthl� : �.;. 3 1/2 b37.69 * ` �„n S21.3d ----------- ---------- 526.05 � �"y � !?ngoing crisis intervention us u� nceded,which includes high � Congregate $4� �3 ti .- Ne otiated Ne otiated Care Ic�el uf case management and B g � Dro Down � �'A involvement with child and � � P provider and 2-3 face-to tace a .:untacts per we�k mintmum AssessmenU , Emergency ,;;: $�7�12 >�� ;, ; .:,' rx ----------- ---------- Level Rate 'I F_.xhibit A to the SS23A 5 Revised 6/?014 LvArci.0- ID#al.e(i AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑x RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this/aZ day of c' c#y20 /5: by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Reflections For Youth, Inc., whose address is 1000 S Lincoln Ave, Ste 200, Loveland, CO 80537-6357, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the count department. o23J 0.20/-002:736'23) SS -23A Agreement to Purchase �C' Revised 6/2015 /0 — B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services - ID# 1530130. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF, The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. docier44) �COUNTY: ATTEST: �• �C.L�oft.k BOARD OF COUNTY COMMISSIONERS Weld By: my Clerk to the Boa Deputy •terk to the Boa APPRIVED AS TO UBSTA CE: Official o Departmen SS -23A Agreement to Purchase WELD COUNTY, COLORADO Mike Freeman, Pro—Tem OCT 12 2015 TOR: Reflections For Youth, Inc. 1000 S Lincoln Ave, Ste 200 Loveland, CO 80537-6357 By: or's (or designee's) Signature an . l ate 020/5-3L7.5 (c23) 14 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Reflections For Youth, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1530130, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $171.66 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. b. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $148.00 per day unless otherwise negotiated based on the needs of the individual child placed within SOMB Transitional Residential Child Care Facility. c. 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 CW-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 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. 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 Exhibit A to the SS23A 1 Revised 6/2015 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%). 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 Ntrce cD(.0 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A O CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) El GROUP HOME/GROUP CENTER CARE El INDEPENDENT LIVING El 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: THIS IS AN AGREEMENT, made this /O1-' day of C20 41-, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Rocky Mountain Kids, whose address is 2210 E. LaSalle Street, #219, Colorado Springs, CO 80909, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county de�C / enti SS -23A Agreement to Purchase 1 �Revised 6/2015 /0- X02 , /5- 3,2.762`/) 3 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Group Home/Group Center Care Services — ID#s 1599808, 1599810, 1613088 and 1619041. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6,'2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. Contractor shall: L 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate SS -23A Agreement to Purchase 5 Revised 6/2015 Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (4) months of the date of the audit. SS -23A Agreement to Purchase 6 Revised 6/2015 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23 A Agreement to Purchase 7 Revised 6/2015 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6/2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement_ 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 6/2015 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to SS -23A Agreement to Purchase 10 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional participates SS -23A Agreement to Purchase 11 Revised 6/2015 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: SS -23A Agreement to Purchase 12 Revised 6/2015 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. Cam( COUNTY: AYfEST:GL�CC��ide4) Gi: �Ip:„k, BOARD OF COUNTY COMMISSIONERS Weld o t Clerk to the Boar i WELD COUNTY, COLORADO By: Deputy 1,g erk to the Boa Mike Freeman, Pro—Tem APPROVED AS TO SU STA. El. ct d Offie al or Depa RACTOR: Rocky Mountain Kids 2210 E. LaSalle Street, #219 Colorado Sp ings, CO 80909 By: OCT 12 2015 Coat actor's (or desig) Signature and Date SS -23A Agreement to Purchase 14 Revised 6/2015 c›20/. -J02736.2}/-) EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Rocky Mountain Kids, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of S100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1613088. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Rocky Mountain Kids, 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 S100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1619041. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Kevised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Rocky Mountain Kids, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1599810. 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 the County. 3. 411 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Rocky Mountain Kids, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1599808. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 tjpvdrad- t ac2(-O AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) El CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CIIRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) I] RESIDENTIAL CHILD CARE FACILITY (RCCF) D RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this �� day of 20 /iby and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Roundup Fellowship, whose address is 3443 South Galena St, Suite 310, Denver, CO, 80231, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Iluman Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WIIEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department.c>2O/O&97-13 6:76) •Revised Agreement to Purchase 1 6/2015 /o-/oZ- B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID#s 45211 & 45212. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PR -1'B within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must he agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 II. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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, (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado,) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 1 � 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 CI RP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. 1. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statementsto the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CI IRP 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 t � will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 1 1 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. F. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. `Phis Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase I 1 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/20 15 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. (�( �� COUNTY: ATTEST: �/.rITA6l/ � ' BOARD OF COUNTY COMMISSIONERS Weld Cnt Cleric to the Board WELD COUNTY, COLORADO By: Deputy ;clerk to the Bo APPROVED AS TO SU TANC 1 or Dep Mike Freeman, Pro-Tem OCT 1 2 2015 CTOR: Roundup Fellowship 3443 South Galena St, Suite 310 Denver, CO, 80231 �F Q/iq{/i7 By: Contr toy's (or designee' gnature and Date SS -23A Agreement to Purchase 14 02�e�3e73 (2,) Revised 6/2015 rl b EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Roundup Fellowship, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 45211, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $162.04 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP) waiver. If the child is deemed CHRP eligible, the Contractor agrees to accept the assessed waiver service rate billable through the MMIS system for the Children's Habilitation Residential Program (CHRP) waiver and the federal SSI rate billable through the County. 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A I Revised 6/2015 1 � 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Roundup Fellowship, hereinafter referred to as, "Contractor." I . County agrees to purchase and Contractor, ID# 45212, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $162.04 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP) waiver. If the child is deemed CHRP eligible, the Contractor agrees to accept the assessed waiver service rate billable through the MMIS system for the Children's Habilitation Residential Program (CHRP) waiver and the federal SSI rate billable through the County. 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 4 i 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 arc 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of I luman Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2015 b)v\-h-osJ AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A OO CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) OO 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: THIS IS AN AGREEMENT, made this pc-• day of ateO.6"W20 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Savio House, whose address is 325 King St, Denver, CO 80219, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county departrent. l� 373 621P) 23A Agreemen t to Purchase W6P-' (72eRevised 6/2015 �o-A72—i� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, B, and C, each of which forms an integral part of this agreement. Exhibit A, B, and C are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, B, and C, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consists of additional provisions for the purchase of Group Home/Group Center Care Services — ID# 1548445, 1621801, and 1644205. Exhibit C consists of additional provisions for the purchase of Residential Child Care Facility Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days SS -23A Agreement to Purchase 2 Revised 6/2015 from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate SS -23A Agreement to Purchase 5 Revised 6/2015 Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (4) months of the date of the audit. SS -23A Agreement to Purchase 6 Revised 6/2015 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/20I5 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6/2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 6/2015 SS -23A Agreement to Purchase 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to 10 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract SS -23A Agreement to Purchase 11 Revised 6/2015 Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal orr state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in SS -23A Agreement to Purchase 12 Revised 6/2015 performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ddrittiA) ATTEST: X1149;i1 BOARD OF COUNTY COMMISSIONERS Weld Ceointy Clerk to the Board WELD COUNTY, COLORADO Savio House 325 King St Denver, CO 80219 Freeman, Pro-Tem OCT 12 2015 By: %�,�'A4 4129, f 7° 35 Contractor's (or design e's) Signature and Date 020/-302 73 SS -23A Agreement to Purchase 14 Revised 6/2015 r1 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Savio House, 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#57183. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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. Pl. 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 often are thera. services needed to address child's individual needs .er NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: ❑ Aggression/Cruelty to Animals Select One Verbal or Physical Threatening Select One __ Destructive of Property/Fire Setting 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 ❑ Emancipation Select One ❑ Eating Problems Select One ❑ Boundary Issues Select One ❑ Requires Night Care Select One ❑ Education Select One O Involvement with Child's Family Select One Exhibit A to the SS23A 3 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 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 O 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 .,pOther: ❑ Sexual Abuse Victimization Treatment Visitation Coordination ❑ Independent Living Skills Training Monitor phone calls and correspondence ❑ Anger Management O Transportation for family/parent/child visits ❑ Behavior Modification Services U Other: ❑ Behavioral Assessment ❑ Other: ❑ Recreation Services ❑ 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 4 Revised 6/2014 ' Needs Based Care Rate Table Weld County Department of Human Service (Effective 710U2015} - ��, .:- �. : � � , e ..� r ,'z = , �'i � ' � LEVEL C1F� ` CtiIILD � t, � ; ADM[1tiIS'�'RA�'��. � ADh1Il�ISTRaTNE 'NILAICAL ;'. � r 'RFSPI I�,� ' � : a �� , SERVILE R'fAIN7'�'iVA'�C� ' i1�AYtiTE1\�nC E ';SERVICFS �iEEDS , . . _� � r e } �' h �, � :� _ , , . , , :,, ,• , . ,� , . �. ,s . ,:;,.�., .. �r;:' .<• v T,evel -` � 4'� : D�tiv"R�te � ,;DaE'y IZaEe� Dai�y`Rate' Daaly`Rate , .�" yDaily Rate' : ` ,..z � �, � , � �` - �� i County Basic „�� AgeQ-10...$17.01 � �'� $12.35 ��: $0.00 `� � ; $.66 � �� No crisis intervention,Mmimal �� under Medieaid. "��'' Maintenanee � Age 1i-14...$18.81 �; �'�� Not needed or cover ---------- �'� CYA involvement,one face-[o- ` Rate Age IS-21...$2Q09 ,� � �,�i face vis�t with child per month. ��' ,:� ', ��, �;,:t =:�� " $15.77 ��u'� $5.t 4 �'*�� Minimal crisis interventionas �'". 1 ��,� $20.56 �"' �.66 „-� needed,one face-to-face visit � Regularly Scheduled �� $3.45 r,� �,< � q's therapy up to d �" �"�� per month with child,2-3 ��': hourslmonth. ��i�;[ contacts per month w�� 1 '/z :� $23.99 k� `; $.66 }7 $17.48 ,�� ----------- , V, ----------- � �`�; '�� '� �19.20 �� $10.?8 �.; �� k Waekl scheduled � �'�.� fJ. Occasional crisis intervention as Y � 2 �ti $27.42 $.66 „�,�,e.: needed,two face-to-face visits therapy 5-8 hours a •'� $4,97 � f � with chiid,2-3 contacts per ' � month with 4 hours of � '� � month ��, group therapy. H '` ,�� 3,_ ll ., : 2%: : $30.85 Y�? $.66 $209{ ` ----------- �� -------- C 1c_ 'y : �� i $?2.62 � $I 5.42 .,� �+„ ��r „�;j ,� ` Regularly scheduled �i t �' ; �, Ungoing crisis interventinn as ; i� weekly,multiple � k�',` ��;j needed,weekly face-to-face ��" Sessions,can include "' $6.50 3 �� $34.27 �.66 visits with child,and intensive ��> more than 1 person, � ��a�� coordination of multip{e i.e.family therapy,foi " services. � �; y:� 9-12 hours/mo�ihly. H�s:: 4-<: ; ': 3 1/2 t�,� $37.69 � ; $.66 .' $24.34 } � ----------- �' ---------- .sr'� '��h' Es.:r ��k� Ac}`. �26.�5 '�,i' �d �� . `�'� J «g,. ,. Ongoing cris-is intervention as � ``�` � 4 �� , . _ Con re ate `'�. needed,which includes high g g � $41.13 � �.f6 level of case mana ement and �Iegotiated Negotiated t� g Care F - � � �� CPA snvolvement with ehild and ; r; ; Drop Down �� '-�+ �, � �_'� j=: � provider and 2-3 face-to face �-��_, t � �` � } o tacts e k mi m �� "�+ x ;,�, � . .;� �4' '` � ��fg�-�l'.: _ u�� s aP��,��f `C� ��„c�..�� p�r er`�"sit�n u's ;s�`�� '^,�w'�`4 �� -��a c �'Y�`��'�_ . we �m F.�, , • ? .�-: �n� ..s .,,. q Ja , .. '�FhY �. Emer enct/ $27.42 : $.66 f $19.20 '.�'-' 5� k � ' ----------- �'� ---------- g Y �a�: ,,� ��" Level Rate e�� :�: ,;, �� , y'y;� .,q,.��. ��SS, F.�chihit A to the SS23A 5 Revised 6/2014 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Savio House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $109.63, per day for children placed within the Group Home/Group Center identified as Provider ID #1548445. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Savio House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $109.63, per day for children placed within the Group Home/Group Center identified as Provider ID #1621801. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Savio House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $109.63, per day for children placed within the Group Home/Group Center identified as Provider ID #1644205. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT C 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Savio House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 48170, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.34 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 Opvirccd 1O'cE2Lo SS -23A Agreement to Purchase AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ID RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION E TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this/vs' day o 20/c, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Shiloh House, Inc., whose address is 6588 W Ottawa Ave, Littleton, CO 80128, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of I luman Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: 'FIRM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department.73 6) tIA'G 020%5'-3071 1 Revised 6.'2015 /0 — /02 - i.) B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID#s 20335, 54169, 62291, 70967, 1528492, 1539982, 1588986. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: SS -23A Agreement to Purchase Revised 6/2015 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Eluman Services, the Colorado Department of Health Care Policy and SS -23A Aureement to Purchase 3 Revised 6/2015 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 - Agreement 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 I Iealth Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Fluman Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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. SS -23A Agreement to Purchase 4 Revised 6'2015 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 I luman Services, Colorado Department 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 In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with G.