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Home My WebLink About20151006.tiff MEMORANDUM 186i , ti�ll r`! = DATE: March 23, 2015 �E TO: Barbara Kirkmeyer, Chair, Weld County Board of Commissioners O - (( �/ v. T FROM: Judy A. Griego, Director, Human Sergi essepa`rt nt iJ l RE: Agreements to Purchase Out-of-Home Placement Services between the Weld County Department of Human Services and Various Providers to be Placed on the Consent Agenda Enclosed for Board approval of additional Provisions for the Agreements to Purchase Out-of-Home Placement Services between the Department and Various Providers. The boiler-plate Agreements were reviewed under the Board's Pass-Around Memorandum dated May 22, 2014, and approved for placement on the Board's Consent Agenda. The additional provisions are to the following agreements: No. Provider/Term Facility Name Daily Rates 1 A Kidz Hope lIomes, Inc. Child Placement Agency Services $95.00 (Provider ID #1531612) Group Home/Group Center Care July 1, 2014— June 30, 2015 Services Colorado Springs, Colorado • 2 Arapahoe House Residential Child Care Facility $186.18 (Provider ID #88692) Thornton, Colorado July 1, 2014 —June 30, 2015 3 New Start Youth Services, LLC Child Placement Agency Services $16.73 — (Provider ID #1528224) Pueblo, Colorado $40.44 July 1, 2014 —June 30, 2015 4 "Fuming Point Center for Youth Group Home/Group Center Care $183.36 (Provider ID #1616504) Services July 1, 2014—June 30, 2015 Fort Collins, Colorado If you have any questions, give me a call at extension 6510. /1 c k 2015-1006 C I C �4--1.3o?ors 4 - 1`- 'g Hgo 8 co t + AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A E] CHILD PLACEMENT AGENCY SERVICES(CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM(CHRP) N GROUP HOME/GROUP CENTER CARE O INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) O RESIDENTIAL CHILD CARE FACILI'T'Y(RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: iRR -01 THIS AGREEMENT is made and entered into this /V day of meg-- , 20/5 , by and between the Board of County Commissioners of Weld County,on behalf of the Weld County Department of Human Services,whose address is P.O. Box 758, hereinafter referred to as,"County,"and A Kidz Hope Homes Inc.,whose address is 1401 W Colorado Ave, Colorado Springs,CO 80904, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESS ETH: WHEREAS,the Colorado State Department of Human Services,hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services,and WHEREAS,County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS,County wishes to provide these services by purchasing them from Contractor,and WHEREAS,Contractor is licensed as a Child Placement Agency, Residential Child Care Facility,certified Psychiatric Residential Treatment Facility,or meets the requirements for other licensed service types. NOW,THEREFORE, 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. SS-23A Revised 6.2014 / oh +-t.OO' Q 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. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions,"which is attached hereto and referred to herein as"Exhibit A.' B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children,are specified in the Child Specific Addendum (SS23B)and Family Services Plan.Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes,except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes,except PRTF. The placement date is that date noted in Child Specific Addendum(SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum(SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time-limited and shall: 1. Address all areas listed in Section 7.714.4,C, 2, (12 CCR 2509-8)together with clinical and other needs including the child's presenting problems, physical health, emotional status,behavior, support system in the community, available resources, and discharge plan. SS-73A Revised 6 2014 2 2. Include specific goals and measurable objectives,expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency,and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment,documented treatment modifications,and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of,or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly,Child Placement Agencies, RCCFs and all other Contractors, other than PRTF,shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition,psychological and social functioning, changes in the child's family situation,educational progress,significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen(15)calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30)calendar days advance notice of such review dates by County. G. Every fourteen (14)days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning,changes in the child's family situation, educational progress, significant incidents or disciplinary actions,and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services,the Colorado Department of Health Care Policy and SS-23A Revised 6/2014 3 Financing(if appropriate),the State of Colorado and any applicable federal laws and regulations, as such,which may be amended from time to time,and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub- Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised,and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act(HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least$25,000 for CPAs($400,000 for PRTFs and RCCFs)for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least$25,000 or two(2)months gross receipts, whichever is greater,covering the activities of any of its officers,agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts,omissions,or any other defalcations of Contractor. 8. Indemnify County,the Colorado Department of Human Services, Colorado Department of Health Care Policy&Financing, and the State of Colorado,against any and loss against all claims and actions based upon or arising out of damage or injury, including death,to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby,or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6,7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents,or employees while performing their professional duties to the SS-23A Revised 6/2014 4 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records,documentation and other records,which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection,review or audit by federal,Colorado Department of l luman Services,Colorado Department of Health Care Policy& Financing,or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent,provide the initial home study,the SAFE study update,annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review,at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to he mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only.Billings for RCCF fee-for-service and CHRP shall be made to either the MM1S System or the County. Billings for RCCFs daily rate,CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty(30)calendar days following the billing due date. 13.Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two(2)weeks written notice by the County.Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14.Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. SS-23A Revised 6`2014 5 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements,prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles(GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject,at any reasonable time,to inspection,audit or copying by appropriate Federal, State or county personnel,or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are$100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements,prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs,RCCFs,and CPAs must be completed and a copy provided to the Colorado Department of Human Services(Attn: Administrator for PRTFs,and RCCFs and Attn:Audit Division Director for CPAs)within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall he presented as described in Section VI, B (1),above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S.Office of Management and Budget (OMB)Circular A-133, Audits of States,Local Governments, and Non- Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner,the Fiscal SS-23A Revised 6,2014 6 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA,then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted,a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four(4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties,or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF;for CPA placements,the negotiated rate or the approved vendor rate; for RCCF placements,the established Fee-for-Service rate and the negotiated rate or the approved vendor rate;and, for CI IRP placements,the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F(12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to,but not including,the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway"status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in SS-23A Revised 6/2014 7 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source,Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission,error, fraud,or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado,the Colorado Department of Human Services and the County.The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child,Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components:child maintenance, administrative services,administrative maintenance,and treatment.Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility,County shall provide transportation to either return the child to the facility or to other care as arranged by County.County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must he negotiated between County and Contractor and are not subject to reimbursement under this Agreement. I lowever, provisions for payment of other transportation may be provided for in the Family Service Plan/ Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement,which are to be borne by persons,or agencies,which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/servicc plan. SS-23A Revised 6/2014 8 D. Transportation may include, but is not limited to;visitation with family members, medical/dental or mental health appointments,extracurricular activities,court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS2313. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment,except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery,ophthalmology services, eyeglasses,orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening,Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren)to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven(7)days within a consecutive 30-day period. Such written permission may be in the treatment/service plan. Further,Contractor and County will also secure,where possible,permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person-to-person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker,supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non-regular work hours,weekends and holidays,Contractor will contact the Emergency Duty Worker at the pager number(970) 304-2749. SS-23A Revised 6/2014 9 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV,Number 10(above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2)weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF,CPA or other Contractor type for any non- Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF,CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. SS-23A Revised 6/2014 10 VII. 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,the SS23B, 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,the SS23B,and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement,Exhibit A, the SS23B,and the Needs Based Care Addendum arc intended to be in lieu of and supersedes 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. SS-23A Revised 6/2014 11 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 public transactions(federal, state,and local)terminated for cause or default. SS-23A Revised 6/2014 12 N. En addition to terminating this Agreement, in accordance with the provisions of Section I., above,County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A,the SS23B,and 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 he of no value to County. Denial of the amount of payment shall he reasonably related to the amount of work or deliverables lost to 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. SS-23A Revised 6/2014 13 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 .� `• ,L�;�k. County, on behalf of the Weld County Department ATTES' of Human Services if4 •,•• 13y Deput} Clerc to , Barbara Kirkmeyer, hair ,,PP 1 3 2015 1561 � •icsaNTRACTOR: Approval as to Substa i WELD COUNTY DE MT 7'"�, A Kidz Hope Homes Inc. OF HUMAN SERVICE ti +�d •:i�' `;.' 