HomeMy WebLinkAbout20163310.tiffCOLORADO
1 Office of Children,
Youth & Families
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SS -23A Agreement to Purchase
Revised 10/15
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT
SERVICES SS23A
CHILD PLACEMENT AGENCY SERVICES (CPA)
CHILD HABILITATION RESIDENTIAL PROGRAM (CHRP)
GROUP HOME/GROUP CENTER CARE
INDEPENDENT LIVING
PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF)
RESIDENTIAL CHILD CARE FACILITY (RCCF)
RESIDENTIAL DRUG/ALCOHOL PROGRAM
SHELTER CARE
SUBSIDIZED ADOPTION
TRANSITION/HOME BASED AFTER -CARE (RCCF)
OTHER (DESCRIBE): _
THIS IS AN AGREEMENT, made this o`/111
day of
6_,t, 00/(0
between Weld County Department of Social/Human Services, PO Box A, Greeley, Colorado,
80632, hereinafter called "County" and Quality Life Services LLC, 11975 Reed Street, Broomfield, CO
80020, hereinafter called "contractor"
THIS AGREEMENT:
Shall include all children placed by Weld County Department of Social/Human Services and
placed with Quality Life Services LLC.
A child specific addendum, identifying individual service needs, must be completed and
attached to supplement this agreement for each child being served by the facility. If this
is a CPA placement, the child specific addendum should also address how administrative
services will be provided in the event the child is placed for adoption in a foster home
supervised by the CPA.
WHEREAS, the Colorado State Department of Human Services, hereinafter called "State
Department" is authorized to provide social services to individuals and families of
individuals through its agents, County Departments of Social/Human Services, and
WHEREAS, the County is authorized to purchase certain services for eligible children
under State Department rules, and
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John W, Hu kentooper, Ggvernor Reggie Bicha. Executive Director
/o -ate i6
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2016-3310
WHEREAS, the County wishes to provide these services by purchasing them from
Contractor, and,
WHEREAS, the Contractor is licensed as a Child Placement
Care Facilit , certified Agency, Residential Child
Y Psychiatric Residential Treatment Facility, or meets the
requirements for other licensed service types.
NOW THEREFORE, it is hereby agreed that in consideration of
the mutual undertakings
the County and the Contractor agree as follows:
Nkg
1. This Agreement shall be in force from the date of the agreement,
g nt,
July 1, 2016, until the end of the Colorado fiscal ear, June
An y be � childy � 30, 20l 7.
may rem oved from the facility prior to the end of the fiscal
year by the county department.
2. This Agreement may be renewed only by entering into
Agreement such as this Agreement a new w written
signed by the authorized
representatives of the parties. Except as otherwise provided above, either
party shall have the right to terminate this contract by giving the
party thirty (30) days other
notice by registered mail, return receipt requested. If
notice is so given, this contract shall terminate
erminate on the expiration of the
thirty (30) days or until the eligible child(ren) can be placed
whichever occurs first, elsewhere,
and the liability of the parties hereunder for further
performance of the terms of this Agreement shall thereupon cease, , but the
parties shall not be released from the duty to perform their obligations
to the date of termination. up
3. This Agreement is in lieu of and supersedes all prior agreements g ents between
the parties hereto and relating to the care and services herein des
cribed.
SECTION I: DESCRIPTION OF SERVICES TO BE PURCHAS
ED:
1. The total rate of payment for care and services under this A reem
the established rate for the PRTF; f g ent shall not exceed:
or 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 placementsthe agreed
service proposal rate. The total rate of a p � geed upon
payment for care and services for other service
types will be as negotiated between the County and the Contractor. Medicaid
govern activities to be covered in the daily rules shall rate paid to PRTFs.
The amount paid for purchased care and services for less than a full
month will be based
upon the daily rate.
2. Payment for a child's temporary absence from the facility, inc l
hos italization wil uding absence due to
p l be made in accordance with State Department rules in Staff
Volume VII, 7.406.1, F (12
CCR Manual
2509-5).
3. Transportation shall be furnished by County between the child's
Id s residence and
Contractor's facility for the initial placement and return after the treatment plan is
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� dhs
John W. Nickentooper, Governor I Reggie Bicha, Executive Director
2
rn
completed. If the child runs away from the Contractor's facility, the County shall provide
transportation to either return the child to the facility or to other care as arranged by the
County. The County has responsibility for the decision to return the child to the facility,
'
with input from the Contractor. l ity,
4. All other transportation associated with the Contractor's proposed services
provided by Contractor. Any transportation p p will be
costs not covered or contemplated in the
original treatment plan must be negotiated between County and Contractor and nd 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
Care. Plan of
5. Any transportation costs to be incurred on behalf of a child in placement, w
be bone by persons, or agencies, which are to
which are not a party to this contract, shall be specified
in the treatment/service plan, and thosepersons shall . acknowledge their responsibility by
signing the treatment/service plan.