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, 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 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 SS -23A Agreement to Purchase 5 Revised 6/2015 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 CARP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 13. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Agreement to Purchase 7 Revised 6/2015 III, TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. 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. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6'2015 plan. Further, Contractor and County will also secure, where possible. permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any SS -23A Agreement to Purchase 9 Revised 6'2015 remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. SS -23A Agreement to Purchase 10 Revised 6 201 a G. Time is of the essence in each and all of the provisions of this Agreement. El. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and it' SS -23A Agreement to Purchase 11 Revised 6/2015 so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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. SS -23A Agreement to Purchase 12 Revised 6/2015 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6-2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: ddrA44) �•�� Weld Ginty Clerk to the Boar, By: Deputy Clark to the Boa APPROVED AS TO SU _ TANC Flee or . epar SS -23A Agreement to Purchase BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Pro-Tem ACTOR: lob House, Inc. 6588 W Ottawa Ave Littleton, CO 80128 By: 0CT 12 2015 Contracltor's (or designee's) Sig and Date c20 ic-32736x7) 14 Revised 612015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor, ID# 20335, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $183.94 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 CW-06-1 1-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. 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/20 t 5 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of I luman Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 54169, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $183.94 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 CW-06-I l -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. 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 612015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/20I5 EXHIBIT A 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 apply to the agreement entitled. "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 62291, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of S183.94 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 CW-06-11-1 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, '`Contractor." I. County agrees to purchase and Contractor, ID# 70967, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $183.94 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 CW-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. 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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%). S. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the 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 writin by the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed LEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1528492, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of S183.94 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A I Revised 6!2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor, ID# 1539982, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $183.94 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- l 1-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6%2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed [EP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6`2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Shiloh House, Inc., hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor, ID# 1588986, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $184.49 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 CW-06-1 1-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A Revised 6/2015 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 the 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, plethysrnographs, 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A O CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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 El SHELTER CARE El SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this zP day of Tvi I Lehalf , 2015 , by and between the Board of County Commissioners of Weld County, on of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Nightlight Christian Adoptions, whose address is 150 E. 29th Street, Loveland, CO 80538, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 6.70 ce . 1 14 6n/L- c,207,--30273 SS -23A Agreement to Purchase I Revised 6/2015 o B, 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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 niles 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this SS -23A Agreement to Purchase 10 Revised 6/2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall SS -23A Agreement to Purchase I I Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: sdritsit)'ei BOARD OF COUNTY COMMISSIONERS Weld C. a ty Clerk to the Boa d - WELD COUNTY, COLORADO By: Deputy Cj rk to he Bo APPROVED AS TO SUBS, ANC EI i ed Officia or Departm CTOR: Nightlight Christian Adoptions 150 E. 29th Street Loveland, CO 80538 By: OCT 12 2015 Contractor's (or designee'signature and Date abi-3a 73(a0 SS -23A Agreement to Purchase 14 Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Nightlight Christian Adoptions, 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#159Q226. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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 by 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 age 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 thera+ services needed to address child's individual needs .er NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Select One • Rating: ■ Aggression/Cruelty to Animals Select One ❑ Verbal or Physical Threatening Select One ❑ Destructive of Property/Fire Setting Select One El Stealing Self -injurious Behavior Substance Abuse Presence of Psychiatric Symptoms/Conditions Enuresis/Encopresis Runaway Sexual Offenses elect One Select One Select One Select One Select One Select One Select One Select One Select One CI CI Inappropriate Sexual Behavior Disruptive Behavior Delinquent Behavior Depressive -like Behavior Select One Select One Medical Needs - (If condition is rated "severe", please complete the Medically fragile NBC) Select One ❑ Emancipation Select One CI CI Eating Problems Boundary Issues Requires Night Care Education Select One Select One Select One Select One Involvement with Child's Family Select One Exhibit A to the SS23A 3 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 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 O 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: O Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) LEVEL' QF SERVICE Age 0-10...$17.01 Age 11-14...$18.81 Age 15-21...$20.09 Level'. County Basic Maintenance Rate $.66 $12.35 No crisis intervention, Minimal CPA involvement, one face-to- face visit with child per month. $0.00 Not needed or cover under Medicaid. 1 $20.56 $.66 $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month. $3.45 1%z $23.99 $.66 $17.48 2 $27.42 $.66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. $4.97 2'A $30.85 $.66 $20.91 3 $34.27 $.66 $22.62 Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $15.42 Regularly scheduled weekly, multiple sessions, can include more than I person, i.e. family therapy, for 9-12 hours/monthly. $6.50 3 1/2 $37.69 $.66 $24.34 4 Congregate Care Drop Down $41.13 $.66 $26.05 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 Assess ment/ Emergency Level Rate $27.42 $.66 $19.20 Exhibit A to the SS23A 5 Revised 6/2014 Ctx,t,,, /V 'ka.210-2- AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A El CHILD PLACEMENT AGENCY SERVICES (CPA) l CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) • GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRT E) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) • RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE E SUBSIDIZED ADOPTION C TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: 111 THIS IS AN AGREEMENT, made this day of , 20 /;) , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Parker Personal Care Homes Inc., whose address is 1597 Cole Blvd, Ste 250, Lakewood, CO 80401-3417, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county d part`m�ent.CW /or73 6961.) SS -23A Agreement to Purchase W 1 Revised 6/2015 10 -/a-i•� B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and B, each of which forms an integral part of this agreement. Exhibit A and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B cosists of additional provisions for the purhase of Group Home/Group Center Care Services — ID#s 1654684 and 1598368. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Fatnily Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6./2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that ail therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County v:ith 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6,2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do nut apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6'2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6.2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 13. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall he recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held b) the Count) is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 4. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 5. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 6. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. RESPONSIBILITIES OF COUNTY: A. County shall: 10. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 11. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 12. 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). 13. 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. 14. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 15. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 16. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 17. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 18. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase I 0 Revised 6/2015 F 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and coiiscquential dainoge s. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5- 103(3), if Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy- the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6,2015 2. 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. 3. 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. O. 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. P. 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. Q. 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 sen-ed 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 documents) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 5.'2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Weld C By: BOARD OF COUNTY COMMISSIONERS lerk to the Board WELD COUNTY, COLORADO Deputy C I rk to the Boar APPROVED AS TO UBS Elec e ► Official o Departm Mike Freeman, Pro -Tern OCT l2 RACTOR: Parker Personal Care Homes Inc. 1597 Cole Blvd, Ste 250 Lakewood, CO 80401-3417 By: SS -23A Agreement to Purchase 14 i n r.' or's d Date esignee s igna S 302 73 (2) Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Parker Personal Care Homes Inc., hereinafter referred to as, "Contractor." I. 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#1512100. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5,2015 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. Exhibit A to the SS23A 2 Revised 5, 2015 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 Select One 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 imolyement by theprovider in scheduling and Select One 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 appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? Select One Select One Select One Al. I low 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 theraserxices needed to address child's individual needs .er NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Select One ment 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 elect une Select One Select One Select One CI resence of Psychiatric Symptoms/Conditions ❑ EnuresistEncopresis Select One ■ Runaway Select One ❑ Sexual Offenses elect One CI 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 Exhibit A to the SS23A 3 Revised 6.'2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency f.71At 'l.33 # :;giietifS'd far Orb £Iiii L e. g I"g#;:tea #•.• :; C'�:S?'9 ❑ Adoption Services S 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 El 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 0 MST Multi -Systemic Therapy Coordinate Assessment for Special Education ❑ Offense Specific Treatment Public School Attendance ■ Drug and Alcohol Treatment U Occupational Therapy • Speech Therapy ❑ Attend Special Education Meetings ❑ Urine Analysis/Drug Screening' Breathalyzer 0 Other: ❑ Sexual Abuse Victimization Treatment ❑ Visitation Coordination • Independent Living Skills Training ■ Monitor phone calls and correspondence ❑ An&er 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6.2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) ,� , FL OIF SERVICE �a£ '.� `,. , `" c� ; t A � .✓ {" � i „t � ,,f, .'rf. r ,.; ,"�`` �.� , ..',�; t F ` C } iz�.,-s�� y9��' 'a, i4' � s'y�:� 1• , r" r ` ,* tr ,D .Y, L.[.Yll',, f Jf."t� p�� .hsv'F: -Gd ,� Age 0-10...$17.01 `- Age 11-14...$18.81 Age 15-21.,.$20.09 l , � � u3 4+4 .,...". � , �S8 "�3 f' ,n f.y fi v< n A, '��59 {, � 'v ��;t�� ,✓-..:, .,., .:.... ... .. ,. ....; }r�♦ "Z!,� �sc {r'". R ''K' 3 3 *gi•'fd ,°",x�. fl ; L FL.2� .,,. ,5 �+� �� F M .;.r'"h County Basic Maintenance Rate $,66 �. � $12.35 No crisis intenention, Minimal CPA involvement, one face -to - face visit with child per month. $0.00 Not needed or cover under Medicaid. f 1 $20.56 $.66 $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month.` $3.45 1 '/: $23.99 S.66 $17.48 2 $27.42 $.66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. ,¢ $4.97 2 %1 $30.85 $.66 $20.91 3 $34.27 $.66 $22.62 Ongoing crisis intervention as; needed, weekly face-to-face .visits with child, and intensive coordination of multiple services. ,:', - f.. �, �.r $15.42 Regularly scheduled weekly, multiple sessions, can include more than I person, i.e. family therapy, for 9-12 hours/monthly. ° sr. $6.50 31/2 $37.69 $.66 $24.34 ---------- 4:' Congregate Care Drop Down $41.13 gip: $.66 $26.05 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 $27.42 , $.66 $19.20 --- Exhibit A to the SS23A 5 Revised 6/2014 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Parker Personal Care Homes Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $143.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1654684. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. 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. Exhibit A to the SS23A 2 Revised 6!20I5 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Parker Personal Care Homes Inc., 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 $146.90, per day for children placed within the Group Home/Group Center identified as Provider ID #1598368. 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 SST rate billable to the County. 3. 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. 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, pleth} smographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A i Revised 6/2015 8. Contractor agrees to actively participate in achiev ing 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 0,0FAiro.d- AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) El GROUP HOME/GROUP CENTER CARE O INDEPENDENT LIVING El PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION O TRANSITION/HOME BASED AFTER -CARE (RCCF) El OTHER: THIS IS AN AGREEMENT, made this /(111 > day ofad641-20 �� , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Kids Crossing, whose address is 1440 E Fountain Blvd, Colorado Springs, CO 80910-3502, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county de a ent.^`: 3�?3 ocv SS -23A Agreement to Purchase �� 1 Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and B, each of which forms an integral part of this agreement. Exhibit A and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consists of additional provision for the purchase of Group Home/Group Center Care Services — ID#s 1534441, 1541496, 1551132, 1552984, 1590619, 1594381, 1597038, 1621890, 1623469, 1625620, and 1667442. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific SS -23A Agreement to Purchase 2 Revised 6/2015 Addendum (SS23B) includedwith this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1 Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this SS -23A Agreement to Purchase 10 Revised 6/2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall SS -23 A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit, the child specific addendum SS23B, or the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shallbe 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. 0. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. C� '''� �,,��,,�'CL// COUNTY: ATTEST: C��d�ry,.i G: I.O'ok BOARD OF COUNTY COMMISSIONERS Weld Clerk to the Beard WELD COUNTY, COLORADO By: Deputy Clerk to the B APPROVED AS TO,$UBS Elected Official • Depa Mike Freeman, Pro-Tem OCT 12 2015 TRACTOR: Kids Crossing 1440 E Fountain Blvd Colorado Springs, CO 80910-3502 By: y /is -- Contract or designee's) Sign.ture and Date SS -23A Agreement to Purchase 14 X0/5_ 3 223 Revised 6/20 5 C50) 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, 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#79752. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? 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, and/or of impairments beyond age Select One 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 (NEEDS often are theraservices needed to address child's individual needs .er NBC assessment? Assessment Select One 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 ❑ 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 3 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 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 m ❑ 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 A 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 O 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 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) ... '.. •LEVEL OF SERVICES e f . Y )0• f,.d Y: "Ski f ` C - M*INTIE]`ie1 a s. `�E)`w ^C y J!.-• , =4 'i°' a ': S T rm �WA',f, ":i''°}v'.tg _' Y i�,h� * y,.{, � .f ��a h'M17{*li :G.'T ,�V -sR e MINIS 11 E` F 1�Lr�gfk .ATE '. '�y^Y�'�?� y y. , pipM.ly %��'• ..T �ti'"' �� rii'•'�c..tT.tc r ; t ;. G,f Y"diw� S9' I! M1714 -1ST - it CES�• ?5 4. -[� 5'.a�a x'"aK'�r5r3 r5 t Y DI it . EDS 3,.. �ia'� •4�rnIFC�A '�Y.i.l F,'�CO.in .. ' Level •EF1#S ail aDail yy�� ,T. �_ ...: '�. •ryv"i'N.Y ti+�+i N " ti". ,,,t, Dail Rate hx ft x Y n a�"gt,,F t .. �i `ie.::�. 11+..,, i, • p ++��1y1'{' ail} Ratee .. '�`.,.µw 1 Ra e ] 'WV $0.00 Not needed or cover under Medicaid. County Basic Maintenance Rate Age 0-10...$17.01 Age 11-14...$18.81 Age I5-21...$20.09 $.66 $12.35 $12.35 No crisis intervention, Minimal CPA involvement, one face -to- face visit with child per month. 1 $20.56 $.66 $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month. $3.45 1 '/z $23.99 $.66 $17.48 2 $27.42 $•66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month •,.$10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. r $4.97 2 '/2 $30.85 $.66 $20.91 3 y $34.27 � $ 66 y $22.62 Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. r $15.42 Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. c $6.50 31/2 = $37.69 = $.66 - $24.34 4 Congregate Care Drop Down c $41.13 _ 4 R' $.66 $26.05 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 ,r ;. y Negotiated ai ....y1�4 -" 7.; �'lr3u.7}��r� ki; ry�t. yOTeT�,' � X44 �7:Y7 ."`.• T.n �t.�,i �M`�"f ::r L... . �`9`� x i {�i{�u'—)'i a"':lr. .. t � �v7A.'Y.�Y1+..4 x.. „ _ - Assessment/l. Emergency Level Rate; .5 ...a. .. ... $27.42 $.66 -dip' }, $19.20 ., l. Exhibit A to the SS23A 5 Revised 6/2014 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1534441. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1 County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1541496. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $95.34, per day for children placed within the Group Home/Group Center identified as Provider ID #1551132. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, 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 $95.34, per day for children placed within the Group Home/Group Center identified as Provider ID #1552984. These services will be for children who have been deemed eli °'"i l cervices under the statutes, rules and regulations of the State of Coloradc Sc c,,ci. 2. Contractor agrees to accept the assesses system for Children's Habilitation Resi and the federal SSI rate billable to the Q oo hrough the MMIS rer eligible children 3. All bed hold authorizations and payme .imum for a child's temporary absence from a facility, incluamg nust,.�a�.��., ... _ _ _. )ld requests must have prior written authorization from the Department Administrator before payment will be release to provider. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1590619. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $88.77, per day for children placed within the Group Home/Group Center identified as Provider ID #1594381. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Horne Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1 County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1597038. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, 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 $118.36, per day for children placed within the Group Home/Group Center identified as Provider ID #1621890. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, 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 $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1623469. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $95.47, per day for children placed within the Group Home/Group Center identified as Provider ID #1625620. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $100.80, per day for children placed within the Group Home/Group Center identified as Provider ID #1667442. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 atoq SS -23A Agreement to Purchase AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A • CHILD PLACEMENT AGENCY SERVICES (CPA) CI IIL..DREN'S HABILITATION RESIDENTIAL PROGRAM (CIIRP) • GROUP HOME/GROUP CENTER CARE E INDEPENDENT LIVING E PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) E RESIDENTIAL DRUG/ALCOHOL. PROGRAM E SHELTER CARE ❑ SUBSIDIZED ADOPTION E TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this day of ,) to , 2015_ , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Smith Agency Inc., whose address is 14394 E. Evans Ave, Aurora, CO 80014-1408, hereinafter referred to as, "Contractor.'' THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county de cartent. , 02 73 (5 J I Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, B and C, each of which forms an integral part of this agreement. Exhibit A, B and C are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, B and C, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consist of additional provisions for the purchase of Group Home/Group Center Care Services — ID# 1540493 Exhibit C consists of additional provisions for the purchase of Residential Child Care Facility Services - ID# 96482 C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days SS -23A Agreement to Purchase 2 Revised 6/2015 from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. 1. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be SS -23A Agreement to Purchase ti Revised 612015 subject, at any reasonable time, to inspection, 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 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 provided to the Colorado Department of Human Services (Attn: Administrator for PR"l'Fs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (4) months of the date of the audit. SS -23A Agreement to Purchase 6 Revised 6/2015 7. Failure to comply with any of these requirements. including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement, II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall he submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 he limited to funds encumbered in this Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may he withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/2015 Cr. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6/2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 612015 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to SS -23A Agreement to Purchase 10 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. I I. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract SS 23A Agreement to Purchase 11 Revised 612015 Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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' Contract Professional 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-I 01, 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. I lave 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: I. Withhold payment to Contractor until the necessary services or corrections in SS -23A Agreement to Purchase 12 Revised 6/2015 performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: dgerhN/ �'C��,,,,,,,// O%ak, BOARD OF COUNTY COMMISSIONERS Weld ce,unxy Clerk to the $card WELD COUNTY, COLORADO By: Deputylerk to the B APPROVED AS TO SUB Elected Official Mike Freeman, Pro-Tem 0CT 12 Z015 ONTRACTOR: Smith Agency Inc. 14394 E. Evans Ave Aurora, CO 80014-1408 By: ,AA--e---x �I(ts Contractors (or designee's) Signature and Date o2o/s 3027363) SS -23A Agreement to Purchase 14 Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Smith Agency Inc., hereinafter referred to as, "Contractor." I. 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#44882. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? Al. How often is CPA/County case management required? (Does not include therapy) Select One **Please Note: The Case Management level may be assessed on a combined basis if a sibling group • uI IIIu■ C wan U,.c l.uuILlJ .uatcu C.IIRJ Ia TV Mil Luc aauic pa u♦ MCI. T1. How NBC often are thera. services needed to address child's individual needs .er NBC assessment? Behavioral Assessment Select One (NEEDS BASED CARE ASSESSMENT) — Assessment Areas: Comment: Rating: ❑ Aggression/Cruelty to Animals Select One ❑ Verbal or Physical Threatening Select One ❑ Destructive of Property/Fire Setting Select One ❑ Stealing Select One ❑ Self -injurious Behavior 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 ❑ 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 3 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 Other: NA Provider agrees to work with family Therapeutic Services funded through Medicaid Fee for Service: (TRCCF Medical Services Doctor Dentist Appointment Coordination Medication Evaluation (not covered under fee for service) Medication Monitoring ❑ Individual Therapy ❑ Nursing Services/Coordination ❑ Group Therapy 0 Physician Services/Coordination ❑ Interactive Group Therapy ❑ Occupational Therapy' LJ Family Therapy 0 Psychological Testing Pharmacological Management Treatment not funded by Medicaid Fee for Service: Home Based Intervention Speech Therapy ❑ Child Find Other: Education: On -Grounds School 0 MST Multi -Systemic Therapy Offense Specific Treatment Drug and Alcohol Treatment Urine Analysis/Drug Screening/ Breathalyzer Sexual Abuse Victimization Treatment Independent Living Skills Training Anger Management Behavior Modification Services Behavioral Assessmen Recreation Services Case Management ❑ Attend Court Hearings O Transportation: To include: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Coordinate Assessment for Special Education Public School Attendance Occupational Therapy Speech Therapy Attend Special Education Meetings Other: Visitation Coordination Monitor phone calls and correspondence Transportation for family/parent/child visits Other: Other: Interpreter Services ❑ Other: Other: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) y .H tit - m. {.,��e SF f'� Ytl° S�7n+ A t �+ � 4 � -, 5k�.. 'd g,� ry, "'# p`1 o�C� ✓ ' ;:k `a -( b T y'p T'1t,t�. 4 � .J� f ?ma * .' i'x ��. 6. - P ,�y 4 � ! ; :'s s ' .#� ' RS'4 ' ya d County Basic Maintenance Rate Rate Age 0-10...S17.01 Age I 1-I 4...$18.81 Age 15-21...$20 09 $.66 . S $12.35 No crisis intervention, Minimal CPA involvement, one face -to - face visit with child per month. '' $0.00 Not needed or cover under Medicaid. t' 1 $20.56 $.66 A $15°77 Minimal crisis intervention as needed, one face-to-face visit per month with child. 2-3,, contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month., i�d y; $3.45 1 '1: - $23.99 $.66 $ 17.48 ri 2 $27.42 . - $.66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month fn $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy.2 $4.97 2 ''A $30.85 $.66 $20.91 3 thx ;t, $34.27 �-- '' ° `= $.66 la �• $22.62 Ongoing crisis intervention as g g needed. weekly face-to-face visits with child, and intensive coordination of multiple i servces. ` ti $15.42 Regularly scheduled weekly. multiple sessions, can include more than I person i.e. family therapy, for 9-12 hours/monthly. .. ' $6.50 3112 " $37.69 $.66 $24.34 4 Congregatef Care Drop Down $41.13 `` $ 66 d $26.05 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 $27.42 $.66 $19.20 Exhibit A to the SS23A 5 Revised 6/2014 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Smith Agency Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $155.30, per day for children placed within the Group Home/Group Center identified as Provider ID #1540493. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 I luman Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6!2015 EXHIBIT C 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 apply to the agreement entitled, "Agreement to Purchase Out -of -1 -tome Placement Services SS23A, 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 Smith Agency Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 96482, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $157.95 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP) waiver. If the child is deemed CHRP eligible, the Contractor agrees to accept the assessed waiver service rate billable through the MMIS system for the Children's Habilitation Residential Program (CHRP) waiver and the federal SSI rate billable through the County. 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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 he negotiated and authorized, in writing by the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then he forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of I luman Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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: 0)111 THIS IS AN AGREEMENT, made this / day ofa6(1120 15, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Southern Peaks Regional Treatment Center, whose address is 700 Four Mile Parkway, Canon City, CO 81212, hereinafter referred to as, "Contractor." 'r r, :_,_ (1_ f_ :' 1 0 • THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county d partent. 0.70/6— c5071, (19 SS -23A Agreement to Purchase I Revised 6/2015 /0- /O2 J/�/ B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services- ID# 1526789. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: SS -23A Agreement to Purchase 2 Revised 6/2015 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. H. 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 SS -23A Agreement to Purchase 3 Revised 6/2015 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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. SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1 Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, 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 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 SS -23A Agreement to Purchase 5 Revised 6/2015 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Agreement to Purchase 7 Revised 612015 III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 SS -23A Agreement to Purchase 9 Revised 6/2015 or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. SS -23A Agreement to Purchase 10 Revised 6/2015 G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if SS -23A Agreement to Purchase 11 Revised 6/2015 so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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. SS -23A Agreement to Purchase 12 Revised 6/2015 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: C/.�Q�%+w1/'� BOARD OF COUNTY COMMISSIONERS Weld o Clerk to the : oard WELD COUNTY, COLORADO By: i - ♦ , Deputy lerk to the APPROVED AS TO S BS Elec Official o SS -23A Agreement to Purchase Mike Freeman, Pro—Tem OCT 12 2015 NTRACTOR: Southern Peaks Regional Treatment Center 700 Four Mile Parkway Canon City, CO 81212 By:‘, , .-- t. Co?ttractor's (or designee's) Signature and Date to (4), Li 020/i -39273(39 14 Revised 6/2015 ,-1r) EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Southern Peaks Regional Treatment Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1526789, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.35 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 CW-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 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. 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 A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 SS -23A Agreement to Purchase AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A El CHILD PLACEMENT AGENCY SERVICES (CPA) 0 CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE E 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: // i►" THIS IS AN AGREEMENT, made this/day of , 20/ , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Special Kids Special Families, whose address is 424 W Pikes Peak Ave, Colorado Springs, CO 80905, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county de art ment. Ft GNP 026%5-3x273 03 ( _ Revised 6/015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 612015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6. 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6,'2015 Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.K.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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non- Protit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the children) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23,A Agreement to Purchase 8 Revised 6:2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review, 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 he construed as prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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, tires, strikes, war, flood, earthquakes or Governmental actions. 1. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 F. -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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' Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 ak`firmation 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. It' Contract Professional 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, Contract Professional shall he 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 Contract Professional receives federal or state funds under the contract. Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 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; 3. Are nut 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, 4. Have not within a three-year period preceding this Agreement, had one or more public transactions ( federal, slate, and local) terminated for cause or default, N. In addition to terminating this Agreement. in accordance with the provisions of Section i., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work fbwid in this Agreement, 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: I. Withhold payment to Contractor until the necessary services or corrections in performance arc satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 62015 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations, in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ,,��GC COUNTY: ATTEST: f1terh) �• '� BOARD OF COUNTY COMMISSIONERS Weld ' `o i . v Clerk to the B i and WELD COUNTY, COLORADO By: Deputy ,+ lerk to the B f 1. Mike Freeman, Pro—Tem APPROVED AS TO S BSTA 1_lect•,•f Official or Departure RACTOR: Special Kids Special Families 424 W Pikes Peak Ave Colorado Springs, CO 80905 By: OCT 12 YQfS or's or designee's) Sig .cure and Date aa/-3,273 (33) SS -23A Agreement to Purchase 14 Revised 6/2015 'I I 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Special Kids Special Families, hereinafter referred to as, "Contractor." I. 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#43184. 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 the County. 4. 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 County's Department Administrator before payment will be release to provider. S. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A Revised 5i2015 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 (LEP) 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. Exhibit A to the SS23A Revised 5'2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 T7. How often are thera services needed to address ' individual needs r NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: • Aggression/Cruelty to Animals Select One • Verbal or Physical Threatening Select One I• 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 ❑ Emancipation Select One REating Problems Select One Boundary Issues Select One R Requires Night Care Select One Education Select One ❑ Involvement with Child's Family Select One Exhibit A to the SS23A Revised 6/2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency Please indicate the ser%ices that are requested for this child. The following information will he reflected on the child specific contract. (Please be specific) ❑ Adoption Services O 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 H Speech Therapy Psychological Testing ❑ Child Find 1 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 Therapy HOccupational Speech Therapy O 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 . Needs Based Care Rate Table Weld County Department of Human Service � (Effccfi��c Z'Ql%Z(115) LEVELOF �CIIILD � � � � AU'11lhIS'CR�TIVE AllDIfti1STR:�Tl�'E �IEDICAL S�R�'ICE � �1.4l;ATE:�:iMC'E RFSPITF �IAIV 1 F:�1�GE SERVIGES � NGEDS � E,e��ei C)ailv'Rate �� U��il} t::�tc � T�ai!} Rate � � ��Dailti�IZat� � E)�ih`I�aiu a $12.3� County Basic Age 0-10...$17A1 $0.00 �laintenance Age I I-14...$18.81 �66 No crisis int�rvzntion,Minimal Not needed or cover ---------- CPA im�olvement,one face-to- Rate Age I�-21...$20.09 under Medicaid. face visit with child per month. $I 5.'7 $�.i� Minimal crisis intervention as Regularly Scheduled I $20.56 $.66 needed,one face-to-face visit ��'�5 therapy up to 4 per month with chiid,2-3 hours/month. contacts per month 1 '/, 523.99 S.6b $(7.�18 ----------- ---------- $I 9.20 $I 0.28 Occasional crisis intervention as Weekly scheduled 2 $27 42 $.66 needed,two face-to-f'ace visits therapy 5-S hours a S�.97 � with child.2-3 coatacts per month with 4 hours of month group therapy. 2 %: $30.85 $.66 $20.91 ----------- --------- 522.62 $I 5.42 Regularly scheduled Ongoing crisis intervention as weekly,multiple 3 $34.27 $_6�, needed,weekly face-to-face sessions,can include $6.50 visits with child,and intznsive more than 1 person, coordination of multiple �.e. 1'amil��thcrapy, tur - services. 9_(Z hours/monthi� 31/2 �37.69 $.66 $2�i.34 . :. ----------- --------- ��" $26.05 — — ; C)ngoing crisis intervention as Congregate needed,which includes high Care $�1'13 �'�i6 levelofcasemanagementand � �'"��"=� �°� ��'��'�� Drop Uown CPA involvement with child and � provider and 2-3 face-to fa�e �" 'r: contacts per weck minimum. ;�,� ..� �� w Assessment/ Emergency $27.�1? �.66 $19.20 ; ___—.— --_._._-- Level Rate 6xhibit A to the SS23A 5 Revised 6�2014 . �., ;: , , < . . .,_ .. ,.,. . Col/k,ATaZ AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A El CHILD PLACEMENT AGENCY SERVICES (CPA) C CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) fl GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM El SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) Ti OTHER: THIS IS AN AGREEMENT, made this, day of , 0 /�, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, `County," and Strong Foundations, LLC, whose address is 1702 68th Ave, Greeley, CO 80634, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department c)2,07-00.213 (31> SS -23A Agreement to Purchase ( Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and B, each of which forms an integral part of this agreement. Exhibit A and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consists of additional provisions for the purchase of Group Home/Group Center Care Services — ID#s 70335 and 54150. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes. except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status. behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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 hoard amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 CIIRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. U. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 612015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of I Iuman Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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, tires, strikes, war, flood, earthquakes or Governmental actions. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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. §8-17.5-1O2(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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional has examined the legal work status of such employee, retained file SS -23A Agreement to Purchase 11 Revised 6/2015 copies of the documents, 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. §8-17.5-101 et seq., County. may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit, the child specific addendum SS23B, or the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall he 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: l . Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase I2 Revised 6/2015 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -1213 A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. dicer484.) ��,,��,,//COUNTY: ATTE " �x,14o,c.k. BOARD OF COUNTY COMMISSIONERS Wel• o my Clerk to the Board WELD COUNTY, COLORADO Elec Official CONTRACTOR: SS -23A Agreement to Purchase Mike Freeman, Pro—Tem Strong Foundations, LLC. 1702 68th Ave Greeley, CO 80634 v; ' Contra aidT a7 to OCT 12 2015 0-7 27 17 or designee's) Signature oZo/.,•-30173(30 14 Revised 6120 15 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 apply to the agreement entitled, "Agreement to'Purchase Out -of -Home Placement Services SS23A, 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 Strong Foundations, LLC, 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#1594056. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A Revised 5/2015 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? 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 does the child require special and extensive involvement by the provider in scheduling Select One often of time and/or activities and/or crisis management? P5. /low much time is the provider required to assist the child because appropriate needs with feeding, bathing, grooming, physical, and/or of impairments beyond age Select One 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 thera• services needed to address child's individual needs .er NBC assessment? Select Assessment 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 ❑ S Stealing Select One ❑ Self -injurious Behavior Select One ❑ Substance Abuse Select One ❑ Presence Psychiatric Symptoms/Conditions Select One of Select One lil Enuresis/Encopresis Select One ❑ Runaway ❑ Sexual Offenses Select One El Inappropriate Sexual Behavior Select One ❑ Disruptive Behavior Select One ❑ Delinquent Behavior Select One El Depressive -like Behavior Select One ❑ Medical Needs - (If condition is rated "severe", please complete the Medically fragile NBC) Select One ❑ Emancipation Select One El 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 3 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 he 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 0 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 ❑ Occupational Therapy Drug Alcohol Treatment ❑ Speech Therapy ❑ and • 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) 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...S17.01 Age 11-14...$18.81 Age IS -21.._$20.09 $.66 $12.35 No crisis intervention, Minimal CPA involvement, one face -to face visit with child per month. $0.00 Not needed or cover under Medicaid. 1 $20.56 $.66 $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $5.14 Regularly Scheduled therapy up to 4 hours/month. $3.45 1 1/2 $23.99 $.66 $17.48 2 $27.42 $.66 $19.20 Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. $4.97 2 '/2 $30.85 $.66 $20.91 3 $34.27 $ 66 $22.62 Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $15.42 Regularly scheduled weekly, multiple sessions, can include more than I person. i.e. family therapy, for 9-12 hours/monthly. $6.50 3 1/2 S37.69 5.66 $24.34 4 Congregate Care Drop Down $41.13 $.66 $26.05 Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 lace -to face contacts per week minimum. Negotiated Negotiated Assessment/ Emergency Level Rate $27.42 $.66 $19.20 Exhibit A to the SS23A Revised 6/2014 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Strong Foundations, LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $82.52, per day for children placed within the Group Home/Group Center identified as Provider ID #70335. 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 the County. 3. 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. 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 the 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 arc 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. l 1. 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. Exhibit A to the SS23A Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Strong Foundations, LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of S80.88, per day for children placed within the Group Home/Group Center identified as Provider ID #54150. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A l Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Strong Foundations, LLC, hereinafter referred to as, "Contractor." 1. Effective August 1, 2015, County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $82.52, per day for children placed within the Group Home/Group Center identified as Provider ID #9875. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 tD D-13 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑x RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this /0' day of , 201 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Regents of the University of Colorado, a body corporate, for and on behalf of the Univeristy of Colorado Denver, whose address is 3738 W Princeton Cir, Denver, CO 80236, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: SS -23A Agreement to Purchase 02.0/-0,2,-7,3(352 Revised 612015 TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 49488. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific SS -23A Agreement to Purchase 2 Revised 62015 Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and `or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6)2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised &2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 and Budget (OMB) Circular A -I33, 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6`20I5 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6=2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I . Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 62015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this SS -23A Agreement to Purchase 10 Revised 6;'2015 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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- I 02(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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall SS -23A Agreement to Purchase 11 Revised 6,20 t 5 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ,, ,,��,,// COUNTY: ATTEST: G/ ..eleo vk BOARD OF COUNTY COMMISSIONERS Wel• •u ty Clerk to the :card WELD COUNTY, COLORADO Mike Freeman, Pro-Tem OCT 12 2015 CONTRACTOR: Regents of the University of Colorado, a body corporate, for and on behalf of the University of Colorado Denver 3738 W Princeton Cir Denver, CO 80236 By: SS -23A Agreement to Purchase 14 r/e(5.xa Contractor's (or designee's) Signature Shaun P. McMullin Deputy Controller /,z.c12 and Date W7o 3213(3/ Revised 6/2015 2 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Regents of the University of Colorado, a body corporate, for and on behalf of the University of Colorado Denver, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 49488, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $178.00 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 CW-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 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. 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 A to the SS23A Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 boniro,c1 ait4 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A LI CHILD PLACEMENT AGENCY SERVICES (CPA) 0 CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CI-iRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) l RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) Cl OTHER: THIS IS AN AGREEMENT, made this%2-day of L'%��6-&/, 20 % , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Tennyson Center for Children, whose address is 2950 Tennyson St, Denver, CO 80212-3029, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county dep rtment. cam; p200-‘5,91-13SS 23A Agreement to Purchase 1 Revised 6/2015 (36g) B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 1529814. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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 CCR2509-5) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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 C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTES . C°lth ;J BOARD OF COUNTY COMMISSIONERS Weld �o r c e oar WELD COUNTY, COLORADO By: Deputy 'J-rk to the Bo, �w, Mike Freeman, Pro-Tem APPROVED AS TO SU Elect OCT 12 FM CONTRACTOR: Tennyson Center for Children 2950 Tennyson St Denver, CO 80212-3029 By: A.14-rt -ems 07/3145 Contractor's (or designee's) Signature and Date c26/6-3.2:73(5‘) SS -23A Agreement to Purchase 14 Revised 6/2015 14 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Tennyson Center for Children, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID€# 1529814, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.35 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 CW-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 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. 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 A to the SS23A Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 275 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) 0 CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) l RESIDENTIAL CHILD CARE FACILITY (RCCF) O RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE O SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this day of 20 /O, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Third Way Center, whose address is PO Box 61385, Denver, CO 80206, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county d partment. (3)6/513 SS -23A Agreement to Purchase 1 Revised 6/2015 /0- /02—/1 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID#s 49487, 65346, 77810, 1507881, 1547437. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2W 5 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above, ��,,��,,// COUNTY: ATTEST: C1 ) JCL; (..k. BOARD OF COUNTY COMMISSIONERS Weld oynt Clerk to the Bo : rd WELD COUNTY, COLORADO Ele• :d Official Mike Freeman, Pro-Tem OCT 12 2015 CONTRACTOR: Third Way Center PO Box 61385 Denver, CO 80206 By: '7.31.1s ontractor's (or designee's) Signature and Date c,V4T- 3,2/3 (3 7) SS -23A Agreement to Purchase 14 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 49487, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $187.76 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 CW-06-1 I -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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 65346, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $187.76 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 77810, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $187.76 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1507881, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $187.76 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1547437, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $184.08 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A Revised 6/2015 bArod g16 - AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CI CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE O INDEPENDENT LIVING O PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) O RESIDENTIAL DRUG/ALCOHOL PROGRAM O SHELTER CARE O SUBSIDIZED ADOPTION O TRANSITION/HOME BASED AFTER -CARE (RCCF) O OTHER: THIS IS AN AGREEMENT, made this/d-' day of , 20/5, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Top of the Trail Inc., whose address is 300 N Cascade, Montrose, CO 81401, hereinafter referred to as, "Contractor." 