401 W Colorado Ave "� Colorado Springs,CO 80904 By: iitt �r�y�,f/&1& I C11ft h l my Di ector's( r desi ee's) Director's (or designee's)Signature Si ature nd Date and Date SS-23A Revised 6/2014 14 O64 -/066(1) APPROVED AS TO SUBSTANCE: SEE PREVIOUS PAGE Elected Official or Department Head N/A Director of General Services APPROVED AS TO FU DING: Contro er APtj FO Cou torney EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A,by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services,"hereinafter referred to as,"County,"and A Kidz Hope Homes Inc.,hereinafter referred to as,"Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services,which are listed in this Agreement at a rate of$95.00, per day for children placed within the Group Home/Group Center identified as Provider ID#1531612. These services will be for children who have been deemed eligible for social services under the statutes,rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP)waiver eligible children,the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 7 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child,will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services,which include, but are not limited to; polygraph tests,plethysmographs,and urinalysis screens, which are not provided within the negotiated provider rate,will need to be authorized, in writing by the County,prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include,but are not limited to: Basic 24-hour care and child maintenance(food, shelter, clothing,educational supplies and allowance),direct child care,transportation, administrative overhead, support overhead, service delivery staff,which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2014 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEF) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. I I. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 612014 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Ilome/Group Center Care Services The following additional provisions apply to the agreement entitled,"Agreement to Purchase Out-of-Home Placement Services SS23A,by and between the Board of County Commissioners of Weld County,on behalf of the Weld County Department of Human Services,"hereinafter referred to as,"County,"and A Kidz Hope Homes Inc., hereinafter referred to as,"Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services,which are listed in this Agreement at a rate of$95.00,per day for children placed within the Group Home/Group Center identified as Provider ID#1531611. These services will be for children who have been deemed eligible for social services under the statutes,rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Ilabilitation Residential Program (CHRP)waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 7 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services,which include,but are not limited to; polygraph tests, plethysmographs,and urinalysis screens, which arc not provided within the negotiated provider rate,will need to be authorized, in writing by the County,prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include,but are not limited to: Basic 24-hour care and child maintenance(food,shelter, clothing,educational supplies and allowance),direct child care,transportation, administrative overhead,support overhead,service delivery staff,which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit A to the SS23A 1 Revised 6/2014 V 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 1 l. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A D CHILD PLACEMENT AGENCY SERVICES(CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM(CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) ❑X RESIDENTIAL CHILD CARE FACILITY(RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: TI IIS AGREEMENT is made and entered into this& day of MIL , 20 /5 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Arapahoe House,whose address is 8801 Lipan St,Thornton,CO 80260, 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," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, 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. SS-23A Revised 6/2014 1 OZ-rah/" /6D (;-) 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. IL SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions,"which is attached hereto and referred to herein as"Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes,except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time-limited and shall: I. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8)together with clinical and other needs including the child's presenting problems,physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. SS-23A Revised 6/2014 2 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management,emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning,changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15)calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30)calendar days advance notice of such review dates by County. G. Every fourteen (14)days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning,changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and SS-23A Revised 6/2014 3 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub- Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two(2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the SS-23A Revised 6/2014 4 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall he subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy& Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review. at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee-for-service and CHAP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate,CPAs and other Contractor types shall he made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2)weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting infonnation available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. SS-23A Revised 6/2014 5 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles(GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs. and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-I33, Audits of States, Local Governments,and Non- Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. [f Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal SS 23A Revised 6/2014 6 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA,then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. Ill. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee-for-Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may he removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization,will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF' and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not he provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in SS-23A Revised 6/2014 7 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado,the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall he for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall he provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must he negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan/ Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to he borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SS-23A Revised 6/2014 8 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses,orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren)to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7)days within a consecutive 30-day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person-to-person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non-regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number(970) 304-2749. SS-23A Revised 6/2014 9 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10(above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2)weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non- Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and hoard. Such amount will he the same as shown in Trails for the child's maintenance. SS-23A Revised 6/2014 10 VII. 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, the SS23B, 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,the SS23B, and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement. Exhibit A, the SS23B, and the Needs Based Care Addendum arc intended to be in lieu of and supersedes 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. SS-23A Revised 6/2014 11 G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. .1. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. 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. Arc 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. SS-23A Revised 6/2014 I2 N. In addition to terminating this Agreement, in accordance with the provisions of Section l., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A,the SS23B, and 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. SS-23A Revised 6/2014 13 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 W , / ; {, County, on behalf of the Weld County Department ATTEST: {/ G �X.�G oC of Human Services 4 By. B Deput lerk to the Board ?.. arbara Kirkmeyer, tChair ] 3 2015 i. �., =k ONTRACTOR: Approval as to Substan e �,(*� ,� WELD COUNTY DER .I^ litR'- '2 apahoe House OF HUMAN SERVIC S S' r , 01 Lipan St k P.# v_. . homton, CO 80260 t By j/t, „ ' By: e () lo-i2-ZQ Y 66untY Di ector's r desig ee's) Director's (or designee's) Signature S"nature nd Date and Date SS-23A Revised 6/2014 14 (20/5—/O e co (,2-) APPROVED AS TO SUBSTANCE: SEE PREVIOUS PAGE Elected Official or Department Head N/A Director of General Services APPROVED AS TO FUG: Controller APfr�Rf5J� TO F Cou Attorney EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled. "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Arapahoe House,hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#88692, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services,which are listed in this Agreement at a rate of$186.18 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 7 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep-over staff,direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). Exhibit A to the SS23A 1 Revised 6/2014 a c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations scheduled within 14 days and dental examinations scheduled within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A O CHILD PLACEMENT AGENCY SERVICES(CPA) ❑ CIIII.DREN'S HABILITATION RESIDENTIAL PROGRAM (CI IRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING O PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) O RESIDENTIAL CHILD CARE FACILITY(RC'C F) L7 RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SI IELTER CARE O SUBSIDIZED ADOPTION O TRANSITION/HOME BASED AFTER-CARE(RCCF) O OTHER: THIS AGREEMENT is made and entered into this ?tttlay of a-P24-. 20 by and between the Board of County Commissioners of Weld County, on behalfof the Weld County Department of I human Services,whose address is P.O. Box 758. hereinafter referred to as. "County,"and New Start Youth Services LLC,whose address is PO Box 1932, Pueblo, CO 81002. hereinafter referred to as,"Contractor." This Agreement covers all children placed by Countywith Contractor. W ITNESSE7'H: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as."State Department." is authorized to provide human services to individuals and families through county departments of human services,and WHEREAS,County is authorized to purchase certain services for eligible children under State Department rules. and WHEREAS.County wishes to provide these services by purchasing them from Contractor,and WHEREAS,Contractor is licensed as a Child Placement Agency. Residential Child Care Facility. certified Psychiatric Residential Treatment Facility,or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein. County and Contractor agree as follows: I. TERM: A. [he term of this Agreement shall he from July I,2014,to and until June 30,2015. SS-23A Revised 6/2014 a.2,O/51- /e9av3) gLo 13. 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 he released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled. "Additional Provisions."which is attached hereto and referred to herein as"Exhibit A." B. County and Contractor agree and understand that the reasons for referral,which necessitate purchasing services for children,are specified in the Child Specific Addendum (SS23B)and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes,except PR'1'F. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes,except PR"I'F. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care tier children in PR'I'Fs within 72 hours. For children in a PRTF,a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time-limited and shall: I. Address all areas listed in Section 7.714.4. C, 2, (12 C'CR 209-8)together with clinical and other needs including the child's presenting problems, physical health. emotional status. behavior, support system in the community, available resources. and discharge plan. SS-23A Revised 6,2014 2 2. Include specific goals and measurable objectives, expected dates ofachievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type. frequency.and duration of clinical therapy services, rehabilitation services, medication management.emergency services. initial assessment.documented treatment modifications. and other services determined to he necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of.or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible tier providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. I . Monthly,Child Placement Agencies, RCCFs and all other Contractors. other than PRTF. shall conduct a monthly review ofeach Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning. changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further. Contractor agrees to sequence reports to he received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30)calendar days advance notice of such review dates by County. G. Every fourteen (14)days. PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress.significant incidents or disciplinary actions,and progress made to achieve goals specified in the Individual Plan ol'Care. II. Contractor shall: I. Conform with and abide by all rules and regulations of the Colorado Department of Human Services. the Colorado Department of Health Care Policy and SS-23.t Revised 6;20 I J 3 • Financing(if appropriate). the State of Colorado and any applicable federal laws and regulations, as such. which may be amended from time to time. and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub- Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973,Title XX of the Social Security Act of 1975 as revised,and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least$25,000 for CPAs($400,000 tur PRTFs and RCCFs) for property damage liability, $150.000 for injury and/or damage to any one person. and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two(2) months gross receipts, whichever is greater. covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions. or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of I Iealth Care Policy& Financing.and the State ofC'olorado,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 afany such claims or actions. (Paragraphs 6. 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only.Contractor shall be responsible tier its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the SS-23A Revised 6.3014 4 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-I20,C.R.S., any claims resulting from the performance of the University of Colorado. its employees or agents under this Agreement. 10. Maintain service program records, fiscal records.documentation and other records,which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall he subject at all reasonable times to inspection, review or audit by federal. Colorado Department of Human Services. Colorado Department of Health Care Policy& Financing,or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. I I. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update.annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review,at a location agreed upon by the County and Contractor. during regular business hours. 12. Invoice the County for services rendered. using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall he made to the MMIS System only. Billings for RCCF fee-for-service and Cl IRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate,CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty(30)calendar days following the billing duc date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two(2)weeks w ritten notice by the County.Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and hoard. Any payment to the foster parent in excess of the child maintenance or room and hoard amount shall he treated as income to the foster parent. l. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. SS-23A Revised 6'2014 5 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall he presented in conformity with U.S. generally accepted accounting principles(GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall he subject. at any reasonable time. to inspection,audit or copying by appropriate Federal. State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must he in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the hills do not confirm to the approved f rmat or the documentation is inadequate. 3. All Contractors whose total annual expenditures are S100.000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than 5100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited,compiled or reviewed financial statements of PRTFs, RCCFs. and CPAs must be completed and a copy provided to the Colorado Department of l luman Services (Attn: Administrator for PRTFs. and RCCFs and Attn: Audit Division Director for CPAs)within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B(I). above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget LOMB)Circular A-133, Audits of States. Local Governments.and Non- Profit Organizations including subsequent revisions,and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations, 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal SS-23A Revised 6/2014 6 Agent may withhold payment until the audit and/or requested information is submitted. 1f Contractor is a CPA.then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided.Contractor will he required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four(4) months of the date of the audit. 