HomeMy WebLinkAbout20150194.tiff MEMORANDUM
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t! Ind DATE: January 8, 2015
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G 0 U N 7 Y TO: Barbara Kirkmeyer, Chair, Board of County Co ' sioners
FROM: Judy A. Griego, Director, Human Serv' s e m t
RE: Individual Provider Contract for Purp of Foster Care
Services and Foster Care Facility Agreement between the
Weld County Department of Human Services and Various
Providers to be Placed on the Consent Agenda
Enclosed for Board approval are Individual Provider Contract for Purpose of Foster Care
Services and Foster Care Facility Agreement between the Department and Various Providers.
The boiler-place agreements were reviewed under the Board's Pass-Around Memorandum dated
July 15, 2014, and approved for placement on the Board's Consent Agenda.
Below are the major provisions of the attached Agreements:
No. Facility Name/Term Facility Type/Location Daily Rate
1 Adams, Matthew and Karen County Foster Care Providers ICPC Placement—
July 1, 2014—June 30, 2015 Apex,North Carolina North Caroline Foster
Care Rates
2 Means,Nathan and Lisa County Foster Care Providers Negotiated based on
July 1, 2014 —June 30, 2015 Greeley, Colorado child needs
3 Pierce, Larry and Kris County Foster Care Providers Negotiated based on
July 1, 2014—June 30, 2015 Greeley, Colorado child needs
4 Sims, Mildred County Foster Care Providers ICPC Placement— Ohio
July 1, 2014—June 30, 2015 Dayton, Ohio Foster Care Rates
5 Smith, Stephanie and County Foster Care Providers Negotiated based on
Pults, Mark Lakewood, Colorado child needs
July 1, 2014—June 30, 2015
6 Wyatt, Justin and Tracy County Foster Care Providers Negotiated based on
July 1, 2014 —June 30, 2015 Eaton, Colorado child needs
If you have questions, please give me a call at extension 6510.
lam''a' Lfr 0 CC! / l( 7 _���y r // 2015-0194
l- l'�- 15
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INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
i
THIS AGREEMENT is made and entered into this/7 day of.?Ju4.Y, 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 Adams,Matthew and Karen,whose address is 2532
Maxton Crest Dr.,Apex,NC 27539, hereinafter referred to as, "Contractor." This Agreement
covers all children placed by County with Contractor.
W ITNESSETH:
WHEREAS,the Colorado State Department of Human Services(hereinafter referred to
as"State Department"), has certified or licensed Contractor's facility as a Family Foster
Home/Emergency Shelter Home (hereinafter referred to as"Facility"), and
WHEREAS,Contractor understands and agrees that it must, during the term hereof, hold
a valid certificate/license for the Facility,maintain certification standards,and read and be fully
familiar with the Minimum Rules and Regulations for Family Foster Home issued by the State
Department, 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 Facility's 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 be from July 1,2014, to and until June 30,2015,
or until the Facility's 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.
CWS-7A Individual Provider Contract I Revised 6/20I4
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.
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.
CWS-7A Individual Provider Contract 2 Revised 6/2014
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.
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(1IIPAA).
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
CWS-7A Individual Provider Contract 3 Revised 6/2014
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
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.
CWS-7A Individual Provider Contract 4 Revised 6/2014
3. To arrange fora 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.
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.
CWS-7A Individual Provider Contract 5 Revised 6/2014
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 ail 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 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.
CWS-7A individual Provider Contract 6 Revised 6/2014
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. Contractor certifies that Contractor is not an illegal immigrant,and further,
Contractor represents, warrants, and agrees that it has verified that Contractor does
not employ any illegal aliens. If it is discovered that Contractor is an illegal
immigrant, employs illegal aliens or subcontracts with illegal aliens, County can
terminate this Agreement and Contractor may be held liable for damages.
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.
CWS-7A Individual Provider Contract 7 Revised 6/2014
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
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.
cws-7A Individual Provider Contract 8 Revised 6/2014
WHEREFORE, the parties have herein set their hands and affixed their seals the day and
date first written above.
Sit)
i ` COUNTY:
he Board of County Commissioners of Weld
"112•4 ounty, on behalf of the Weld County Department
ATTEST:d � r ��; ;� Hum Services
Deputy rtjerk to the B.."+ c arbara Kirkmey r, Chat_
JAN 14WU
CONTRACTOR:
Approval as to Substance:
WELD COUNTY DEPARTMENT Adams, Matthew and Karen
OF HUMAN SERVICES 2532 Maxton Crest Dr.
Apex,NC 27539
By: �r 1 , �. �I�_ B � D 71
u ty P ir'ctor's in designer,s) on ractor's(or esignee's) Signature
g ature a d Date Y and Date
By: ,Wan—) Qom. r to✓ /a//0/#4
Contractor's(or designee's) Signature
and Date
APPROVED AS TO
FUNDING:
t;-4 C 1
Controoll er C '
APPROVED AS TO FORM:
County Attorney
CANS-7A Individual Provider Contract 9 Revised 6/2014
O20 - _o '?? ( i)
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT ��..``
THIS AGREEMENT is made and entered into this/ ay of AI u46 i 20 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 Means,Nathan and Lisa,whose address is 2632 15th
Ave,Greeley,CO 80631,hereinafter referred to as,"Contractor." This Agreement covers all
children placed by County with Contractor.