SECTION II: LEGAL STATUS AND AUTHORIZATIONS:
1. Such permission as is held by the County is hereby granted to the Contracto
r to
authorize routine or emergency medical and dental treatment except that:
a. Medical or dental care shall be provided by personnel duly licensed by law
required by the State of Colorado. as
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 y
g County and Contractor. Medicaid
rules shall govern activities to be covered in the daily rate paid to PRTFs.
2. County and Contractor shall insure that the child(ren) is enrolled in the Early and
Periodic Screening, Diagnosis and Treatment Program.
3. It is agreed and permission is granted for the child(ren) to participate in
recreational and social activities of p p planned
activities Contractor, including supervised off grounds
excursions and extended trips within the State, provided that Contractor has wr
itten
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
cutive
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 p rents or
guardians of the child placed with the Contractor. Any planned absence of more
hours for children placed in a PRTF isthan 24
not Medicaid reimbursable.
4. County and Contractor shall inform each other and the local school district
of any
changes in parental residence affecting educational status which comes attention. to their attention.
SECTION III: REASONS FOR REFERRAL, TREATMENT PLAN,
AND PROGRESS
REPORTS:
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John W. Hickenlooper, Governor l Reggie Bicha, Executive Director
3
1. County and Contractor agree and understand that the reasons
necessitatefor referral, which
purchasing se rvices for children are specified in the attached child s ecific
addendum and Family Services Plan. Any other relevant inf p
children that does not necessitate u ormat�on concerning these
p rchasing services is also included in the addendum.
2. County and Contractor shall develop an initial plan that addresses
esses the immediate
and/or emergency needs of the child within 72 hours of admission children for children in RCCFs
or group homes except PRTF. County and Contractor shall formulate an '
s 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 attached child specific
addendum included with this contract. The Child's Family Service • -
as an Individual Plan of Plan may be utilized
Care for this purpose for facilities. Modifications to this plan
shall be agreed to in writing on the plan or as a supplemental
pp document.
3. County and Contractor shall formulate an initial individual plan
PRTFs within 72 hour p of care for children in
s. 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 attached '
' child specific
addendum included with this contract. Modifications to this plan shall be agreed to in
writing on the plan or as a supplemental document.
4. The individual plan of care shall be goal oriented and time -limited an
d shall:
a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with
clinical and other needs including the child's presenting problems, physical
health, emotional status, behavior, support system in the community,
resources, and discharge plan. available
b. Include specific goals and measurable objectives, expected dates
achievement, specific P of
p discharge and transitional/after-care and follow up services
criteria to be met for termination of treatment.
c. Specify the type, frequency, and duration of clinical therapy services,
rehabilitation services, medication in
itial
management, emergency services,
assessment, documented treatment modifications, and other services determined
to be necessary to meet the child's specific ec i fi goals.
d. Specify that all therapeutic services are necessary to meet the needs child
of the child
and to treat the child's current diagnosis.
e. Identify the provision of, or the referral for, services other than RC
and shall document any CF services
y court ordered treatment including identifying the agency
responsible for providing the court ordered treatment. g y
f. Anticipated living arrangement for the child at the date of discharge;
g. Anticipated educational arrangement for the child at the time of discharge;
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g
John W. Hickentooper, Governor I Reggie Bicha, Executive Director
4
h. Anticipated date for discharge from treatment purchased for the child.
i. A permanency goal for the child.
5. Monthly, Child Placement Agencies, RCCFs and other contractor types other than
PRTF, shall conduct a monthly review p
of each plan to evaluate whether the short-term
and long-term goals have been achieved or not achieved. These parties shall provide the
County with written reports which address
p 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 made to achieve
progress e e goals
specified in the treatment plan. Further, the Contractor agrees to sequence reports to be
received by the County 15 calendar days prior
p
y to or administrative hearings or
reviews when provided with 30 calendar days advance notice of such dates by County.
.
6. Every 14 days, PRTFs shall provide the County with written reports which address
changes to the child's physical condition, psychological and social functioning, changes
chan es
in the child's family situation, educational progress, significant incidents or disciplinary
p y
actions, and progress made to achieve goals specified in the treatment plan.
SECTION IV: CONTRACTOR SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of
Human Services, the Colorado Department of Health Care Policy and Financing ( if
appropriate), the State of Colorado and any applicable federal laws and regulations, as
such, which may be amended from time to time, and shall be binding on Contractor and
control any disputes in this Agreement.
2. Maintain a current license and maintain license requirements as specified under State
law and rule.
3. Not charge any fees to children or families of children referred by county for
any
services provided under this Agreement.
4. Not assign the obligations under this Agreement nor enter into any sub -contract
without the express written approval of the Director of the County Department or his/her
appointed designee.
5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act
of 1964, Section 504 of the Rehabilitation Act of 1973,
3, Title XX of the Social Security
Act of 1975 as revised, and provide confidentiality of information concerning the child in
compliance with the Health Insurance Portability ' '
and Accountability Act (HIPAA).
6. Maintain during the term of this Agreement a liability insurance policy of at least
$25,000 for CPAs and $400,000 for P p y PRTFs, and RCCFs for property damage liability,
$150,000 for injury and/or damage to any one person, and $600,000 for total injurie
s
es
arising from any one accident.