7. Failure to comply with any of these requirements. including items on the addendum is justification fiar the County to impose possible fiscal sanctions. penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF: for CPA placements. the negotiated rate or the approved vendor rate: for RCCF placements. the established Fee-for-Service rate and the negotiated rate or the approved vendor rate; and, for Cl 1RP placements,the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the teen by County. The amount paid for purchased care and services fir less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization. will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F(12 CCR 2509-5). C. All invoices from contractor shall he submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to. but not including,the day ofdischarge. Medicaid payments tax PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not he limited to funds encumbered in this Agreement and shall also include Medicaid funds lbr PRTF and RCCF therapeutic services and CIIRP services paid by the Department of I lealth Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway"status unless the County has previously approved it. Invoices for therapy costs tier clients enrolled in PRTF, RCCF, and Cl-1RP programs shall be submitted to the Medicaid Fiscal Agent in SS 23A Revised 6:201.1 7 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day. regardless of funding source,Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error. fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County. as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child,Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services,administrative maintenance, and treatment.Contractor type will determine which of these four components will he included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. lithe child runs away from Contractor's facility.County shall provide transportation to either return the child to the facility or to other care as arranged by County.County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must he negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However. provisions for payment of other transportation may be provided for in the Family Service Plan/ Individual Plan of Care. C. Any transportation costs to be incurred on behalf ofa child in placement. which are to be borne by persons,or agencies. which are not a party to this Agreement,shall he specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SS-BA Revised G.^2014 8 ft Transportation may include, but is not limited to: visitation with family members, medical/dental or mental health appointments,extracurricular activities.court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS2313. V. LEGAL STATUS AND AUTHORIZATIONS: I. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment,except that: a. Medical or dental care shall he provided by personnel duly licensed by law as required by the State of Colorado. h. It is mutually understood hereto that hospital expenses. surgery. ophthalmology services, eyeglasses.orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening. Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren)to participate in planned recreational and social activities of Contractor. including supervised off grounds excursions and extended trips within the State. provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7)days within a consecutive 30-day period. Such written permission may be in the treatment/service plan. Further. Contractor and County will also secure.where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a I'RTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which conies to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will he made in person-to-person communication, not through phone mail messages. During regular work hours,Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non-regular work hours, weekends and holidays. Contractor will contact the Emergency Duty Worker at the pager number(970)304-2749. SS-23A Revised 6'2t)la 9 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of I luman Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV. Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services. federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of 1 Iuman Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two(2)weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF.CPA or other Contractor type for any non- Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. SS-2:%A Revised 6;2014 10 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall he 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.the SS23B, 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 he construed as prohibiting the periodic amending of this Agreement. Exhibit A. the SS23B, and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum are intended to he in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of l-Iuman Services shall he and hereby is permitted to monitor service program. fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports. on-site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to 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 he retained and available for audit purposes for at least five years after final payment hereunder. SS-23A Revised 6..2014 l 1 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 he 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 public transactions(federal, state, and local)terminated for cause or default. SS-23A Revised G`?u1-} 1? N. In addition to terminating this Agreement. in accordance with the provisions of Section 1.. above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement. Exhibit A, the SS2313.and 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 he 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 tinder 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 he strictly reserved to the undersigned parties or their assignees. and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall he an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement he 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. 0. 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 alter 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. SS-23A Revised 6%2014 13 • WI IEREFORE, 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 L County, on behalf of the Weld County Department ATTEST: • �; of Human Services By: 13Aida4--___Z114,L2W_2,4,_, Depute- .lerk to f ' rd''T `7• - Barbara Kirktneyer, Chair 1 3 2015 . (Mt "`.{ :..,4t NTRACTOR: Approval as to Substa \t'4- ` ' - WELD COUNTY DEI :�r"� c_ w Start Youth Services LI.C OF HUMAN SERVICE. .rr� --- O Box 1932 �..w,. . : ,^ Pueblo,CO 81002 By: i, _ L \JukJ BY: I r ( • u ty Dir tor's(or esign s) Director's(or designee's) Signature S I, ,lure and Date ' and Date SS-23A Revised 6/2014 14 v2 D/�� / ) . (3) APPROVED AS TO SUBSTANCE: SEE PREVIOUS PAGE Elected Official or Department Head N/A Director of General Services APPROVEDASTO UN ING: 44 /-3(22-62140Controller APP/'�� • OR n• Coun,��orrrney EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled. "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County.on behalf of the Weld County Department of Human Services." hereinafter referred to as."County."and New Start Youth Services LLC, hereinafter referred to as, "Contractor.