WITNESSETH:
WHEREAS,the Colorado State Department of Human Services(hereinafter referred to
as"State Department"), has certified or licensed Contractor's facility as a Family Foster
Home/Emergency Shelter Home(hereinafter referred to as"Facility"),and
WHEREAS,Contractor understands and agrees that it must,during the term hereof, hold
a valid certificate/license for the Facility,maintain certification standards,and read and be fully
familiar with the Minimum Rules and Regulations for Family Foster Home issued by the State
Department. 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 Facility's 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 teen of this Agreement shall be from July 1,2014,to and until June 30,2015,
or until the Facility's 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 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.
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.
CWS-7A Individual Provider Contract 1 Revised 6!?014
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2. To safely provide the 24-hour physical care and supervision of each child until
removed or until the agreement is renewed.
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.
CWS-7A Individual Provider Contract 2 Revised 6/2014
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•
i. Any information received regarding a change of address of the parents or
guardians.
I4. 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.
CV‘S-7A Individual Provider Contract 3 Revised 6/2014
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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
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:
I. 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.
CWS-7A Individual Provider Contract 4 Revised 6/2014
•
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.
I I. 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 shall be and hereby is
permitted to monitor service program, fiscal and other records sufficiently to assure
CWS-7A Individual Provider Contract 5 Revised 6/2014
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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 live 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 he 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. Contractor certifies that Contractor is not an illegal immigrant,and further.Contractor
represents, warrants, and agrees that it has verified that Contractor does not employ
any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs
illegal aliens or subcontracts with illegal aliens,County can terminate this Agreement
and Contractor may be held liable for damages.
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
CWS-7A Individual Provider Contract 6 Revised 6/2014
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•
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:
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.
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.
CW'S-7A Individual Provider Contract 7 Revised 6/2014
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WHEREFORE,the parties have herein set their hands and affixed their seals the day and
date first written above.
COUNTY:
�'°AThe Board of County Commissioners of Weld
ounty,on behalf of the Weld County Department
ATTEST: - + ' Human Services
Deputy !lerk o t '� R� 1► j Barbara Kirkmeyer, Char JAN 1 4 2015
CONTRACTOR:
Approval as to Substance:
WELD COUNTY DEPARTMENT Means, Nathan and Lisa
OF HUMAN SERVICES 2632 15th Ave
Greeley,CO 80631
By: .t �. , . / By: �..1
C u ty Dir tor's(o u esignee s) Contractor's(or designee's) Signature
igr ature a d Date and Date
By: inf2A
Contractor's(or designee's) Signature
and Date
APPROVED AS TO FUNDING:
Controller
APPROVED AS TO FORM:
.kE===>
County Attorney•
CWS-7A Individual Provider Contract 8 Revised 6/2014
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EXHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase
Foster Care Scr%ices 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 Means,Nathan and Lisa,hereinafter referred to as,"Contractor."
GENERAL PROVISIONS
I. County and Contractor agree that a child specific Needs Based Care Assessment.
designated within this exhibit as Exhibit B, 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 Exhibit C.regardless of the child's level of need.
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 the Child Maintenance level of
service, as indicated by the Needs Based Care Rate Table,designated within this exhibit
as Exhibit C. for children placed within the Weld County Certified Foster Care Home
identified as Provider ID# 1601788. 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 9 Revised 6/2014
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•
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.
8. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Contractor substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Contractor as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Human Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Human Services;
C. Recover from the Contractor any incorrect payment due to omission,error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Contractor,or by Human
Services as a debt to Human Services or otherwise as provided by law.
9. Contractor shall promptly notify Human Services 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 Human Services'
CWS-7A S-7A Individual Provider Contract 10 Revised 6/2014
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•
Director. The term"litigation" includes an assignment for the benefit of creditors.and
filings in bankruptcy, reorganizations and/or foreclosure.
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 Weld County Department of Human Services or Weld County
Department of Human Services staff 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.
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.
II. Maintain behavior observation notes as required by the level of care assessed for each
child.
12. Assure and certify that it and its principals:
A. Are not presently debarred,suspended, proposed for debarment,and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
13. 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;
C'WS-7A Individual Provider Contract 11 Revised 6/2014
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violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records,making false
statements.or receiving stolen property:
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state,or local)with commission of any of the offenses
enumerated in paragraph(B)above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions(federal,state,and local)terminated for cause or default.
13. 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.
C\t•S-7A Individual Provider Contract 12 Revised 6/2014
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• EXHIBIT B
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: Select One
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. !low much time is the provider required to intervene at home and/or at school with the child in Select One
conjunction with a regular or special education •Ian?
P4. I low 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. I low much time is the provider required to assist the child because of impairments beyond age Select One
annropriate 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
or more than one County foster child is with the same provider.