7. Maintain during the terms of this Agreement an insurance policy or a fidelity bond in
1575 Sherman Street, 2nd Floor, Denver , CO 80203 P 303-866-5932 F 303-866-5536 www.cotorado.gov/cdhs
_John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
5
I
i
I
an amount deemed sufficient by the county, covering the activities of any of
ees responsible for its officers,
agents, or employees pthe implementation and/or administration of this
contract in order to make reparations for any wrongful acts, omissions, or
defalcations of the Contractor.any other
8. Indemnify County, Colorado Department of Human Services, Colorado Department of
Health Care Policy & Financing, and the State of Colorado against an
all claims and actions ba g y and loss against
sed upon or arising out of damage or injury, including death, to
persons or property caused or sustained in connection with the performance of this
contract or by conditions created thereby, or based upon any violations of any � statute,
ordinance, or regulation and the defense of any such claims or actions.
Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county
departments.
9. In regards to University of Colorado contractors only, the contractor shall I be
responsible for its own wrongful or negligent acts or omissions or those of its offi
cers,
agents, or employees while performing their professional duties to the full extent allowed
the foregoing,
by law. Notwithstanding g g, nothing in this Agreement is a limitation or
waiver of the application of the Colorado Governmental Immunity set Act forth -
l n §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
which will sufficiently records,
and properly reflect all direct and indirect costs of any nature
incurred in the performance of this Agreement. The
g above shall be subject at all
reasonable times to inspection, review or audit by federal, Colorado Department p nt of
Human Services, Colorado Department of Health Care Policy & Financing,
authorized • • g, or county
personnel, and other
persons ed in writing by the Executive Director of the
Colorado Department of Human Services.
11. Contractor shall, in any instance of a potential adoption by a foster parent,pr
ovide prov lde the
initial home study, the SAFE study update, annual certification updates
requested by the p and related
materials when
County within fourteen working days of the request. At
all other times the Contractor shall make home studies and related materia
ls available to
the County for review, at a location agreed upon by the County and the Contractor,
during regular business hours.
12. Bill the County for services rendered, using the required form. This form
mailed to the County by the last day of is to be
the month of care. Billings for PRTFs shall be
made to the MMIS System only. Billings for RCCF fee -for —service and CH
made to either the MMIS System RP shall be
y or the County. Billings for RCCFs daily rate, CPAs and
other contractor types shall be made to the County only. Contractor '
when y will not be paid by
the county billing is not received by the County within 30 calendar days following
the billing due date. y
13. Attend and participate in Administrative Reviews for children in
placement with the
Contractor pursuant to two (2) weeks written notice by the County. y The Contractor shall
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John W. Hicicenlooper, Governor I Reggie Bicha, Executive Director
6
encourage children over the age of twelve to attend their Administrative Reviews._
Participation may be in person or by teleconference.
14. The Contractor shall pay the foster parent the amount agreed upon with the county as
the child maintenance or room and board. Any payment to the foster parent in excess of
the child maintenance or room and board amount shall be treated as income to the foster
parent.
15. The Contractor shall have the on -site presence of at least one (1) official who has
received State training in how to use and apply the reasonable and prudent parent
standard and who, with respect to any child or youth placed at the Contractor's facility, is
designated to be the caregiver authorized to apply the reasonable and prudent parent
standard to decisions involving the participation of the child or youth in age or
developmentally -appropriate activities. In the case of a Foster Care Home certified by a
Child Placement Agency, Contractor agrees that each foster parent has received State
training in how to use and apply the reasonable and prudent parent standard to decisions
involving the participation of the child or youth in age or developmentally appropriate
activities.
16. Contractor shall ensure that each foster parent or caregiver authorized to apply the
reasonable and prudent parent standard receives sufficient, ongoing training to continue
to use and apply the reasonable and prudent parent standard for each child or youth
placed in the foster home or facility.
SECTION V: COUNTY SHALL:
1. Determine eligibility of the children under this Agreement for placement and medical
coverage. Medicaid rules and regulations shall govern determination of Medicaid
eligibility.
2. Assess and collect fees in accordance with the rules and regulations of the Colorado
Department of Human Services.
3. Reimburse Contractor by the 15th of the following month in accordance with fiscal
system time frames for services purchased under this Agreement in accordance with the
established rate when billing is submitted as described in Section IV, Number 10
(above).
4. Abide by all the rules and regulations of the Colorado Department of Human Services,
federal rules and regulations and the laws of the State of Colorado, any of which may be
amended from time to time.
5. If this agreement covers an initial placement for a child, the Contractor may receive a
clothing allowance in accordance with State Department rules.
6. Monitor children's progress in accordance with the treatment/family services plan and
the requirements of Colorado Department of Human Services rules and provide
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John W. Hickenlooper, Governor I Reggie Bicha, Executive Director
•
consultation to Contractor in relation to the services purchased
under this Agreement.
7. Invite Contractor to Administrative Reviews at least 2 weeks '
prior to the scheduled
review.