- I. County and Contractor agree that a child specific Needs Based Care Assessment. designated in this exhibit as Exhibit B.shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services,which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service,as indicated by the Needs Based Care Rate Table, designated in this exhibit as Exhibit C, for children placed within the CPA identified as Provider Ill#1528224. 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. For Children's Habilitation Residential Program (CHRP)waiver eligible children. County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 7 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year. if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services,which include, hut are not limited to: polygraph tests. plethysmographs,and urinalysis screens. which are not provided within the negotiated provider rate, will need to be authorized, in writing by County,prior to the service being performed. Any payment for specialized services not authorized in writing will he denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall he notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. Exhibit A to the SS23A 1 Revised 6'2014 9.' Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be f r and to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement,the Contractor shall complete or obtain a completed lEP. A copy will then he forwarded to the County. 1 i. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies arc not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6i2014 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. I low 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. flow often is the foster care provider required to participate in child's therapy or counseling Select One sessions? P3. 11ow 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. 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{ow 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. Flow often is C'PAiCounty 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. I low often arc theca w services needed to address chill's individual needs er NBC assessment? Select One NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Assessment Areas: Comment: Rating: E - Aggression/Cruelty to Animals - __ Select One ❑ Verbal or Physical Threatening I Select One II Destructive of Property.Fire Setting Select One ❑ Stealing Select One ❑ Self-injurious Behavior Select One Substance Abuse _ Select One T❑ Presence of Psychiatric Symptoms'Conditions Select One O- Enuresis/Encopresis Select One ❑ Runaway _ Select One ❑ Sexual Offenses Select One Inappsuriate Sexual Behavior Select One Disruptive Behavior Select One Delinquent Behavior Select One Depressive-like Behavior Select One ❑ Medical Needs-t l f condition is rated"severe",please Select One complete the Medically fragile NBC) ❑ Emancipation Select One —❑— Eating Problems Select One ❑ Boundary Issues .._� _ Select One_E Requires Night Care Select One !ducat ion Select One ❑ Involvement with Child's Family Select One Exhibit A to the SS23A 3 Revised 612014 F.SIHl3ff B WILD COUNTY OHS Requested Secs ices from Agency ('lease indicate the sea ices that arc requested fur this child. he folhm ing information o ill be rcllected on the child specific en titr:ict. ( 'Icusc he specific) ❑ I Adoption Services ❑ I Medical Services ❑ I Other. NA ❑ Doctor Dentist Appointment Coordination ❑ Pros ider agrees to work with family ❑ Medication Evaluation(not covered under fee for service) Therapeutic Services funded through Medicaid Fee for ❑ Medication Monitoring ❑ Service: QRCCF) ❑ Indisidual Therapy ❑ Nursing Services'Coordination ❑ ❑ Group Therapy _ Physician Sery ices'Coordination ❑ i Interactive Group Therapy ❑ Occupational Therapy ❑ Speech Therapy ❑ � Family therapy ' ❑ I Psychological Testing 0 Child Find ❑❑ F Pharmacological Management ❑ Other: LEI I Treatment not funded by Medicaid Fee for Service: I ❑ Education: ❑ Home Based Intervention If] On-Grounds School ❑ MST Multi-Systemic Therapy ❑ Coordinate Assessment for Special Education _p Offense S ecific Treatment ❑ Public School Attendance H Occupational Therapy ❑ Drug and Alcohol Treatment ❑ Speech Therapy LI Attend Special Education Meetings Urine Analysis/Drug Screening Breathalyzer ❑ Other: ❑ Sexual Abuse Victimization Treatment I ❑ Visitation Coordination ❑ Independent Living Skills Training Monitor phone calls and correspondence E Anger Management ,44 Transportation for family/parent/child visits Behavior Modification Services ❑ Other: ❑ Behavioral Assessment 0 Other: ❑ Recreation Services ❑ Inter reter Services ❑ Case Management Other: O_..._ s __Attend Court Hearings —❑_I Transportation: To include: Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: COMM eats: Exhibit A to the SS?3A 4 Revised 6^2014 EX111B11 C Weld County Department of Iluman Service Needs Based Care Rate"Table (Effective 7/01/2014) t a• ;Y? ?''71:, '':.-V 1'1'rc'; y. v,-r .,,,AA � , kGZ'" •. Mg r : .;. �Z a '',:..c - �.r �s t t�7,`' g yc" i.r7'.�tst� Ttt i�- � i 4 t,r�-� 4y'.t � � { .,4::,-;," LEVEL.OF r 4 *fit ; p,7��A� ADM •!RAT►E ' AUMU�Ip4);_1,TW t ` +"!≤1 cz [1! {a' ?,. .y.-' '" "+ c'' r.. ..moo.* r ' - D SERVICE ti'tt �' �. �)'' 6,3,,,....,,y,..„...;-,,.;$:;,,,‘t .r,1 :• �MAi., 4+Gk'e SER " .� `}r ti t� I p ' ` YY� a'iTit: H r-a Lei� t} f,,rJl�.;:• ap ?a „- 'h'+ 7Zi.' i -dw+rw'y.i n f y ttf."I' a,} 'lye ''' f.(:t� P,�� f I 1) II 1 Vr 4�Yn .tea,. `t,.-,....v,...,,„al , �.. S 1 _r 0. L �tiv , iulyi et *- re •t S12.1•t $0.00 is(aunty BasicAgv U-]0 .S1h.73 $,6G No crisis intervention.Minimal '° Slaintenancc :'- Age I I-14...518.50 ',1'. Not needed or cover i r CIA invohement,one lace-to- Rate t': Age 15-221...519.75 tare visit+v ith child per month. We under medicaid. 5.5 : S I I :F1: $5.05 • • Minimal ci7.lti intervention as •err Kegularl} Scheduled I 520.22 . S.or, needed.one Iace-to-lace visit $?'') :i therapy up to 4 per month with child.2-± hours 'month. 6T contacts per month S23.59 S 66 $17.19 518.88 SIII•II Occasional crisis intervention a, r. Weekly scheduled 2 S2G.r)h S h6 t needed.oto tare-to-tare visit. therapy 5-8 hours a $4.89 '`• +v ith child.2-3 contacts per ' month++ith 4 hours of t ,,,,-„*4- 'A,?.