TI.How often are thera• 'services needed to address child's individual needs •er NBC assessment? Select One
NBC (NEEDS BASED CARE ASSESSMENT) - Behavioral Assessment
Assessment Areas: Comment: Rating:
O 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
B Sexual Offenses Select One
Inappropriate Sexual Behavior Select One
❑ Disruptive Behavior Select One
❑ Delinquent Behavior Select One
O Depressive-like Behavior Select One
Medical Needs-(If condition is rated"severe",please Select One
El
complete the Medically fragile NBC)
❑ Emancipation Select One
11 Eating Problems Select One
Boundary Issues Select One
Requires Night('are Select One
Education Select One
❑ Involvement with Child's Family Select One
Exhibit B to the Additional Provisions 13 Revised 6/2014
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EXHIBIT C
Weld County Department of Human Service
Needs Based Care
Rate Table
(Effective 7/01/2014)
, e f.i�` - `�i r a,,t' 4 '.r•�• S i
. . �. s
,_ yr. ,,,'C .i t �_ N
. '. r � � �CPi' . .
rIN('aunty Basic Age 0-10...516.73 $12.14 $0.00 1
aintenance ,/, Age I1-14...$18.50 d $'66 No crisis intervention,Minimal
M
Not needed or cover -^�
,°r;% CPA involvement,one face-to-
Rate g 4 Age 15.21...$19.75 /,
' face vis •it with child per month. under M vx
edicaid.
$15.51 ,.
r 55.05 et-
,.,'
' �1 Minimal crisis intervention as i ' Regularly Scheduled it',..:
1 '•F $20.22 5.66 needed,one face-to-face visit the v u to 453.31
f./., per month with child,2-3 P
- ` hours month. __
contacts per month
,�
I v: S73.59 tgii 5.66 .1'7:4>., $17.19 -------- 5-r;
r-J
a 518.88 Y s.0.„
,......
'-� Weekly scheduled
..,
Occasional crisis intervention as <x
2 Fs, 526.96 I $.66 needed.two face-to-face visits therapy 5.8 hours a $4.591
.l with child,2-3 contacts per . month with 4 hours of '.
;? fil month group therapy. r
2 / tili 530 33 1;4/.
$.66 ® $20.56itil 'fit
7113 $22 24
$15.16
: Regularly scheduled A
-,11.'",,''. Ongoing crisis intervention us weekly,multiple
3 $,3'ro needed,weekly face•tn face sessions.can include ''lit.'' So.39
5.66
visits with child,and intensive Fl more than 1 person.
coordination of multiple ' {,c family therapy,for
services. + 9-12 hnurs/monthly-
1a
31/2 ' S17 06 € $.66 5?3.93 -------0
a
91 — ...,. $25.61 i
.-, ongoing crisis intervention as kil
kg :Pi
4 '+ aF needed.which includes high
R('CF .`n- $40.44 5.66 'g' Ne�.otiated
0.$+0. *fir Icvcl of case management and ,
Drop Down ' v -r CPA involvement with child and
.. Vrtrot
:_ C-• °= provider and 2-3 face-to face
,J! ' contacts per week minimum. "i4 R,
ksscssment/ ', .r
�tsi � gg�r•
t:merl;cnc� .r $26.96 3.66 $18,88 k-
1.e%el Rate -, •.
Exhibit C to the Additional Provisions 14 Revised 612014
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
THIS AGREEMENT is made and entered into this /II day of f411440,201.
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 Pierce,Larry and Kris,whose address is 3017 54th
Ave.,Greeley,CO 80634,hereinafter referred to as,"Contractor." This Agreement covers all
children placed by County with Contractor,
WITNESSETH:
WHEREAS,the Colorado State Department of Human Services(hereinafter referred to
as"State Department"), has certified or licensed Contractor's facility as a Family Foster
Home/Emergency Shelter Home(hereinafter referred to as"Facility"),and
WHEREAS,Contractor understands and agrees that it must,during the term hereof, hold
a valid certificate/license for the Facility,maintain certification standards,and read and be fully
familiar with the Minimum Rules and Regulations for Family Foster Home issued by the State
Department,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 Facility's 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 be from July 1,2014,to and until June 30,2015,
or until the Facility's 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.
CWS-7A Individual Provider Contract 1 Revised 6/2014
2. To safely provide the 24-hour physical care and supervision of each child until
removed or until the agreement is renewed.
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. I'
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.
gene Y
h. Any pertinent discussion with parents or guardians about the child or
supervising agency.
CWS-7A Individual Provider Contract 2 Revised 6/2014
i I
i. Any information received regarding a change of address of the parents or
guardians.
14. To comply with the Civil Rights Act of 1964, Section 504,Rehabilitation Act of
1973, and the ADA of 1990,concerning discrimination on the basis of race,color,
sex,age, 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.
CWS-7A Individual Provider Contract 3 Revised 6/2014
•
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
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.
CWS-7A Individual Provider Contract 4 Revised 6/2014
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.
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 I
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 shall be and hereby is
permitted to monitor service program,fiscal and other records sufficiently to assure
CWS-7A Individual Provider Contract 5 Revised 6/2014
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.
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. Contractor certifies that Contractor is not an illegal immigrant,and further,Contractor
represents,warrants, and agrees that it has verified that Contractor does not employ
any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs
illegal aliens or subcontracts with illegal aliens,County can terminate this Agreement
and Contractor may be held liable for damages.
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
CWS-7A Individual Provider Contract 6 Revised 6/2014
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 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
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.