8. Involve Contractor in planning for the child andgive the
Family Services Plan Contractor a copy of the
at time of placement or as soon as completed and when updated • p d or
revised.
9. The County shall seek recovery from the RCCF, CPA or
other contractor type for any
non -Medicaid payment amounts that have been misused as defined
may withhold subsequent in rules. The County
q payments to recover any funds misused by the RCCF, CPA or
other contractor type. The County shall seek recovery of any '
due the County for the benefit remaining funds as a debt
of the state. The RCCF or CPA may appeal the decision t
recover or withhold subsequent payments a ments as defin p o
ed in rules.
10. The County shall identify the amount agreed upon with th
the foster arent for thp e Contractor to be paid to
p e child's room and board. Such amount will be the same as
in Trails for the child's maintenance. shown
1 1. Reimbursement rates that are negotiated between the County and the Contractor shall
be for allowable costs in one or more of four primary components: child maintenance,
administrative services, administrative maintenance, and treat
ment. Contractor type will
determine which of these four components will be included in
the reimbursement rate.
12. The County shall provide the Contractor with a copy of the e policy that identifies
activities that providers trained in the reasonable and prudent
approve, and identifies activitip parent standard may
es that require County department approval.
13. The County shall require that the person(s) authorized to apply the reasonable and
prudent parent standard, including each foster parent, will complete mplete State training
specific to the reasonable and prudent parent standard and will receive ongoing training
as necessary in order., to meet the needs of each child or youth, and to use
reasonable and prudent parent standard. and apply the
SECTION VI: GENERAL PROVISIONS:
1. The Parties to this Agreement intend that the relationship betty
by this Agreement is that of em 1 een them, contemplated
p oyer independent contractor. No agent, employee, or
servant of Contractor shall be deemed to be an employee, y agent, or servant of the County.
Contractor will be solely and entirely responsible for its acts or of any agent, employee,
servants and sub -contractors during the performance of this Agreement.
g nt.
2. Payment pursuant to this Agreement, if in State of Colo
rado, county, or federal funds,
whether in whole or in part, is subject to and contingent
of State of Colora g upon the continuing ava�laiblity
do, county, and federal funds for the purpose thereof.
3. It is agreed that if, after investigation, it is shown that rea
sonable care was given to
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.gov/cdhs
John W. Hickeniooper, Governor I Reggie Bicha, Executive Director
8
guard and protect personal items brought to Contractor by the children, Contractor will be
released from responsibility for loss or damage to such personal items.
4. This Agreement is intended to be applied in conjunction with the child specific
addendum and family services plan as the complete integration of all understandings
between the parties. No prior or contemporaneous addition, deletion or other amendment
hereto shall have any force or affect whatsoever, unless embodied herein in writing. No
subsequent notation, renewal, addition, deletion, or other amendment hereto shall have
any force or effect unless embodied as a part of this written Agreement. This section shall
not be construed as either prohibiting the periodic amending of the family services plan
or appending a county designed addendum to this agreement.
5. The contract shall permit the State Department to monitor service program, fiscal and
other records sufficiently to assure the purchase of services in this Agreement are carried
out for the benefit of the aforementioned client. Monitoring may occur through review of
program reports, on -site visits where applicable and other contracts as deemed necessary.
The Contractor understands that the State Department may provide consultation to
Contractor to assure satisfactory performance in the provision of purchased services
under this Agreement.
a. All reimbursement requests shall be submitted to and approved by the
appropriate County staff Reimbursement for placement services shall be paid
from the date of admission up to, but not including, the day of discharge.
Furthermore, Medicaid payments for PRTF and CHRP placements are permitted
on the day of discharge in compliance with regulations promulgated by the
Colorado Department of Health Care Policy and Finance. Fee for Service will be
reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to
funds encumbered in this contract and shall also include Medicaid funds for
PRTF and RCCF therapeutic services and CHRP services paid by the
Department of Health Care Policy and Financing. Payment for placement
services will not be provided for clients on "runaway" status unless the County
has previously approved it. Reimbursement requests for therapy costs for clients
enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the
Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal
Agent. The Contractor shall forward copies of such billings to the County on a
monthly basis.
In the event that a Contractor receives payment for a per diem discharge day,
regardless of funding source, the Contractor shall refund those dollars forthwith.
b.The purpose of these requirements is to provide minimum assurance that the
Contractor has adequate accounting and budgeting information available to allow
management to maintain a financially viable enterprise and to demonstrate
financial accountability to the county departments of human/social services and
Colorado Department of Human Services for the use of public funds.
(1) The Contractor must have in place a double entry accounting system and all
financial transactions must be posted to this system. Financial statements,
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John W. Hickentooper, Governor I Reggie 6icha, Executive Director
9
prepared from information provided by this system, shall be presented in
conformity with U.S.
y generally accepted accounting principles (GAAP). The
Contractor must also have adequate time keeping and cost allocation systems to
allocate salary cost and indirect cost to a Y
appropriate cost centers. Books and
records of the 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.
el.