30\ N- Co.503.8e Ave, THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the cou partment. 0.20/ -(5,g1,38') SS -23A Agreement to Purchase 1 Revised 62015 l /0C) --/o1--/ B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6,`2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6.2015 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 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. 1 1 . In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6=12015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6,`2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6x2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 62015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 62015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST. diritet) �C.�•� Weld . u tv lerk to the Boar CONTRACTOR: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Pro-Tem Top of the Trail Inc. 300 N Cascade Montrose, CO 81401 By: Contractor's (or and Date OCT 1 2 2015 aoir-3a73 (30 SS -23A Agreement to Purchase 14 Revised 612015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Top of the Trail Inc., 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#28112. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 often are thecaservices 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 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 II Medical Needs - (If condition is rated "severe", please complete the Medically fragile NBC) Select One ❑ Emancipation Select One O Eating Problems Select One ❑ Boundary Issues Select One R Requires Night Care Select One Education Select One Er Involvement with Child's Family Select One Exhibit A to the SS23A Revised 6/2014 Needs Based Care Assessment WELD COUNTY DHS Requested Services from Agency Please indicate the sere ices that are requested for this child. The following information will be reflected on the child specific contract. (Please be specific) 8 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 R Occupational Therapy Family Therapy Speech Therapy ■ Psychological Testing ❑ Child Find Pharmacological Management A Other: Treatment not funded by Medicaid Fee for Service: Education: Home Based Intervention ❑ A 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 R 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 familyiparent/child visits Behavior Modification Services Other: Behavioral Assessment Other: ■ Recreation Services Interpreter Services Case Management O 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 4 Revised 6,2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/01/2015) County Basic Maintenance Rate Age 0-10..,..$17.01 Age I1-14...$18.81 Age 15-21...520.09 5.66 $12,35 No crisis intervention, Minimal CPA involvement, one face-to- face visit with child per month. 1 $20.56 $.66 $15.77 Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $23 99 $.66 $17,48 $0.00 Not needed or cover under Medicaid. $5.14 Regularly Scheduled therapy up to 4 hours/month. $3.45 1'/2 2 $27.42 5,66 $ 19,20 Occasional crisis intervention as needed, two face -to -lace visits with child, 2-3 contacts per month $10.28 Weekly scheduled therapy 5-8 hours a month with 4 hours of group therapy. $4.97 2 'A $30.85 5,66 $20.91 534,27 $ 66 $22.62 Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $15.42 Regularly scheduled weekly, multiple sessions, can include more than I person, i.e. family therapy, for 9-12 hours/monthly. 56.50 3 1/2 $37.69 $.66 $24.34 4 Congregate Care Drop Down $41.13 5.66 $26.05 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 $27.42 $,66 $1920 Exhibit A to the SS23A 5 Revised 6,2014 l.1cicd tD 2.27 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) • GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/I-IOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this /i"— day of , 20 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Turning Point Center for Youth, whose address is 1644 South College Ave, Fort Collins, CO 80525, hereinafter referred to as. "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county d part;n ng t, D2 -0/5-c_32'13 -2V13(3a) SS -23A Agreement to Purchase 1 Revised 6/2015 /0 102'4 am 13. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID#s 45179 and 1616504. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. I). County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6.'2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 Governmental Immunity Act set forth in §24-I0-101 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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, 13 (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. HI. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Aereement to Purchase 9 Revised 6/2015 S. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. .1. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 shalt 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase l 1 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit, the child specific addendum SS2313, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. deritel) COUNTY: ATTEST:'� BOARD OF COUNTY COMMISSIONERS Weld ' otlnt Clerk to the Bo. d WELD COUNTY, COLORADO By: Deputy Ilerk to the APPROVED AS TO S Elec -d Official o Depar CONTRACTOR: Turning Point Center for Youth 1644 South College Ave Fort Collins, CO 80525 0CT 12 2015 actor's (or d- ignee's) Signature d late CrxC�v-nvc'�rP.��-a tC.a a 2 O 7.1-- 3.273 (o SS -23A Agreement to Purchase 14 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Turning Point Center for Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 45179, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $186.48 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 CW-06-1 1-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 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. 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 A to the SS23A 1 Revised 6'2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Turning Point Center for Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1616504, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of S186.48 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- l 1-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 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. 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 A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 1 1. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) 0 CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) O RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE [] SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this j day of _._, 20 15. , by and between the Board of County Commissioners of Weld County, on ehalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Youthtrack Inc., whose address is 5424 LAS NWYLl35', ih*»?imr Cd, garter , hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor, 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county epartment. /� �3(*) SS -23A Agreement to Purchase �� l C /Reviseed6/2015 /0 —42-- /. B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor, acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Group Home/Group Center Care Services — ID# 11724. Exhibit B consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 11725. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRITh. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/20 IS E, The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, suppgrt system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5, 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 5 Revised 6/2015 SS -23A Agreement to Purchase 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole, When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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, C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23 A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. O, 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTES BOARD OF' COUNTY COMMISSIONERS Weld ' ou , erk to the Bo : d WELD COUNTY, COLORADO By: Deputy Cl APPROVED AS TO Elected • fficial o CONTRACTOR: Youthtrack Inc. S9 Z z(S aV'zd- M4--fJVltG'1 irc 8 Con ' . ctor's or designee's) Signature and Date OCT 12 2095 SS -23A Agreement to Purchase 14 02o/6 -3A-13 6747 Revised 6/2015 EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Youthtrack Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $225.00, per day for children placed within the Group Home/Group Center identified as Provider ID #11724. 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 the County. 3. 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. 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 the 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 or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2015 S. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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. Exhibit A to the SS23A 2 Revised 6/2015 EXHIBIT B 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Youthtrack Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 11725, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $148.25 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 CW-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 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. 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%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2015 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 alLeaMsfj (0_0,2 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ID CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CI IRP) ❑ 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) E OTHER: THIS IS AN AGREEMENT, made this ir� day of , 20 / by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, `'County," and Lutheran Family Services Rocky Mountains, whose address is 363 S. Harlan Street, Suite 200, Denver, CO 80226, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July' 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. tiff -23A Agreement to Purchase W: O2 00—G502-13 (49 � Revised6;2015 o B. 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 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 he 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: I. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services. rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to he necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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. Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with wTitten 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 612015 I I. 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 - Agreement 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 (H[PAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and hoard. 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. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will he based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. SS -23A Agreement to Purchase 7 Revised 6/2015 III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum. SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services. eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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 PRT'Fs. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening. Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970)346-7670. V RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Iluman Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any' non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RC'CF. CPA 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 SS -23A Agreement to Purchase 9 Revised 6/2015 or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. 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. y§8 -I 7.5-IO2(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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional shall be liable for actual and consequential darna,es. SS -23A Agreement to Purchase 11 Revised 6/2015 Except where exempted by federal law and except as provided in C.R.S. § 24-76.5- 103(3). if Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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: 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County Lind and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2, 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. 3. Recover from Contractor any incorrect payment to Contractor due to omission. SS -23A Agreement to Purchase 12 Revised 612015 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. I. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase l3 Revised 6/015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Weld Clerk to the Boar BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO tea•• q,,, Deputy perk to th_�:�. �� 1 Mike Freeman, Pro—Tem APPROVED AS T Etc SS -23A Agreement to Purchase CONTRACTOR: OCT 12 2015 Lutheran Family Services Rocky Mountains 363 S. Harlan Street, Suite 200 Denver, CO, 0226 Contract° and Date 14 Signature 020/x- 3o%3 (4-1) Revised 6/2015 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Lutheran Family Services Rocky Mountains, 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#45080. 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 the County. 4. 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 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 famished by the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A Revised 5/2015 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 he forwarded to the County. II. 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. Exhibit A to the SS23A 2 Revised 5/2015 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? 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 oices needed to address _t ``' individual needs tc r NBC assessment? NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Select One Assessment Areas: Comment: Rating: • Aggression/Cruelty to Animals Select One • Verbal or Physical Threatening Select One • Destructive of Property/Fire Setting 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 El Needs - (If condition is rated "severe", please complete complete the Medically fragile NBC) Select One ❑ Emancipation Select One ❑ Eating Problems Select One ❑ Boundary Issues Select One ❑ Requires Night Care Select One O Education Select One • Involvement with Child's Family Select One Exhibit A to the SS23A 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 ServicesB Medical Services R 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: o 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (F.ffecti��e"Ill�'?Q1S) � 1,I:�F�L(}F CH11,D � ��Ubll�Il$'I�R4'f1C'E r�Dt'1(�ISTRA7'IVE �1EUICAL RN:SPI F'₹�'; SEKVIC'E '�t.�ItiTEY.4tiCE i11r1(h'�EV.1`C:E SEA�tCE5 NEED5 Gcvul I>aity Ra�e f7ail4�Iiate 1?aiiy Rate Uaily Rate Dail.�E�atc C'ounty Basic Age 0-10...$17.01 ��Z 3� $0.00 Maintenance Age I I-14...S18.81 $•66 Nu crisis intervention,Minimal �;�t needed or eo�er --------- Rate Age I S-?l...$20.09 CPA im�olvement,onz face-to- under Medicaid. face visit with child per month. $15.77 $5.I4 Minimal crisis intervention as Regularly Scheduled 1 520.56 5.66 needed,one face-to-tace visit $3.45 therapy up to� per munth with child,2-3 hours/mon[h. contacts per month 1 '/� $23.9N $.66 $I 7.48 ----------- ----------- S I 9.20 S 10.28 Occasional crisis interven[ion as Weekly scheduled Z S2�_4Z $.66 needed,iwo face-to-face visits therap} 5-8 hours a $�.97 with child,2-3 contacts per month with 4 hours uf' month group therapy. 2 Y: $30.8� $.66 $20.91 ----------- --------- 522.62 �I 5.42 Regularly scheduled Ongoing crisis intervention as weekiy,multiple 3 $3:�.2., g.�� needed.weekiy fuce-to-face sessions,can indude 56.50 visits with child,and intensive more than I penon, coordination of multiple i r. family thrrapy, tbr .: sen�ices. y_�?hours;monthh 3 U2 $37 69 $.66 $?-i.3-1 ----------- ---------- $26.05 � Ongoing crisis intervcntion a� ;.� Congregdte necded,which inct�Jes high $41.13 5.66 Ievel of case management and :�'egotiated Negotiated Care Drop Down CP 1 involvement with child and ��;.: � a.,.. provider and Z-3 facr-to facc ,�_ w,� contacts per week minimun! 1ucs.ment Emergenc� �27 1? -` $.66 $I`.>''U ----------- 4 ---------- Level Katc I � � Exhibit A to ihe SS23A 5 Revised 6/2014 Nv*ckc,1- AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) E 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: Tµ THIS IS AN AGREEMENT, made this day of L �,:. , 20/a , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and C & M Group Home, whose address is 1920 81st Ave, Greeley, CO 80634, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. SS -23A Agreement to Purchase 6&%1-15/4" /5- 4; 73 61-02-) 1 Revised 6/_015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provision for the purchase of Group Home Care Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 II. 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. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23 A Agreement to Purchase 4 Revised 6/2015 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 of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of I luman Services. 11. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 CIIRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 CIIRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CIIRP 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 Agreement 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. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CIIRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/2015 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this SS -23A Agreement to Purchase 10 Revised 6/2015 .• 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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. §8-17.5-1O2(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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall SS -23A Agreement to Purchase 11 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor SS -23A Agreement to Purchase 12 Revised 6/2015 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. 3. 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. U. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. /, COUNTY: ATTEST: A f •�C,LLDf&C BOARD OF COUNTY COMMISSIONERS Weld ' o t Clerk to the Boa d WELD COUNTY, COLORADO By: Deputy lt'erk to the APPROVED AS TO S Ele e . Official or CONTRACTOR: Mike Freeman, Pro-Tem 0C1 12 2015 C & M Group Home 1920 81st Ave GreelevrCO 80634 By aaVavia,S Contractor's (or designee's) Signature and Date im/,5 SS -23A Agreement to Purchase Q20/.--32-73 61a) 14 Revised 6/2015 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 C & M Group Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $60.82, per day for children placed within the Group Home identified as Provider ID#9875. 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. 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 County's Department Administrator before payment will be release to provider. 3. The services purchased under this Agreement for Group Home 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. 4. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 5. 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. 6. 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 will be placed in the group home placement binder. 7. Contractor agrees to meet with the Department of Human Services Group Home Coordinator for a minimum of two hours weekly (7.709.21). 8. Contractor agrees to work collaboratively with Department staff, mental health professionals, GAL's, CASA volunteers, and other service providers in arranging times that Contractor's home is open to professional visits. Contractor also understands that the County Department Caseworker and GAL have the right to make unannounced home visits to check the child's safety, needs, and environment. Exhibit A to the SS23A 1 Revised 6/2015 r 9. Contractor agrees to ensure that hired staff are completing training specific to the children they service, and are current on all trainings and other requirements as mandated by CDHS Volume 7 Policy and Procedure Manual section 7.700. 10. Contractor agrees to accompany key professionals to school conferences, IEP meetings, school -related staffings, Foster Care Reviews and Court Hearings. 11. Contractor agrees to immediately report any significant issue, regarding the youth, to the youth's assigned caseworker. Issues may be medical, behavioral, legal/ criminal, or educational in nature. If a youth becomes a threat to him/herself or others, al5propriate "critical incident" documentation must be prepared by the specialized group home parent according to State guidelines (7.701.52), in addition to notification to the caseworker. While specialized group home parent attempts to maintain the youth at the group home level of care, the specialized group home parent will be familiar with Weld County's continuum of care and understand when a child needs to be forwarded or regressed through the continuum. 12. Contractor agrees to immediately report to the County and/or local law enforcement any known or suspected child abuse or neglect as set forth in Section 19-3-304, C.R.S. Exhibit A to the SS23A 2 Revised 6/2015 borykra0 t gq SS -23A Agreement to Purchase AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) El CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) C7x RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION El TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: 'r14. THIS IS AN AGREEMENT, made this day of6-er444420, % , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Excelsior Youth Centers, whose address is 15001 E. Oxford Ave, Aurora, CO 80014, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county department. Ge; s l4 -Gµ-) 0.20/.3--302-1 3 I Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Residential Child Care Facility Services — ID# 45243. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 6/2015 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 6/2015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: 1. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 6/2015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The SS -23A Agreement to Purchase 9 Revised 6/2015 County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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 SS -23A Agreement to Purchase 10 Revised 6/2015 audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. 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 SS -23A Agreement to Purchase 11 Revised 6/2015 C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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 SS -23A Agreement to Purchase 12 Revised 6/2015 deliverables lost to County. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -23A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: WirdtatAi e-do;tA. Weld . r ty Clerk to the Bo By: Deputy erk to the Bo APPROVED AS TO SU Elec - • • fficial or BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Pro-Tem CONTRACTOR: Excelsior Youth Centers 15001 E. Oxford Ave Aurora, CO 80014 r By: OCT 12 2015 Cont ac ' ' or designee's) i gne and P ate I Na) SS -23A Agreement to Purchase 14 Revised 6/2015 m , EXHIBIT A 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Excelsior Youth Centers, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 45243, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $189.34 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. b. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $265.00 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility 21 day Assessment and Stabilization program. c. 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 CW-06-11-1 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 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. 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 Exhibit A to the SS23A 1 Revised 6/2015 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). 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 the 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 the 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 or Team Decision making meetings. 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 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the 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 will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in 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. Exhibit A to the SS23A 2 Revised 6/2015 hr‘.-\-c&cf- tV) ,ax5 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A El CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S 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: THIS IS AN AGREEMENT, made this 2 day of , 20/a, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Frontier Family Services, whose address is 1290 Boston Ave, Longmont, CO 80501-5810, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county d partment. et ski C41A- o7o/ —30273 f SS -23A Agreement to Purchase I Revised 6/2015 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A and B, each of which forms an integral part of this agreement. Exhibit A and B are specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A and B, define the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. Exhibit B consists of additional provisions for the purchase of Group Home/Group Center Care Services ID# 1526756. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be SS -23A Agreement to Purchase 5 Revised 6/2015 subject, at any reasonable time, to inspection, 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 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (4) months of the date of the audit. SS -23A Agreement to Purchase 6 Revised 6/2015 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/2015 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6/2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 6/2015 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to SS -23A Agreement to Purchase 10 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days SS -23A Agreement to Purchase I I Revised 6/2015 after 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, 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: SS -23A Agreement to Purchase 12 Revised 6/2015 I. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. Financial obligations of the County payable after the current fiscal year are contingent SS -23A Agreement to Purchase 13 Revised 6/2015 Weld 91u tyClerk to the Boa APPROVED AS CO" d Official SS -23A Agreement to Purchase 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Wita44) �BOARD OF COUNTY COMMISSIONERS WELD COUNTY, ,COLORADO Mike Freeman, Pro-Tem OCT 1 2 2015 CONTRACTOR: Frontier Family Services 1290 Boston Ave Longmont, CO 80501-5810 Contractor's (or dcsi and Date ignature 14 Revised 6/2015 c".2-0/5:c3o2 (4.4O 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Frontier Family Services, 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#38041. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? 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 often does the child require special and extensive involvement by theprovider 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 appropriate needs with feeding, bathing, grooming, physical, 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 TI. How often are theraservices 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 ❑ 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 ❑ 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 3 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 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 1�leeds Based Care Rate Table Weld County Department of Human Service (Effective 7/Ol/201S) LE�'ELOF �CHI1.D ADM['YISIRA'I"iVF, AD�1[NISTRaTI�'E b9EDICAI. RESPIT`G tik:RVIC:E �tAINTEti,ANCE �lA[N7'E'Y:1�CF. SER�'ICES NF;EDS I.evei L�aily Rate Daily Rate I7aily Rate Daily Rate Uaily Rate County Basic Age 0-t0...$17.01 $12.35 $�0� $.66 No crisis intervention,Minimal Maintenance Age I I-14...$18.81 Not needed or cover ---------- Rate Age 15-21...$20.09 �PA involvement,one face-to- under Medicaid. face visit with child per month. $15.77 $5.I�4 Minimal crisis intervention as Regularly Scheduled 1 $20.56 $.66 needed.one face-to-face visit $3.45 therapy up ro 4 per month with child,2-3 hours/month. contacts per month 1 '/Z $23.99 $.66 $17.48 ----------- ----------- $19.20 $10.28 Occasional crisis intervention as . Weekly scheduled 2 �27•42 ��' � needed,two face-to-face visits therapy�-8 hours a $4.97 with child,2-3 contacts per " �»��nth with=4 hours of month group therapy. 2'/: $30.85 �.bc, 's?0.91 ----------- ---------- — x22.62 $I�.42 Itegularly scheduled Ongoing crisis intervention a, weekly,multiple 3 $34.27 y�.�,�, needed,weekly face-to-face ;��y�ons,can include $6.50 �i,it;�vith child,and intensi�c i»ore than I person. coordination of multiple �.,;. family therapy,for services. �)-I?hours/monthly. , 3 1/2 �37.69 $.66 $24.�-4 ----------- ---------- $26.0j 4 Ongoingcrisis intcr��nti��n u, Con re ate needed,which includes high g � $41.13 $.66 level of case management and ��tiated Negotiated Care Drop Down CPA involvement with child an� provider and 2-3 face-to facc contacts per week minimum. Assessment/ Emergency $27.42 $.66 $19.?0 ----------- ---------- Level Rate Exhibit A to the SS23A 5 Revised 6/2014 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A E CHILD PLACEMENT AGENCY SERVICES (CPA) g CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) Cl GROUP }-TOME/GROUP CENTER CARE Q INDEPENDENT LIVING C PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) IT RESIDENTIAL CHILD CARE FACILITY (RCCF) C RESIDENTIAL DRUG/ALCOHOL PROGRAM I_, SHELTER CARE U SUBSIDIZED ADOPTION O TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER: THIS IS AN AGREEMENT, made this day of , 20 AT, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Commonworks D.B.A. Synthesis, whose address is 9520 E. Jewell Ave, Suite C, Denver, CO 80247, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the county departs nt. aj SS -23A Agreement to Purchase /o- /02,, c ' Revised 6/2015 �.oi5- 60773 6./) B. 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 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 liahility of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not he released from the duty to perform their obligations up to the date of termination. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. I. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 shalt formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRT'Fs within 72 hours. For children in a PRTF, a comprehensive individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 6/2015 E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the typc, 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6/2015 H. Contractor shall: I. 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 - Agreement 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8_ Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. I I, In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 5 Revised 6/2015 SS -23A Agreement to Purchase 2. All billing by 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 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 principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 pe.r Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D, In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith, ii. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type SS -23A Agreement to Purchase 7 Revised 612015 will determine which of these four components will be included in the reimbursement rate. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C, 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A, Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. C. 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 SS -23A Agreement to Purchase 8 Revised 612015 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dentalissues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V. RESPONSIBILITIES OF COUNTY: A. County shall: I. 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 far 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. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. SS -23A Agreement to Purchase 9 Revised 6/20t5 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt duc the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid 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. VI. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. SS -23A Agreement to Purchase 10 Revised 6/2015 F. 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. G. Time is of the essence in each and all of the provisions of this Agreement, H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature, L, 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized SS -23A Agreement to Purchase l l Revised 6/2015 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. §8-17.5401 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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 rccords, making false statements, or receiving stolen property; 3. 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 (13) above. 4. 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, N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. SS -23A Agreement to Purchase 12 Revised 6/2015 2. 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. 3. 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. 0, 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. SS -21A Agreement to Purchase 13 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ddrAtIV eJ� COUNTY: ATTEST: �• '� BOARD OF COUNTY COMMISSIONERS Weld iu•ty Clerk to tie Bard WELD COUNTY, COLORADO B Deputy lerk to the Freeman, Pro —Tern APPROVED AS TO SU Ele ;, ' Official or b epartm SS -23A Agreement to Purchase OCT 12 2015 CONTRACTOR: Commonworks D.B.A.. Synthesis 9520 E. Jewell Ave, Suite C Denver, CO 80247 By: Bcd.' . 701116 Contractor's (or designee's) Signae and Date 14 Revised 6t2015 c,ZO/i 3a -?.3 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Commonworks D.B.A. Synthesis, 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#104085. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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 theraservices needed to address child's individual needs .er NBC assessment? Behavioral Assessment Select One (NEEDS BASED CARE ASSESSMENT) — Assessment Areas: Comment: Rating: ❑ Aggression/Cruelty to Animals Select One ❑ Verbal or Physical Threatening Select One ❑ Destructive of Property/Fire Setting Select One ❑ Stealing Select One ❑ Self -injurious Behavior 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 ❑ 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 3 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 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/Ol/2015) � LEVEL OF CH�ILD ADMIN[STR4TIVE ADMINISTRATIVE � � MEDICAG SER�'ICE MA[NT��VA�'CE ��PITE MAINTENANCE SERVICES NEEDS Leti•el Daily Rate �aily Rate Daily Rate Daily Rate Daily Rate �l 2.35 County Basic Age 0-10...$17.01 $6� No crisis intervention,Minimal $0.00 Maintenance Age I 1-14...$18.81 �� , Not needed or cover ---------- CPA involvement,one face-to- Rate Age 15-21...