CWS-7A Individual Provider Contract 7 Revised 6/2014
' t
WHEREFORE,the parties have herein set their hands and affixed their seals the day and
date first written above.
t �t /` COUNTY:
\` ° a%t.The Board of County Commissioners of Weld
`ounty,on behalf of the Weld County Department
ATTEST: ii ' .t i t .j�.•'. - '� Human Services
By By:
Deputy erk to t�a�'1'4 �' Barbara Kirkmeyer, Chair JAN 1 4 2015
CONTRACTOR:
Approval as to Substance:
WELD COUNTY DEPARTMENT Pierce, Larry and Kris
OF HUMAN SERVICES 3017 54th Ave.
Greeley, CO 80634
By By: ��� � I g
unty D' ector's or desi ee's) onC tractor's r ed signa"t6re
S gnature nd Dat and Datte�/� " c
on �
By. C �hxe a_fr6A c, �/ /
on tor's(or designee's) Signature
and Date
APPROVED AS TOFU FUNDING:
Controller
APPROVED AS TO FORM:
441
County Attorney
CWS-7A Individual Provider Contract 8 Revised 6/2014
I
020/0-- O/9/_ (3)
. I
• s
EXHIBIT A to the CWS-7A
( I
Additional Provisions for the Agreement to Purchase
Foster Care Services and Foster Care Facility Agreement
CWS-7A
I I
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 Pierce,Larry and Kris,hereinafter referred to as,"Contractor."
GENERAL PROVISIONS
1. County and Contractor agree that a child specific Needs Based Care Assessment,
designated within this exhibit as Exhibit B, 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 Exhibit C,regardless of the child's level of need.
I !!!
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 the Child Maintenance level of
service,as indicated by the Needs Based Care Rate Table,designated within this exhibit
( as Exhibit C, for children placed within the Weld County Certified Foster Care Home
identified as Provider ID# 1586620. 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 9 Revised 6/2014 I�
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•
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•
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.
8. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Contractor substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Contractor as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
•
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Human Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Human Services;
C. Recover from the Contractor any incorrect payment due to omission,error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Contractor,or by Human
Services as a debt to Human Services or otherwise as provided by law.
I +
9. Contractor shall promptly notify Human Services 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 Human Services'
CWS-7A Individual Provider Contract 10 Revised 6/2014
Director. The term"litigation" includes an assignment for the benefit of creditors,and
filings in bankruptcy, reorganizations and/or foreclosure.
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 Weld County Department of Human Services or Weld County
Department of Human Services staff 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.
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. Assure and certify that it and its principals:
A. Are not presently debarred,suspended,proposed for debarment,and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain,or performing
a public(federal, state, or local)transaction or contract under a public transaction;
CWS-7A Individual Provider Contract 11 Revised 6/2014
•
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery,bribery, falsification or destruction of records, making false
statements,or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity (federal, state,or local)with commission of any of the offenses
enumerated in paragraph (B)above.
D. Have not within a three-year period preceding this Agreement,had one or more
public transactions(federal, state, and local)terminated for cause or default.
13. 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 6/2014
• • w
LXHIBIT B
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: Select One
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 Select One
conjunction with a regular or special education plan?
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
or more than one County foster child is with the same provider.
T1.How often are therapy services needed to address child's individual needs •er NBC assessment? Select One
NBC (NEEDS BASED CARE ASSESSMENT)—Behavioral Assessment
Assessment Areas: Comment: Rating:
❑ Aggression/Cruelty to Animals Select One
8 Verbal or Physical Threatening Select One
Destructive of Property/Fire Setting Select One
❑ Stealing Select One
O 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 complete
Needs-(If condition is rated"severe",please Select One
complete the Medically fragile NBC)
❑ Emancipation Select One
-O Eating Problems Select One ,
❑ Boundary Issues Select One
❑ Requires Night Care Select One
❑ Education Select One
❑ Involvement with Child's Family Select One
� I
Exhibit B to the Additional Provisions 13 Revised 6/2014
.
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EXHIBIT C
Weld County Department of Human Service
Needs Based Care
Rate Table
(Effective 7/01/2014)
County Basic I-2:i. I $12.14 ( $0.00 �LL
• $.66 , • No crisis intervention,• Minimal i
Maintenance ;,.y Age 11-14..$18.50 3 CPA involvement,one face-to- Not needed or cover .: --------
Rate , Age 15-21-..$19.75 i ,I under Medicaid- a ,
'i : face visit with child per month.
t +; t $15.51 $5.05
'` 1 Minimal crisis intervention as Re ularl Scheduled
1 ' $20.22 $.661:.',''',I, needed,one face-to-face visit € 8 y $3.39
Sztherapy up to 4
per month with child,2-3 hours/month.
contacts per month " '""
1 c .. $2159 1 $.66 $17.19 a ________ •
1 _______
N..* .1 Sr a-
a -1 ;� $18.88 $10.11
'� i -~1 Occasional crisis intervention as • Weekly scheduled ••�;!
2 i:�3� $26.96 �} $.66 ", needed,two face-to-face visits therapy 5.8 hours a 'RI $4.89
i.' •4 with child,2.3 contacts per 1 month with 4 hours of r
month group therapy. Tf
y
. fi+j
2'A $30.33 i `,v $-66 - $20.56 d ------ j
4 , . $22.24 $15.16
S ; ,c ' Regularly scheduled
Ongoing crisis intervention as 1
weekly,multiple
3 $33.70 $,66 needed,weekly face-to-face `, sessions,can include j $6.39
I visits with child,and intensive
: more than 1 person,
}1 coordination of multiple r ,
i.e.family therapy,for
'' �, f services. 9-12 hours/monthly.