(2) All billing by the contractor must be in a format approved by the fiscal agent
or county. Contractors must bill the fiscal agent and county at least once a
month. Contractors may bill twice a month, on the 15th and last day of the
month, for services rendered. Bills will be
returned unpaid if the bills do not
conform to the approved format or the documentation is inadequate.
(3) All Contractors whose total annual expenditures are $100,000 or more shall
submit an annual audit of their financial statements by an independent certified
public accountant. Contractors with P
total annual expenditures less than $100,000
may submit an audit as described above or may submit compiled or reviewed
financial statements, prepared in accordance with generally accounting
accepted P
principles. If the Contractor is a government agency that has an independent audit
done by another agency of that government,P
g Y 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
Department P copy
provided to the Colorado De
p ent of Human Services (Attn: Administrator
for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs days after the contractor's � within 1 80
fiscal year end. The audited financial statements and
supplementary information defined in regulation for various agencies shall be
presented as described in Section VI, g
B (1), above and must contain sufficient
detail to provide evidence of financial accountability under the terms of this
contract and controlling state regulations. Contractors that are a subsidiary of a
parent organization must submit separate financial p statements for the subsidiary
that detail each of the Contractor's facilities and/or programs that provide
Department of Human Services services
for the Colorado
and also must provide a
reconciliation of these financial statements to the consolidated financial
statements of the organization as a whole. When applicable, the Contractor must
comply with the audit requirements found in the Single Audit Act of 1984 and the
Single Audit Act Amendments of 1996 and U. S. Office of Management and
Budget (OMB) Circular A-133, Audits of g
States, Local Governments, and Non -
Profit Organizations including subsequent revisions, and appropriate ro riate audit and
financial reporting requirements as defined in State laws, rules, and regulations. g s.
(4) If Contractors do not submit their annual audit or refuse to disclose financ
ial
ial
information regarding the operation of the program in a timely manner, th
e he Fiscal
Agent may withhold payment until the audit and/or requested information q is
submitted. If the contractor is a CPA, then sanctions of the contractor may occur
for failure to submit.
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John W. Hickentooper, Governor I Reggie Bicha, Executive Director
10
(5) In cases where documentation does not exist to support audit information or
services provided, contractor will be required to repay all funds received for
which documentation does not exist.
(6) In cases where audit deficiencies are noted, a plan of corrective action shall
be submitted to the State Department's Audit Division for approval within 4
months of the date of the audit.
(7) Failure to comply with any of these requirements, including items on the
addendum is justification for the County to impose fiscal sanctions, penalties, or
cancel the contract.
6. In the event this contract is terminated, final payment to the Contractor may be
withheld at the discretion of the County until final audit. Incorrect payments to the
Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the
Contractor either by deduction from subsequent payments under this contract or other
contracts between the County and the Contractor or by the County, as a debt due to both
the State of Colorado, the Colorado Department of Human Services and the County. The
waiver of any violation shall not be construed as a waiver of any other or subsequent
violation of this contract or appropriate statutes and regulations.
WHEREFORE, the parties have herein set their hands and affixed their seals the day and
date first written above.
COUNTY:
ATTEST: G; p� _ BOARD OF COUNTY COMMISSIONERS
Weld C my Clerk to the Beard WELD COUNTY, COLORADO
By:
Deputy` Jerk tom! ' �:. �� Mike Freeman, Chair
'CONTRACTOR:
OCT 2 4 2016
Quality Life Services LLC
11975 Reed Street
Broomfield tO 80020
By:
ontractor's (or designee's) signature
and Date
ity Life Service
11975 Reed Street Suite 1
Broomfield, CO 80020
1575 Sherman Street, 2nd Floor, Denver, CO 80203 P 303-866-5932 F .303-866.5536 www.colorado.gov/cdhs
John W. Hickentooper, Governor I Reggie Bicha, Executive Director
11
•
EXHIBIT A to the SS23A
Additional Provisions for the Agreement to Purchase
Out -of -Home Placement Services SS23A
For the Purchase of
Child Placement Agency Services
The following additional provisions of this Exhibit apply to the agreement ' pp Y g entitled, "Agreement
to Purchase Out -of -Home Placement Services SS23A, attached hereto, by and between een the Board
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, to as, "`Contractor."
hereinafter
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 servic
es, 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 child
ren
placed within the CPA identified as Provider ID#32066. These services will be fo
r
children who have been deemed eligible for social services under the statutes, rules
u es and
regulations of the State of Colorado.
I
I
I
I
0
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3. If a child is deemed eligible for the Children's Habilitation Residential Program g (CHRP)
waiver, Contractor agrees to accept the assessed waiver service rate billable throug
h the
MM IS system and the federal SSI rate billable through the County.
Y
4. All bed hold authorizations and payments are subject to a 7 day maximum for a child's
child s
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from Count ' q
y s Department Administrator before
payment will be release to provider.