$20.09 under Medicaid. face visit with child per month. $15.77 ti�.14 Minimal crisis intervention n; �Z�„�i�,��1��Scheduled 1 $20.56 $.66 needed,one face-to-face�i;it 53.45 thcrapy up to 4 per month with child,�-3 huurs/month. co�tacts per month I 'h $23.99 $.66 $17.4�S ----------- ----------- $19?0 $10.28 Occasional crisis intcr��ntion a, � Weekly scheduled 2 $27.42 $.66 -��., needed,two face-to-tace visits dierapy 5-8 hours a $4.97 with child,2-3 contacts per month with 4 hours of nwnth group therapy. 2'/: $30.85 S t;(, ��?U.91 ----------- ---------- - 522.62 $15.42 Regularly scheduled Ongoing crisis intervention as weekly,multiple 3 $34.27 �;,�,�, needed,weekly face-to-face sessions,can include $6.50 ci5it;with child,and intensive more than t person, cuordination of multiple � ;.�, family therapy,for services. 9-13 hours/monthly. 3 U2 �37.69 q �.66 ..:::. $24.34 ----------- ---------- $26.05 4 Ongoing crisis intervention as Congregate needed,which includes high Care $41.13 $.6� level of case management and Negotiated Negotiated Drop Down CPA involvement with child and provider and 2-3 face-to face N ; contacts per week mi�imum. Assessment/ Emergency $27.42 $.66 �19.20 ----------- ---------- Level Rate Exhibit A to the SS23A 5 Revised 6/2014 INDIVIDUAL PROVIDER CONTRACT FOR PURPOSE OF FOSTER CARE SERVICES AND FOSTER CARE FACILITY AGREEMENT THIS AGREEMENT is made this /a2''ay of C, 20/.7 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Schulz, Lindsey, whose address is 5121 W. 11th St., Apt. 409, Greeley, CO 80634, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Provider has read and is fully familiar with the Minimum Rules and Regulations for Family Foster Homes and/or Specialized Group Care Facilities issued by the Colorado Department of Humans Services and holds a valid certificate/license as a Family Foster Home with which such certification standards that shall be maintained during the term hereof and WHEREAS, County may, but shall not be obligated to, purchase foster care services, and the County or any duly authorized agent may request such services to be provided to any child at any time within the limits of the certificate/license and without prior notice. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall he from July 1, 2015, to and until June 30, 2016, or until the facility certificate/license is revoked or suspended. B. 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. II. AGREEMENTS OF THE PARTIES: A. Contractor agrees: 1. To furnish foster care services to eligible children at the established rate based on type of facility and individual child rates negotiated between the county and the provider. 2. To safely provide the 24 -hour physical care and supervision of each child until removed or until the agreement is renewed. CWS-7A Individual Provider Contract Cc: /a -c gyp -i2 /' o2a/-3a73 (46) Revised 6/2015 3. To accept children only with the approval of the certifying/licensing agency. 4. To cooperate fully with the County Department or its representatives, and participate in the development of the Family Service Plans for children in placement, including visits with their parents, siblings, and relatives, or transition to another foster care facility. 5. To maintain approved standards of care as set by the State Department of Human Services. 6. To keep confidential the information shared about the child 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 to anyone without prior authorization from the Department. 10. To allow representatives of the County Department to visit the foster home and to see the child at any reasonable time. 11. To give the County Department two weeks notice, except in an emergency, to remove a child for placement elsewhere and to work with the County Department as requested in preparing the child for the next placement. 12. To provide transportation to the child to enable the utilization of professional services when necessary. 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 Services Plan. 13. To report promptly to the Department: a. Any unplanned absence of the child from provider's care. b. Any major illness of the child. c. Any serious injury to the child. d. Any significant change in the child's sleeping arrangement. e. Any contemplated change of address or change of household members. f. Any conflict the child may have with law enforcement, school officials, or other persons in the authority. g. Any emergency. h. Any pertinent discussion with parents or guardians about the child or supervising agency. i. Any information received regarding a change of address of the parents or guardians. CWS-7A Individual Provider Contract 2 Revised 6/2015 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, religion, political beliefs, national origin, or handicap, and to provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 15. To attend core certification training prior to the placement of any child. 16. To attend on -going training as required by State Department regulations. 17. To attend Administrative Reviews for children in placement. 18. To fully comply with the Minimum Rules and Regulations for Foster Family Homes or Specialized Group Facilities. 19. Not to enter into any subordinate subcontract hereunder. 20. To keep such records as are necessary for audit purposes by state and federal personnel. The records shall document the type of care and the term during which care is provided for each child. In addition, medical, educational, and progress summary records shall be maintained for each child in accordance with Volume 7 requirements. 21. To maintain medical, dental and educational records for each child/youth and supply updated information to the County Department. 22. To 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. 23. To maintain a current license and maintain license requirements as specified under State law and rule. 24. Not to charge any fees to children or families of children referred by County for any services provided under this Agreement. 25. Not to 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. 26. To 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. 27. To indemnify County and the State Department 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 CWS-7A Individual Provider Contract 3 Revised 6/2015 any statute, ordinance, or regulation and the defense of any such claims or actions. 28. To 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, State Department, or County personnel, and other persons authorized in writing by the State Department Executive Director. B. County agrees: 1. To share all available information about the child, including relevant social, medical and educational history, behavior problems, court involvement, parental, sibling and relative visitation plans, and other specific characteristics of the child, with the provider before placement and to share additional information when obtained. 2. To inform the provider of expectations regarding the care of the child, such as meeting medical needs, handling special psychological needs, and separation/loss issues. 3. To arrange for a medical examination of the child before placement or within 14 days after placement and give a copy of the completed form to the out -of -home provider. 4. To give the provider a written record of the child's admission to the home at the time of placement. 5. To give the provider a written procedure or authorization for obtaining medical care for the child. 6. To involve the provider in service planning for the child as part of the overall treatment team. 7. To give the provider a copy of the Family Services Plan for the child at the time of placement or as soon as it is completed following placement. 8. To give at least two weeks notice of plans to remove a child from the facility. The two-week notice may be waived by mutual consent to allow immediate removal of said child 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 children. 9. To pay the provider at the rates established by the State Department of Human Services or as negotiated between the provider and the county. The rate of payment per month shall be based on the type of facility and individual rates. Payment shall be by warrant drawn by the duly authorized county officer. 10. To provide or arrange through statewide contracted training a minimum of twelve hours of core certification training for family foster homes. The county department is responsible for providing information on county specific procedures. CWS-7A Individual Provider Contract 4 Revised 6/2015 11. To invite the provider to Administrative Reviews for Children in placement. 12. To incorporate provider information in planning for the child. 13. To assure that the service described herein has been accomplished and a record made thereof on a case by case basis. 14. To provide notice of hearings. C. At such time or as soon as possible after the acceptance of a child for services, the County Department and the Provider shall verify foster care placement of each child in writing on the required form, which shall become an addendum to this contract, subject to all the terms and conditions hereof. III. GENERAL PROVISIONS: A. 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. B. 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. C. 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. D. This Agreement is intended to be applied in conjunction with Exhibit A 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, Exhibit A and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, 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. E. The State of Colorado Department of Human Services and the County shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department and the County may provide consultation to CWS-7A Individual Provider Contract 5 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions of this Agreement. H. 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. 1. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 F -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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional 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 Contract Professional 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. Contract Professional shall deliver to County, a written notarized CWS-7A Individual Provider Contract 6 Revised 6/2015 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional 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 Contract Professional 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. M. Contractor assures and certifies that it and its principals: 1 Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. 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; 3. 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. 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions if the County finds and determines that the Contractor has substantially failed to satisfy the scope of work 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: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor CWS-7A Individual Provider Contract 7 Revised 6/2015 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established U. 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. CWS-7A Individual Provider Contract 8 Revised 6/2015 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ddrAilti COUNTY: ATTEST: "'• 'i1 BOARD OF COUNTY COMMISSIONERS Weld ? o Clerk to the Board WELD COUNTY, COLORADO By: Deputy lerk to the APPROVED AS TO S Elec Official or Mike Freeman, Pro-Tem CONTRACTOR: Schulz, Lindsey 5121 W. 11th St., Apt. 409 Greeley, CO 80634 By: By: CWS-7A individual Provider Contract 9 OCT 1 2 2015 Contractors (or design s) Signature and Date Contractor's (or designee's) Signature and Date of o ,6"- 502773 0/4") Revised 6/2015 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 Schulz, Lindsey, hereinafter referred to as, "Contractor." GENERAL PROVISIONS 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated within this exhibit shall be used to determine the Child Maintenance and Medical Needs, if applicable, for each child placed with Contractor unless the child is placed in a County certified kinship foster care home or a County foster/adoption home as a pre -adoptive placement. Kinship foster care homes and pre -adoptive placements will be reimbursed at the County Basic Maintenance level for Child Maintenance as indicated on the Needs Based Care Rate Table, designated in this exhibit as, regardless of the child's level of need. 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 within this exhibit, for children placed within the Weld County Certified Foster Care Home identified as Provider ID# 1665608. 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. 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. 4. 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. 5. All reimbursement requests shall: A. Be submitted in a format approved by the County. If submitted in an unapproved format or inadequate documentation is provided, the County reserves the right to deny payment. B. Be submitted by the 4th of each month following the month of service. If the reimbursement request is not submitted within twenty-five (25) calendar days of the month following service, it may result in forfeiture of payment. CWS-7A Individual Provider Contract 10 Revised 6/20I5 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). 6. 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. 7. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may posses, 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. CONTRACTOR SHALL: 1. Attend or participate in 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. 2. 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. 3. 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, and comply with the treatment plan of the child. 4. 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. 5. Attend all necessary school meetings and support any plan that is developed regarding the child in order to promote educational success. 6. 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. 7. Maintain, access and review information weekly on FIDOS. CWS-7A Individual Provider Contract I I Revised 6/2015 8. Read, be familiar with and agree to the terms and conditions as set forth in the Foster Parent Handbook which can be accessed through FIDOS. 9. 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. 10. Maintain/update medication logs on a daily basis, if child is taking medications. 11. Maintain behavior observation notes as required by the level of care assessed for each child. 12. 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. CWS-7A Individual Provider Contract 12 Revised 6/2015 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 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 appropriate needs with feeding, bathing, grooming, physical, 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 TI. !low often are thera. services needed to address child's individual needs ser NBC assessment? Select One NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Assessment Areas: Comment: Rating: El Aggression/Cruelty to Animals Select One ❑ Verbal or Physical Threatening Select One 0 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 ■ 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 B to the Additional Provisions 13 Revised 6/2014 . Iveeds Based Care Rate Table , Weld County�Department of Human Service (F.ffective 7(011201�) L�VELE7F : GHI1.D•�'. � £ � `ADMiN.[S"1'it�i1'IV� 4;= s1I}MP,VISTRATIY� � rMEDI�.A,G 12ESPI'�E E. , SF,RViCE = MAIt�tT�:NA�ICE � � - " ' M�Ilti7'ENA[VCE _ ., { ',#`` ° .,� '�SE1iV�C�S ; ' � 2�1E�h U� ,. . . :- .� ,, , ; � � . �. ,- . ..;: -. � . � : . . ,� _ _ ,� . ,. �� . ,,� .. .,�5 > .��, , ;, . ,.i. �, ., Leve� T3a��y R�tC Dail�ktat� �;� Dailv R��e - .`C?ai(y ltate Daily itate ° $I?.35 Cuunty Basic Age 0-10...$17.01 ,;_' $�6 y`Y No crisis inter�ention,Minimal 'F $0 f)O Ntaintenance Age I I-Id...$18 81 � �; �' Not needed or cover ---------- ' CPr1 involvement,one faco-to- - Rate Age 15-21 _S20 Q9 �s under Medicaid. face visit with child per month. ��- .,� �i ,�. �l�.77 $5.14 "` Niinimal crisis intervention as � Re ularl 5cheduled �� $�� needed.one face-to-face visit '# � y_ �` �-�'�� ' therapy up to 4 ��:. per month with child.2-3 .��, hourslmonth. '` contac[s per month '«�; � , �, :: 1 % �� $2394 �, 5.66 ��.�-. $17.48 ,,�,r ----------- ` ,�; ----------- Sl 9.20 $f 028 (�ccasional crisis intervention as �.;` u'tz�+ly scheduled - Z $'-�•�'- ��'�' needed,two face-to-tace visits g therapy 5-8 hours a "�� $4.97 � with child.2-3 contacts per �'-' month�vrth�hours of _ �� month group therapy. —-- -- ' ,., 2 '/z �.t.; �30.85 : 5.66 _,' $20.91 _� ----------- '� a ---------- �22.62 � $l 5.4? ,�; Regularly scheduted Ungoing crisis intervention as >�_ � wcekly. multiplc �k needcd,weekl fac�-to-t�ace b` 3 $3�1.27 r �.66 }� � sessions,can includc. � $6.50 vi�ils with child,an� intensive �� '�� more than I person t- cvordination of multiple � i_e. Camily therapy,tor �h, services. 9-12 hourslmonth(y, 3 1,'2 ��"a �37,69 � ` $6G �' $24 34 '� �� ----------- � �,. --------- $26.05 � *,�, 4 ="f On�;uing crisis intervention as ��T Con re ate needed,which includes high � ,� Carr $`�� 3 b 6b level of case management and � hegotiatzd `��'; Negotiated Drop Duwn ' CPA involvement wrth child and ;� provider and 2-3 face-to face ,,;, contacts per week minimum. - 'i. .§�. � S,Iti: �,t�i: ;r,�'��X ,s.;� � a�E .!� _ ��,' '� w� �:�. . . . ..: . w , ..z. , , �,k, . ..... � .. . -� i��. , ,� . . � ., .. : z . � , T:Y H,•" � .,.r.�-� ;,�� . vW ' .Assessment/ �'y Emergency ` �27.4� : $.66 �19.20 �Y�� Level Rate �^. CWS-7A Indivicival ProviderContract 14 Revised 612015 &p,,,t_tt,,x iv 0217 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A DD CHILD PLACEMENT AGENCY SERVICES (CPA) C] CHILDREN'S 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: THIS IS AN AGREEMENT, made this /at day o , 20/6-1 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services whose address is P.O. Box A, Greeley, CO, 80632, hereinafter referred to as, "County," and Whimspire CPA, whose address is 9540 E. Jewell Ave, Denver, CO 80247, hereinafter referred to as, "Contractor." THIS AGREEMENT: Shall include all children placed by County with Contractor. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the Contractor. 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 referred to as, "State Department," is authorized to provide social services to individuals and families of individuals through its agent, County Departments of Human Services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, 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 Contractor agree as follows: TERM: A. This Agreement shall be in force from July 1, 2015, until the end of the Colorado fiscal year, June 30, 2016. Any child may be removed from the facility prior to the end of the fiscal year by the cou ty department. SS -23A Agreement to Purchase Revised 6/2015 22o / �`? 3(Y-7 B. 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 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. C. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. DESCRIPTION OF SERVICES TO BE PURCHASED: A. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). B. The terms of this Agreement are contained in the terms recited in this document and in Exhibit A, each of which forms an integral part of this agreement. Exhibit A is specifically incorporated herein by this reference. County and Contractor acknowledge and agree that this Agreement, including specifically Exhibit A, defines the performance obligations of Contractor and Contractor's willingness and ability to meet those requirements. Exhibit A consists of additional provisions for the purchase of Child Placement Agency Services. C. County and Contractor shall develop an Initial Individual Plan of Care 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 Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in the Child Specific Addendum (SS23B) with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. D. County and Contractor shall formulate an initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B) included with this contract. Modifications to the Individual Plan of Care must be agreed to in writing on the plan or as a supplemental document. SS -23A Agreement to Purchase 2 Revised 62015 E, The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. 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, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the 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. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. 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 court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide 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, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide 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 Individual Plan of Care. SS -23A Agreement to Purchase 3 Revised 6t2015 H. 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 - Agreement 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 I964, 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 at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($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. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, 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 crcated thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, 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 SS -23A Agreement to Purchase 4 Revised 6/2015 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 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. In any instance of a potential adoption by a foster parent, provide 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 Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice 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 he 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 and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. 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. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. SS -23A Agreement to Purchase 5 Revised 5/2015 2. All billing by 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 SI00,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than S 100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that 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 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 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 Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, 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 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. 4. If Contractor does 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 until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 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 four (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 possible fiscal sanctions, penalties, or cancel the Agreement. SS -23A Agreement to Purchase 6 Revised 6/2015 II. PAYMENT TO CONTRACTOR: A. 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 service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. 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) and County Policy. C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. 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 Agreement 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. Invoices 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. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and 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 Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. SS -23A Agreement to Purchase 7 Revised 6/2015 G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable 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. III. TRANSPORTATION: A. 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 completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall 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. C. 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 Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. IV. LEGAL STATUS AND AUTHORIZATIONS: A. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: I. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. 2. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. 3. 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. B. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. SS -23A Agreement to Purchase 8 Revised 6/2015 C. 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 Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. D. 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. E. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Screening Department at (970) 346-7670. V, RESPONSIBILITIES OF COUNTY: A. County shall: I . 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. Monitor children's progress in accordance with the treatrnentlfamily services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. SS -23A Agreement to Purchase 9 Revised 6/2015 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. $. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA 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 the decision to recover or withhold subsequent payments as defined in rules. 9, Identify the amount agreed upon with Contractor to be paid 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. VI, GENERAL PROVISIONS: A. 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 arty 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. D. 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. C. 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. D. This Agreement is intended to be applied in conjunction with the child specific addendum and the 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 prohibiting the periodic amending of the family services plan or appending a count designed addendum to this agreement. E. The State of Colorado Department of Human Services shall be and hereby is permitted 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 Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to SS -23A Agreement to Purchase I 0 Revised 6/2015 Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. 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. G. Time is of the essence in each and all of the provisions ofthis Agreement. H. 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. I. 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. J. 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. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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 ox 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 the illegal alien within three (3) days of receiving notice. Contract Professional 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. Contract Professional 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 Contract Professional participates in the State of Colorado program, Contract Professional shall, within twenty days SS -23A Agreement to Purchase 1 l Revised 6/2015 after 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, 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. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Contract Professional 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 Contract Professional receives federal or state funds under the contract, Contract Professional must confirm that any individual natural person eighteen (IS) 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 Contract Professional 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, § 24-76.5-10I, 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. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency, 2. 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; 3. 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, 4. 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. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, 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: SS -23A Agreement to Purchase 12 Revised 6/2015 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. 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. 3. 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. O. 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. P. 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. Q. 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. R. Any amendments or modifications to this agreement shall be in writing signed by both parties. S. 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. T. Contractor shall strictly comply with all applicable federal and State laws, rules and regulations in effect or hereafter established SS -23A Agreement to Purchase 13 Revised 6/2015 U. 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. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: � deddditi1401 &C. BOARD OF COUNTY COMMISSIONERS Weld '.uty Clerk to the Beard WELD COUNTY, COLORADO Deputy APPRO ED ASTOS Elect • O fiscal or Depart SS -23A Agreement to Purchase ke Freeman, Pro—Tem OCT 12 2015 CONTRACTOR: Whimspirc CPA 9540 E. Jewell Ave Denver, CO 80247 BY: UiItttO ' d..a... "7/2q (I5 Contractor's (or designee's) Signature and Date olo <S,,s1S 61- -1) 14 Revised 6/2015 aY1 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 apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, 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 Whimspire CPA, 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#19562. 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 the County. 4. 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 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 the 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 or Team Decision making meetings. 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 the County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 5/2015 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. Exhibit A to the SS23A 2 Revised 5/2015 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? Select One 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? 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? 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 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 theraservices needed to address child's individual needs .er 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 Select One Select One Select One Presence of Psychiatric Symptoms/Conditions Enuresis/Encopresis Runaway Sexual Offenses Select One Select One Select One 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 Exhibit A to the SS23A 3 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 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: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the SS23A 4 Revised 6/2014 Needs Based Care Rate Table Weld County Department of Human Service (Effective 7/O1/2015) LE�'EL OF GHILD AD;41I1�ISTRATIVE ADbiINIST[L4TIYE t�iEDICAL SEE2VICE �11AItiTE�i�1�VCE RE9PITE ��al'�;TENANCE SER�'ICES NEEDS Level [?aily Rate Daily Rate Daily Rate Daily Rate Daily Rate ....d;. .,; r, �12.35 County Basic Age 0-10...$17.01 $6� No crisis intervention,Minimal �0.00 Maintenance Age 11-14...$18.81 Not needed or cover ---------- CPA involvement,one face-to- Rate Age 15-21...$20.09 face visit with child per month. under Medicaid. $15J7 $5.14 Minimal crisis intervention as Regularly Scheduled 1 $20.56 $.66 needed,one face-to-face visit therapy up to 4 �3.45 per month with child,2-3 hours/month. contacts per month 1 '/: $23.99 $.66 $17.48 ----------- ----------- $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'/: $30.85 $.66 $20.91 ----------- ---------- $22.62 $15.42 Regularly scheduled Ongoing crisis intervention as weekly,multiple 3 $34.27 $.66 needed,weekly face-to-face ;essions,can include $6.50 visits with child,and intensive i»ore than I person, coordination of multiple i.e, family therapy,for services. y_l2 hours/monihly. 31/2 �37.69 $.66 $24.34 ----------- ---------- $26.05 4 Ongoing crisis intervention as Congregate needed,whic6 includes high Care $41�13 ��'�' levelofcasemanagementand Negotiated Negotiated Drop Down ( PA involvement with child and provider and 2-3 face-to face '` contacts per week minimum. F:r Assessment/ Emergency $27.42 $.66 $19.20 ----------- ---------- Level Rate Exhibit A to the SS23A 5 Revised 6/2014 Esther Gesick From: Sent: To: Cc: Subject: See below Esther — Cecilia Moreno Monday, September 28, 2015 2:13 PM Esther Gesick Lesley Cobb; Jacquie Higinbotham FW: contracts Cecilia Moreno Employment Services Support Specialist Employment Services 315 N 11 Ave 8 Greeley, CO 80631 970-353-3800 ext. 6756 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Judy Griego Sent: Monday, September 28, 2015 2:11 PM To: Cecilia Moreno Subject: RE: contracts I am okay with it as long we make a notation as to why we didn't go through the pass -around and who was involved in the decision making. Keeping the emails of this exchange would be good. Judy A. Griego, Director Weld County Department of Human Services 315 N 11th Avenue BLDG B Greeley, CO 80631-2014 970.352.1551, extension 6510 Fax 970.353.5215 griegoia@weldgov.com <image003.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 2015-3273 1 From: Cecilia Moreno Sent: Monday, September 28, 2015 2:09 PM To: Judy Griego Cc: Esther Gesick; Lesley Cobb; Jacquie Higinbotham Subject: RE: contracts The 43 contracts in question are Foster Care Facility Agreements CWS-7A with Exhibit A. The thought process of Esther and Child Welfare is that Legal/Finance/BOCC have already reviewed the contract template and rate approvals so there is no reason to review them again now that they are filled out with provider information; thus developing a "fast -track" within the CMS. Do you have a different take on this? Cecilia Moreno Employment Services Support Specialist Employment Services 315 N 11 Ave 8 Greeley, CO 80631 970-353-3800 ext. 6756 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Judy Griego Sent: Monday, September 28, 2015 1:55 PM To: Cecilia Moreno Subject: RE: contracts If we bypass the pass -around process, I am wondering out loud what that means. I can't tell what type of contracts you are listing. Judy A. Griego, Director Weld County Department of Human Services 315 N 11th Avenue BLDG B Greeley, CO 80631-2014 970.352.1551, extension 6510 Fax 970.353.5215 griegoia@weldgov.com <image003.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 2 From: Cecilia Moreno Sent: Monday, September 28, 2015 1:53 PM To: Frank Haug Cc: Judy Griego; Barb Connolly; Lesley Cobb; Jacquie Higinbotham; Esther Gesick Subject: RE: contracts Frank, The contracts have actually been sitting with the originator. These are the items that Esther has deemed fast -track since the form was approved and now the signed items just need to go to consent. Frank/Barb, the contracts you can move forward without review are as follows: 192, 193, 194, 195,197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 216, 217, 218, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236. Also, please note that 185, 196, 219, are still with the originator waiting for the statement of work to be uploaded but will be considered fast -track as well. Judy, I believe Esther said these can bypass pass -around as well but I am waiting for her response to be sure. Cecilia Moreno Employment Services Support Specialist Employment Services 315 N 11 Ave B Greeley, CO 80631 970-353-3800 ext. 6756 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Frank Haug Sent: Monday, September 28, 2015 11:42 AM To: Cecilia Moreno Subject: contracts I saw several contracts had been initiated, but I don't see them on my queue, just wanted to let you know. My guess is they are with accounting or something. Frank N. Haug Assistant Weld County Attorney 1150 O Street Moiling Address: P.O. Box 758, Greeley, CO 80632 tel: (970) 356-4000 x4394 fax: (970) 352-0242 3 Hello