312 1 $37.06 •_ $.66 $23.93 x -------- '.r .--.....
--;:I 1 $25.61
SI
tr Ongoing crisis intervention as ;J
•
4 - needed,which includes high
RCCF $40.44 $.66 level of case management and ------- ', Negotiated '',...
Drop Down 4 -t, 1 CPA involvement with child and I,..
j E•, provider and 2-3 face-to face
'' -1
contacts per week minimum.
r 'i
Assessment/ z .
IX
Emergency �� $26.96 ', $66 ', $18.88 I t ° '�
Level Rate f IIii -.1i
1
Exhibit C to the Additional Provisions 14 Revised 6/2014 !,
I
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•
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
EM
THIS AGREEMENT is made and entered into this / -'day of�i ll4eY•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 Sims,Mildred,whose address is 5604 Troy Villa
Blvd,Dayton,OH 45424, hereinafter referred to as,"Contractor." This Agreement covers all
children placed by County with Contractor.
WITNESSETH:
WHEREAS, the Colorado State Department of Human Services(hereinafter referred to
as"State Department"), has certified or licensed Contractor's facility as a Family Foster
Home/Emergency Shelter Home(hereinafter referred to as"Facility"),and
WHEREAS,Contractor understands and agrees that it must,during the term hereof, hold
a valid certificate/license for the Facility,maintain certification standards,and read and be fully
familiar with the Minimum Rules and Regulations for Family Foster Home issued by the State
Department,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 Facility's 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 be from July 1,2014,to and until June 30,2015,
or until the Facility's 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 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.
CWS-7A Individual Provider Contract I Revised 6/2014
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U. AGREEMEN
TS OF THE PARTIES:
A. Contractor agrees:
to eligible children at the
h esta ished county bad theased
1 To furnish foster care services
type of facility and individual child rates negotiated be
twen provider•
child until
envision of each
provide the 24-hour physical care and sup
2. To safely P agreement is renewed. agency.
removed or until the ag in 1�censing
dren ony with the approval of the certify €�
;, To accept chill resentatives,and
with the County Department or its rep
cooperate fhey ent of the Family Service Pl and or hill enrin
t ansition
4. To parents,sibling
participate in the development
with their
placement,including uman
to another foster care facility. ds of care as set by the State Department of H
5. To maintain approved standards
Serf ices.
6. To keep confidential the information shared about the child and his/Vier faint Y�
7. Not to accept money from parents or guardians.
8 Not to make any independent agreement
with parents or guardians.
' d to anyone without prior authorization from the
9. Not to release the child home and to
Department.
10.To allow representatives of the County Department to
reasonable time•
t in an emergency,to
see the child at any Department
Department two weeks notice,except
c h the County
l l•To give the County DeP placement.
remove a child for placement elsewhere and to
as requested in preparing the child for the next p professional
fprowonal
of transportation to be provided ilf l be
transportation to the child toenable the utilization o
12.To provide The amount mutual agreement
when necessary• be changed upon Services o Plan.
e
services upon at placement and may
agreedrthe County Department.as recorded in the Family provider and
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.
Revised 6/2014
CWg_7q Individual Provider Contract
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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.
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
CWS-7A Individual Provider Contract 3 Revised 6/2014
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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
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.
CWS-7A Individual Provider Contract 4 Revised 6/2014
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3. To arrange fora 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.
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.
CWS-7A Individual Provider Contract 5 Revised 6/2014
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Ill. 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 1-luman 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.
CWS-7A Individual Provider Contract 6 Revised 6/2014
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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. Contractor certifies that Contractor is not an illegal immigrant,and further,
Contractor represents,warrants,and agrees that it has verified that Contractor does
not employ any illegal aliens. If it is discovered that Contractor is an illegal
immigrant,employs illegal aliens or subcontracts with illegal aliens, County can
terminate this Agreement and Contractor may be held liable for damages.
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.
CWS-7A Individual Provider Contract 7 Revised 6/2014
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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:
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.
CWS-7A Individual Provider Contract 8 Revised 6/2014
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WHEREFORE,the parties have herein set their hands and affixed their seals the day and
date first written above.
COUNTY:
The Board of County Commissioners of Weld
County,on behalf of the Weld County Department
ATTEST: E t t �of Human Services
By `..'•r`w>,'i�1� ' BY
Deputy clerk to 1 42015
Barbara Kirkme er,
Chair JAN
CONTRACTOR:
Approval as to Substance:
WELD COUNTY DEPARTMENT Sims, Mildred
OF HUMAN SERVICES 5604 Troy Villa Blvd
Dayton, OH 45424
By: By:
C y irec or's(or ignee' Contractor's(or designee's) Signature
g ature an Date and Date /a--N2p & (Hy
By:
Contractor's(or designee's)Signature
and Date
APPROVED AS TO FUNDING:
0 -taC4•L)
(.Ort1
Controller
APPROVED AS TO FORM:
'lk:==>
County Attorney
CWS-7A Individual Provider Contract 9 Revised 6/2014
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020/5 o/91(�
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
THIS AGREEMENT is made and entered into this q day of Oc#ober , 2014
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,Stephanie and Pults, Mark,whose address is
25 Yukon St.,Lakewood,CO 80226, hereinafter referred to as, "Contractor." This Agreement
covers all children placed by County with Contractor.