5. A minimum of one polygraph test per Colorado fiscal year, if needed by the
child, 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
�thin
the negotiated provider rate, will need to be authorized, in writing by County,prior p or to the
service being performed. Any payment for specialized services not authorized ' writing
will be denied.
in wri
7. Contractor agrees to have appropriate personnel available to attend or ar ' ' p tic�pate in
Family Engagement, Team Decision Making meetings, or court hearings.
g g 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
duration of placement.
shorten the
Exhibit to the SS23A 1
Revised 6/2016
9. Contractor agrees to have physical examinations completed within 14 days and dental
examinations completed within 8 weeks of the child being placed with Contractor. All
documentation of these examinations shall be forward to County.
10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP)
for youth designated as a Special Education Student every 3 years and coordinate reviews
every year. If the IEP is due while the child is in placement, the Contractor shall
complete or obtain a completed IEP. A copy will then be forwarded to the County.
11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities
and Child Placement Agencies are not eligible to receive clothing allowances as outlined
in the Weld County Department of Human Services Policy and Procedure Manual.
12. County shall have access to Contractor's financial records as they relate to this Agreement
for purposes of audit. Such records shall be complete and available for audit 90 days after
final payment hereunder and shall be retained and available for audit purposes for at least
five years after final payment hereunder.
13. Time is of the essence in each and all of the provisions of this Agreement.
14. Neither party to this Agreement shall be liable to the other for delays in delivery or failure
to deliver or otherwise to perform any obligation under this Agreement, where such
failure is due to any cause beyond its reasonable control, including but not limited to Acts
of God, fires, strikes, war, flood, earthquakes or Governmental actions.
15. Any notice required to be given under this Agreement shall be in writing and shall be
mailed or delivered to the other party at that party's address as stated above.
16. This Agreement and the provision of services hereunder shall be subject to the laws of
Colorado and be in accordance with the policies, procedures. and practices of County.
17. This Agreement is nonexclusive and County may engage or use other contractors or
persons to perform services of the same or similar nature.
18. Contract Professional certifies, warrants, and agrees that it does not knowingly employ or
contract with an illegal alien who will perform work under this contract. Contract
Professional will confirm the employment eligibility of all employees who are newly
hired for employment in the United States to perform work under this Agreement, through
participation in the E -Verify program or the State of Colorado program established
pursuant to C.R.S. §8-17.5-102(5)(c). Contract Professional shall not knowingly employ
or contract with an illegal alien to perform work under this Agreement or enter into a
contract with a subcontractor that fails to certify with Contract Professional that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform
work under this Agreement. Contract Professional shall not use E -Verify Program or State
of Colorado program procedures to undertake pre -employment screening or job applicants
while this Agreement is being performed. If Contract Professional obtains actual
knowledge that a subcontractor performing work under the public contract for services
knowingly employs or contracts with an illegal alien Contract Professional shall notify the
subcontractor and County within three (3) days that Contract Professional has actual
knowledge that a subcontractor is employing or contracting with an illegal alien and shall
terminate the subcontract if a subcontractor does not stop employing or contracting with
Exhibit to the SS23A
Revised 6/2016
the illegal alien within three (3) days of receiving notice. Contract
t Professional shall not
terminate the contract if within three days the subcontractor provides '
establish that the subcontractor information to
o has not knowingly employed or contracted with an illegal
alien. Contract Professional shall comply with reasonable requests g
an investigation, undertaken q s made in the course of
g pursuant to C.R.S. §8-17.5-102(5), by the Colorado
Department of Labor and Employment. If Contract Professional '
program, Contract Professional participates in the State of
Colorado 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
and not altered or falsified p of the documents,
the identification documents for such employees. Contract
Professional shall deliver to County, a written notarized affirmation '
the legal work status of that it has examined
g such employee, and shall comply with all of the other
requirements of the State of Colorado program. If Contract Profession
with an uirement of al fails to comply
Y re q this provision or of C.R.S. §8-17.5-101 et seq., , may
CountY
terminate this Agreement for breach, and if so terminated, Y
ed, Contract Professional shall be
liable for actual and consequential damages.
Except where exempted by federal law and except as provided in C.
if Contract Professional r R.S. § 24-76.5-103(3),
eceives federal or state funds under the contract, Contract
Professional must confirm that any individual naturalperson eighteen
older is lawfully present in g en (18) years of age or
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 '
(a) is a citizen of the United States or is p Y perjury y that it:
otherwise lawfully present in the United States
pursuant to federal law, (b) shall produce one of the forms of identification required
C.R.S. § 24-76.5-101, et seq., and (c) shall equired by
q produce one of the forms of identification
required by C.R.S. § 24-76.5-103 prior to the effective date of the con
tract.
19. Contractor assures and certifies that it and its
principals:
a. Are not presently debarred, suspended, proposed for debarment and
ineligible or voluntarily � declared
excluded from covered transactions by a federal
department or agency;
b. Have not, within a three-year period of preceding this Agreement, g reem
ent, 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
a public (federal, state, or local) transaction p g obtain, or performing
or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
, falsification
theft, forgery, bribery, or destruction of records, making false
statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly char
government entity ged by a
state, or local) with commission of any of the offenses
enumerated in paragraph ( ) above;ra h B
d. Have not within a three-year period preceding this Agreement, g ree
ment, had one or more
public transactions (federal, state, and local) terminated for cau
se or default.
20. In addition to terminating this Agreement, in accordance with ' the provisions of the
attached Agreement, the County may exercise the following remedial
r dial actions County find
and determine that Contractor actor has substantially failed to satisfy the scope of work found
p in
Exhibit to the SS23A
3
Revised 6/2016
the Agreement, any
Addendum Exhibit, the child specific
• Substantial failure to P 'c addendum SS23B
Addendum.
or improper satisfy the scope of or the Needs Bean
activities or inaction P work shall be defined Care
include, but r are not limited by the Contractor. to mean
to, anyfolloi These remedial
one or more of the following:
actions
a. Withhold payment ng'
to Contractor until performance are satisfactorily
the necessar services actorily completed. y vices or corrections in
b. Deny payment
or recover reimbursement f
have not been performed for those s
and which due services or deliverables which
the cannot be e of performed would be o . caused by Contractor
Payment shall be reasonably f no value to Count
deliverables lost to onably related to County. denial of
County.the amount of work or
c. Recover from Contractor any incorrect
and/or defalcation by payment to Contractor du
Agreement, fraud,
or other deducting from subsequentate omission,
agreements between payments
County, or orofotherwise Count and under this
as provided by law. Y Contractor, or as a
debt to
21. It is expressly understood
this and agreed
Agreement, and r' g that the enforcement of the terms and conditionstherelatingtoenforcement, of
shall be
Agreement shallgive or their assignees, strictly
included or allow any claim g , and nothing contained
Agree in this Agreement. or right of action in this not any entity other g meet. It is the express whatsoever by any o
than the undersigned p s intention of the undersigned Cher person
benefits under this g ed parties or their gery parties
Agreement shall be assignees receiving p s that
an incidental beneficiary g services or
22. No portion oft only.
his Agreement she
including those provided shall be deemed to c
seq., as P dell by the Colorado constitute a waiver
applicable now or Governmental [ of any immunity
possess amended, that the I I r 1 et
a duty may � nor shall any parties or their
of care that did portion of this Agreement officers or
createdto Anot previously exist with p meat be deemed son not to
Agreement. respect tohave
Agreement The parties hereto any e
t is intended to circumvent acknowledge and agree person a party
or replace such immunities.
that no pan of this
23. Contractor shall unities.
respondent promptly notify County
in a which involves in the event in which it
within case, services provided is a party defendant
five (5) calendar days after under the agreement. or
Contractor, othr pleading which has Y being served The or agency, been filed in any with a summons
shall copies of � federal or state • , complaint,
"`litigation" includes deliver P such documents to court or r.administrative
hdes an assignment document(s) the County p;r.
reorganizations des ar f- t for the benefit o f creditors,
ector. The term
foreclosure.
editors, and filings g bankruptcy,
24. Any amendments
or modifications to this
parties. agreement shall be in writinsigned by both
25. Financial obligations gations of the Count
upon l for that y payable after the
purpose current fiscal year are
upon
funds of this being appropriated, budgeted contingent
e available.
Agreement by dgeted and otherwise
County to expend f County does not create made o
funds not otherwise an obligation
appropriated in each g on the part of
succeeding year.
Exhibit to the SS234
4
Revised 6/2016
•
Exhibit to the SS23A
26• Contractor agree
agents °r s that it is an rode
benefits fromployees will independent Contractor and
count not become employees that Contractor'
perform its duties y as a result of the of Count S officers,
hereunder execution of this Agreement. nor entitled to perform
tt for its acts and as an independent g Bement any employee
pursuant to those pendent Contractor. Contractor
responsible
to this Agreement. Contractor,
on of its agents and em tractor shall
unemployment nt tractor employees for shall be solely
shall not, its employees and agents all acts perforn1ed
pay for or insurancetworkers' are et
ern Y otherwise provide benefits t not entitled to
plo ees,through such coverage for Contractor County and County
County reserves the right t or any or its a
• gents or
policy, or other proof ° require the Contra
of insurance le rdiscretion. to provide
at its sole a cent ficate
of insurance,
S
Revised 6;2016
Needs Based Care
NBC (NEEDS BASED Assessment
Answers to the
closest r � following CAREASSESSMENT)
atin for this questions will
P1. How —__child. determine the
often does the child The followin
Therapy; Medical reseven 7 NBC Care Payment. For
Treatment :;;—nsportation �estiong are
in the treatmentby the foster car `r-nutull, eXclusich question w
p • lan? Family Visitation; Belo
2. How often is the Extraordinary e provider for the V -a - p/ease select
sessions? foster care Educational follow;n: the
P3. How Provider required to Needs; etc., Select One
much participate outlined
time is the rovider Pate in child'
con "unction s thera
with a re_ War or equ�rcd to i PY or counseling
p4' How often does the s I ecial education
at home
and child re uc---won elan? a and/°rat school
quire special and extensive with the
monitorin • child n
of time and/or involvement
P5. How much time activities and/ b the rovi
a is the or crisis der in scheduling
r° riate needs provider re mana •
with feeding,required to assist the child ement?
bathing, because
Al. How often is grooming, physical of impairments be o»d a e
Note: The Y case mans occupational therapy?
group Case Management
required?