WITNESSETH:
WHEREAS, the Colorado State Department of Human Services(hereinafter referred to
as"State Department"), has certified or licensed Contractor's facility as a Family Foster
Home/Emergency Shelter Home(hereinafter referred to as"Facility"), and
WHEREAS, Contractor understands and agrees that it must, during the term hereof,hold
a valid certificate/license for the Facility, maintain certification standards, and read and be fully
familiar with the Minimum Rules and Regulations for Family Foster Home issued by the State
Department,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 Facility's 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 be from July 1,2014,to and until June 30,2015,
or until the Facility's 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.
CWS-7A Individual Provider Contract l Revised 6/2014
0,0/5-0/9/(5)
2. To safely provide the 24-hour physical care and supervision of each child until
removed or until the agreement is renewed.
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.
CWS-7A Individual Provider Contract 2 Revised 6/2014
i. Any information received regarding a change of address of the parents or
guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of
1973,and the ADA of 1990, concerning discrimination on the basis of race, color,
sex, age, 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.
IS. 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.
CWS-7A Individual Provider Contract 3 Revised 6/2014
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
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.
CWS-7A Individual Provider Contract 4 Revised 6/2014
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.
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 shall be and hereby is
permitted to monitor service program, fiscal and other records sufficiently to assure
CWS-7A Individual Provider Contract 5 Revised 6/2014
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.
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. Contractor certifies that Contractor is not an illegal immigrant,and further,Contractor
represents,warrants, and agrees that it has verified that Contractor does not employ
any illegal aliens. If it is discovered that Contractor is an illegal immigrant,employs
illegal aliens or subcontracts with illegal aliens,County can terminate this Agreement
and Contractor may be held liable for damages.
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
CWS-7A Individual Provider Contract 6 Revised 6/2014
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:
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.
CWS-7A Individual Provider Contract 7 Revised 6/2014
WHEREFORE,the parties have herein set their hands and affixed their seals the day and
date first written above.
COUNTY:
E lida
the Board of County Commissioners of Weld
• , iy.unty,on behalf of the Weld County Department
. Human Services
ATTEST: it61
1� ;`iJz� — t�
J •ni* ��
By ,� I L. � 3r�f���f By:
Deputy lerktothe." ,�.. ' Barbara Kirkm yer, Chair
JAN 1 4 2015
CONTRACTOR:
Approval as to Substance:
WELD COUNTY DEPARTMENT Smith,Stephanie and Putts, Mark
OF HUMAN SERVICES 25 Yukon St.
Lakewood, CO 80226
By: s : G
o ty Dire tor's( r design 's) s(or designee's) Signature
ig ature an Date and Date Q��
By: El��—F- '
Contractor's(or designee's) Signature
and Date
/APPROVED AS TO FUNDING:
—thalet a eax,,a____
Controller
APPROVED AS TO FORM:
County Attorney
CWS-7A Individual Provider Contract 8 Revised 6/2014
c,1o%T o/4V (5)
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 Smith,Stephanie and Pults,Mark, hereinafter referred to as,
"Contractor."
GENERAL PROVISIONS
1. County and Contractor agree that a child specific Needs Based Care Assessment,
designated within this exhibit as Exhibit B, 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 Exhibit C,regardless of the child's level of need.
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 the Child Maintenance level of
service,as indicated by the Needs Based Care Rate Table,designated within this exhibit
as Exhibit C, for children placed within the Weld County Certified Foster Care Home
identified as Provider ID# 1645696. 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 4t'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 9 Revised 6/2014
•
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.
8. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Contractor substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Contractor as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Human Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Human Services;
C. Recover from the Contractor any incorrect payment due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Contractor,or by Human
Services as a debt to Human Services or otherwise as provided by law.
9. Contractor shall promptly notify Human Services 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
CWS-7A Individual Provider Contract 10 Revised 6/2014
administrative agency, shall deliver copies of such document(s)to the Human Services'
Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
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 Weld County Department of Human Services or Weld County
Department of Human Services staff 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.
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. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment,and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement,been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain,or performing
CWS-7A Individual Provider Contract 11 Revised 6/2014
a public (federal, state,or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft,forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state,or local)with commission of any of the offenses
enumerated in paragraph (B)above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions(federal, state,and local)terminated for cause or default.
13. 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 6/2014
EXHIBIT B
I 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.
r Pl. How often dots the child require transportation by the foster care provider for the following: Select One
Therapy; Medical Treatment; Family Visitation;Extraordinary Educational Needs;etc.,as outlined
in the treatment plan? _ --j
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 Select One
conjunction with a regular or special education plan?
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?
�AI. 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
or more than one County foster child is with the same provider.
T1.How often arc ther . services needed to address child'• individual needs • r NBC assessment? Select One
NBC (NEEDS BASED CARE ASSESSMENT)-Behavioral Assessment
Assessment Areas: Comment: Rating:
111Aggressiotu'Cruelty to Animals Select One—.l-❑ Verbal or Physical Threatening Select One
❑ Destructive of Property/Fire Setting j Select One
Select One
El Steal ing Select One
(] Self injurious Behavior
❑ `Substance Abuse
Select One
B
Presence of Psychiatric Symptoms/Conditions Select One
Enuresis/Encopresis Select One
0 ' Runaway Select One
• Sexual Offenses Select One
Inappropriate Sexual Behavior Select One
Disruptive Behavior Select One
Delinquent Behavior Select One
L Depressive-like Behavior Select One
Medical Needs-(if condition is rated"severe",please Select One
El complete the Medically fragile NIIC)
C] Emancipation Select One 7
Eating Problems Select One
Boundary Issues Select One
Requires Night Care Select One
Education Select One
0 Involvement with Child's Family Select One
Exhibit B to the Additional Provisions 13 Revised 6/2014
EXHIBIT C
Weld County Department of Human Service
Needs Based Care
Rate Table
• (Effective 7/01/2014)
$12.14 $0.00
5.66
County Basic Age 0-10.316.73 "' No crisis intervention.Minimal
Maintenance Age II-14...$18.50 Not needed or cover --------
Rate Age 15-21...$19.75 - CPA involvement,one face-to- under Medicaid.
face visit with child per month.
$15.51 $5.05
Minimal crisis intervention as Regularly Scheduled
I $20.22 $.66 needed,one face-to-face visit therapy up to 4 $3.39
per month with child,2.3 hours/month.
contacts per month
1 % $23.59 $.66 $17.19 ----•— --------
$18.88 $10.11
Occasional crisis intervention as Weekly scheduled
2 $26.96 $.66 needed,two face-to-face visits therapy 5-8 hours a $4.89
with child,2-3 contacts per month with 4 hours of
month group therapy.
2•% $30.33 5.66 $20.56 -------- -------
$22.24 $15.16
Regularly scheduled
Ongoing crisis intervention as weekly,multiple
3 $33.70 $.66 needed,weekly face-to-face sessions,can include $6.39
visits with child,and intensive more than I person,
coordination of multiple i.e.family therapy,for
services. 9-12 hours/monthly.
3 la $37.06 $.66 $23.93 ---•-- -------
$25.61
Ongoing crisis intervention as
4 needed,which includes high
RCCF 540.44 $.66 level of case management and — Negotiated
Drop Down CPA involvement with child and
provider and 2-3 face-to face
contacts per week minimum.
Assessment/
Emergency $26.96 $.66 $18.88 ----__ --._---
Level Rate
Exhibit C to the Additional Provisions 14 Revised 6/2014
INDIVIDUAL PROVIDER CONTRACT
FOR PURPOSE OF FOSTER CARE SERVICES
AND
FOSTER CARE FACILITY AGREEMENT
THIS AGREEMENT is made and entered into this z5-day of 59INIIMY 20 /S
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 Wyatt,Justin and Tracy,whose address is 418
Dogwood Ct.,Eaton, CO 80615, hereinafter referred to as, "Contractor." This Agreement
covers all children placed by County with Contractor.
WITNESSETH:
WHEREAS, the Colorado State Department of Human Services (hereinafter referred to
as"State Department"), has certified or licensed Contractor's facility as a Family Foster
Home/Emergency Shelter Home (hereinafter referred to as "Facility"), and
WHEREAS, Contractor understands and agrees that it must, during the term hereof, hold
a valid certificate/license for the Facility,maintain certification standards, and read and be fully
familiar with the Minimum Rules and Regulations for Family Foster Home issued by the State
Department, 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 Facility's 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 be from July 1,2014, to and until June 30, 2015,
or until the Facility's 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.
CWS-7A Individual Provider Contract 1 Revised 6/2014
0o /S— oi9 (G)
2. To safely provide the 24-hour physical care and supervision of each child until
removed or until the agreement is renewed.
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.
CWS-7A Individual Provider Contract 2 Revised 6/2014
i. Any information received regarding a change of address of the parents or
guardians.
14. To comply with the Civil Rights Act of 1964, Section 504, Rehabilitation Act of
1973, and the ADA of 1990, concerning discrimination on the basis of race, color,
sex, age, 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.
CWS-7A Individual Provider Contract 3 Revised 6/2014
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
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.
CWS-7A Individual Provider Contract 4 Revised 6/2014
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.
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 shall be and hereby is
permitted to monitor service program, fiscal and other records sufficiently to assure
CWS-7A Individual Provider Contract 5 Revised 6/2014
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.
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. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor
represents, warrants, and agrees that it has verified that Contractor does not employ
any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs
illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement
and Contractor may be held liable for damages.
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
CWS-7A Individual Provider Contract 6 Revised 6/2014
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:
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.
CWS-7A Individual Provider Contract 7 Revised 6/2014
WHEREFORE, the parties have herein set their hands and affixed their seals the day and
date first written above.
COUNTY:
\IL, sThe Board of County Commissioners of Weld
�� 'county,on behalf of the Weld County Department
ATTEST: , !� uman Services
161
By
Deputy,ir Jerk tot !f rl \ �` Barbara Kirkm yer, Ch 'r JAN 1 4 2015
CONTRACTOR:
Approval as to Substance:
WELD COUNTY DEPARTMENT Wyatt,Justin and Tracy
OF HUMAN SERVICES 418 Dogwood Ct.