Bement level may be °Does
not include
or more than assessed on a therapy)
Ti. How often are they Count foster child
�s with combined basis if a siblingro
dress child's individual
BASED CARE AS needs .er 1V
Assessment ASSESSMENT)
BC assess,,,e
❑ ent Areas: nt.
Tj ' Behavioral
A : ression/Cruelt to
Verbal or Ph Animals Assessment
Destructive of s�cal Threatenin •
pro.e
❑ Stealin: /Fire Settin •
■ Self-in•urious
Substance Behavior �-
Abuse
Presence of Ps chiatric
Enuresis/
Enco . resis S m •toms/Co
-___ Runawa toms/Conditions
Sexual Offenses
I»a,'ro a riate
Dis Sexual Behavior
Sexual Behavior
Delin. uent Behavior
Depressive like
Medical - Behavior
Needs - (If condition
complete the
Medically fragile'NBC) +severe"
Emancipation ) ' Please
I of
Eatin . Problems
Bound. Issues
Re. uires Ni • ht Care
Education
Involvement
with Chil
Iibit A to the SS23A
i ly
6
Comment:
Select One
Select One
Select One
Select One
Select pie
Select One
Ratin .
Select One
Select One
Select One
One
Select1ec- t
One
Select One
Select One
Select One
Select One
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Select One
Select One
Select One
Select One
Select One
Se/ect One
Select One
Select One
Select One
Revised 6/2014
S
O
•
•
104
Ado do
n Services
Other: NA
Provider a
Needs Based Care Assessment
Re9RS
WELD COUNTY D
ted Services from ge
Please Indicae ncy
i he following info ni4 t. e services a r
ton thate will be reflected
requested
d on the for this child.
(Please be specific) child sp
ecific contract.
green to work with famil
Therapeutic Y
Individual T
Service: Services funded through
gh Medicaid F
Grow. ra.Fee for
Thera.
Interactive Grou, Thera
a,
.va a • '
Ps choloical T
Pharmacolo , iestin
Trea _ cal Mana
cal
not fund ement
Home Based Intervention
b Medicaid Fee
n[ervention
MST Multi -S ste for Se'��
Offense S.e ci fimtc Thera '
c Treatment
Drug and Alcohol Treatment
aI Urine Anal
aj Sexual sis/pru_ Screenin: Br
Abuse Victimization eathal ter
Inde,endent nation Treat
n_ Skills ►Went
Livi
An_er Mana-ement Trainin
Behavior Modification
BehavioralServices
Recreation Assessment
Case Services
Mana • e►ne ---�_
Attend Court rat
fleari .
Trans�..t_tion: To include:
:s
'veils 'vels of Care:
Provider Level:
Case Mana
Ther Bement Level:
apy Level:
Date Staffed:
.tpa n ts:
its•
hibit A to the SS23A
7
a
❑
at
ats
■
imm
a
a
awn
aim
❑
V
'El
a
Medical Services
Doctor/Dentist
Medc A
anon ointment CoOrdin
service) Evaluation (not anon
Medication covered under fee for
Monitoring
Nursin • ServicPh es/Coordination
Osician ServiCeS/Co
cc
u,ation ordination
al Thera
S,eeCh Thera
,
Child
Find
Other:
Education:
On -Grounds School
Coordinate
Public Assessment f
School Attendance
S,eeCh Thera,
Attend S •eclat Education Meetin . s
Visitation
Coordination
Monitor .hone
Trans. calls and comes.. ndenc
oration for famil /.arent/
Other: e
Other: child visits
Imte • reter Se
Other: n'iCeS
Revised 6/2014
Level
County Bask
Maintenance
Rate
1
1Y
2
2 1.4
3
3 112
4
'ongrega to
Care
prop Down
pssment/
',regency
'l Rate
Exhibit A to the SS23A
Needs Based Care Rate e Table
Weld County Department of Hu
(Effective 7/01/2015) an Service
$12.35
No crisis intervention, Minimal
CPA involvement one face-to-
face visit with child per month.
$15.77
Minimal crisis intervention ration as
one face-to-face
per month with child, visit
contacts '
per month
$19.20
Occasional crisis interve
needed ration as
two face-to-face visits
with child, 2-3 contacts per
month
$22.62
Ongoing crisis intervention as
needed, weekly
visits with child face-to-face
intensive
coordination of m Itipl
e
services.
$26.05
Ongoing crisis intervention as
needed, which includes high
level ofcase
management and
CPA involvement with child and
provider and 2-3 face -t
contacts o face
per week minimum.
8
Daily Rate
$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 1 person,
i.e. family therapy, for
9-12 hours/monthly.
Revised 6/2014
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