Eaton,CO 80615
By: By:
C t ty Direc or's(o signee' C n ctor's(or signee's) Signature
g ature an Date an Date
Bctk
Contractor'' r d signe ) ignature
and Date
APPROVED� AS TO&141
FUG:
Controller
APPROVED AS TO FORM:
County Attorney
CWS-7A Individual Provider Contract 8 Revised 6/2014
020 /at O/9' (4)
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 Wyatt, Justin and Tracy, hereinafter referred to as, "Contractor."
GENERAL PROVISIONS
County and Contractor agree that a child specific Needs Based Care Assessment,
designated within this exhibit as Exhibit B, 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 Exhibit C, regardless of the child's level of need.
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 the Child Maintenance level of
service, as indicated by the Needs Based Care Rate Table, designated within this exhibit
as Exhibit C, for children placed within the Weld County Certified Foster Care Home
identified as Provider ID# 1601806. 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 9 Revised 6/2014
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.
8. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Contractor substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Contractor as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Human Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Human Services;
C. Recover from the Contractor any incorrect payment due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Contractor, or by Human
Services as a debt to Human Services or otherwise as provided by law.
9. Contractor shall promptly notify Human Services 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 Human Services'
CWS-7A Individual Provider Contract 10 Revised 6/2014
Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
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 Weld County Department of Human Services or Weld County
Department of Human Services staff 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.
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. Assure and certify that it and its principals:
A. Are not presently debarred, suspended,proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not,within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local) transaction or contract under a public transaction;
CWS-7A Individual Provider Contract 11 Revised 6/2014
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
13. 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 6/2014
EXHIBIT B
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: Select One
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 Select One
conjunction with a regular or special education plan?
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 impainnents 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
or more than one County foster child is with the same provider.
TI. How often are thera services needed to address child's individual needs •er NBC assessment? Select One
NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment
Assessment Areas: Comment: Rating:
U Aggression/Cruelty to Animals Select One
_ Verbal or Physical Threatening Select One
Destructive of Property/Fire Setting Select One
Stealing Select One
U Self-injurious Behavior Select One
U Substance Abuse Select One
U Presence of Psychiatric Symptoms/Conditions Select One
❑ Enuresis/Encopresis Select One
O Runaway Select One
U Sexual Offenses Select One
❑ Inappropriate Sexual Behavior Select One
n Disruptive Behavior Select One
❑ Delinquent Behavior Select One
Depressive-like Behavior Select One
❑ Medical Needs-(If condition is rated"severe",please Select One
complete the Medically fragile NBC)
❑ Emancipation Select One
1J Eating Problems Select One
❑ Boundary Issues Select One
n 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
EXHIBIT C
Weld County Department of Human Service
Needs Based Care
Rate Table
(Effective 7/01/2014)
..ii. n br irF��i. , -
•
•L f - NIIS
._.. $.66 No cnstsintenenhon.M .. ._ . .-..:'
x ._. $ 14
County Basic Age 0-10...$16.73 d . •. L.. $0.00. . Minimal L": 1:.,
Maintenance Age 11-14...$18.50 ,b,,,. Not needed or cover
CPA involvement,one face-to- r, under Medicaid. .Rate Age 1541...$19.75 x' $1 . . ,r,-
- _+1 face visit with child per month. 4
r'
!^ $15.51 $5.05
A Minimal crisis intervention as 'itlye, Regularly Scheduled '`-
1 • $20.22 '_Y 5.66 if• needed,one face-to-face visit C $3 3v
• therapy up to 4 F.-.
per month with child,2-3 hours/month.
', t
contacts per month r r
1 $23.59 ?�d: $.66 $17.191.".i.! =:>
•
$18sg z , $10.11 ;_
W, Occasional crisis intervention as t. Weekly scheduled F
2 •. $26.96 •, ' $66 needed,two face-to-face visits therapy 5-8 hours a $4.89
with child,2-3 contacts per "'e. month with 4 hours of "i...,,
month :li group therapy. it
yLT
2 '/_ $30.33 .n $.66 $20.56 F_a--
" 333? $22.24 r $15.16 `:,
q ''' W,,:* Regularly scheduled ppS,�
Ongoing crisis intervention as Gr.
weekly,multiple Y-1'.
3 $33.70 $.66
• needed,weekly face-to-face 4'
sessions,can include Fir. $6.39
•
visits with child,and intensive t9
:-' more than 1 person, kvk�.,:
coordination of multiple i:,' i.e.family therapy,for c'i?
services. . 9-12 hours/monthly. u.,,..
31/2 $37.06 , $.66 $23.93 +'^ i b
•
$25.61
Ongoing crisis intervention as a
4 I needed,which includes high ≥-
RCCF $40.44 $.66 .`m. level of case management and `'�' ,, Negotiated
Drop Down - • CPA involvement with child and I'Ji
• 4 ': ' provider and 2-3 face-to face
,-, contacts per week minimum.
...,,p.�+as.,$'�'"3PatEWATvA +' .. ..L'...y..„.4 t.� lc., : .i�!"'... ..,. . . ..• ..at W I i a ,...... ...._..,a�.'J
Assessment/ 'w '
Emergency Pa. $26.96 gym* $.66 $18.88 r,
Level Rate '' ,, •,•:. it'=
Exhibit C to the Additional Provisions 14 Revised 6/2014
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