-- month group therapy. `-'• 1.fi;, Sn6 # $20.5h t., S2' 'a $15.16 Regularly scheduled t;l, ;;`y Ongoing crisis intervention as ,. weekly,multiple 1`"'i 533.79 j;;r, needed,steckl• y face-to-face sessions,can include S(, `, .' visits with child.and intensive }r. '�, t more than 1 person. ,. coordination iii multiple i.c. Tamil} therapy.for serv-iccs. 9-12 hour/monthly. + I 2 537.011 '. S23.93 it Ongoing crisis inter%cation.1- ;4 kii needed,which includes high • K(:( I' 541)44 S a6 .` '— Negotiated level of case management and g V. 11r-op Dawn '.F • CPA intolvemcnt with child and Nii•. provider and 2-3 face-to lace . 0 _ contacts per week minimum. - • '-. p ' � , .•..ry'r,... 4 w', ?�}�: . ehi- s .,4'_ ...',....4. ''• 'sr4 ,- .. _ .. ., et M4 , 4'; ,. ', tr. .‘ssessnietill v F:merBenn 526.96 $.ho $18.88• ,- it t.cvel Rate - •'i. 4 Exhibit A to the SS23A 5 Revised 6/2014 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES(CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CEN"I ER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY(RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE • SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: THIS AGREEMENT is made and entered into this[j day of APE"' , 2045< 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 758, hereinafter referred to as, "County,"and Turning Point Center for Youth,whose address is 1644 South College Ave, Fort Collins,CO 80525, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS,Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW,THEREFORE, 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. SS-23A Revised 6/2014 I 2Orb -/&O ( H-RINOW 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. 11. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions.'which is attached hereto and referred to herein as"Exhibit A." B. County and Contractor agree and understand that the reasons for referral,which necessitate purchasing services for children,are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes,except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF,a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time-limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. SS-23A Revised 6/2014 2 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to he met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to he necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15)calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30)calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and SS-23A Revised 6/2014 3 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub- Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised,and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act(HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least$25,000 for CPAs ($400,000 for PRTFs and RCCFs)for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least 525,000 or two (2) months gross receipts,whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy&Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the SS-23A Revised 6/2014 4 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy& Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee-for-service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty(30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two(2)weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14.Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. SS-23A Revised 6/2014 5 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs. and RCCFs and Attn: Audit Division Director for CPAs)within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB)Circular A-133,Audits of States, Local Governments,and Non- Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner,the Fiscal SS-23A Revised 6/2014 6 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA,then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted,a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four(4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee-for-Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements,the agreed upon service proposal rate. The total rate of payment for care and services for other service types will he as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will he based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall he submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway"status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF. RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in SS-23A Revised 6/2014 7 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado,the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons,or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SS-23A Revised 6/2014 8 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities,court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: L Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7)days within a consecutive 30-day period. Such written permission may be in the treatment/service plan. Further,Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person-to-person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non-regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number(970)304-2749. SS-23A Revised 6/2014 9 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non- Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. SS-23A Revised 6/2014 10 VII. 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. the SS23B, 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, the SS23B, and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum are intended to be in lieu of and supersedes 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. SS-23A Revised 6/2014 1 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. SS-23A Revised 6/2014 12 N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A, the SS23B, and 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 he 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. SS-23A Revised 6/2014 13 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 G . of Human Services /�` • By: �: � i�3;oi� ".. By�� fdll Deputy lerk t. . t✓ arbara Kir meyer, air p �8s. � R 13 2015 tiONTRACTOR: Approval as to Subst. WELD COUNTY DE?' ' .1 cif ct, uming Point Center for Youth OF HUMAN SERVIC O'; t t, 1644 South College Ave ' . �✓ Fort Collins,CO 80525 By: C � B /O. —1. r u ty Direc or's (or de ignee's Di ct is (or desi ee's) Signature ig ature an Date nd D to SS-23A Revised 6/2014 14 ocO/x_/066, ("C) APPROVED AS TO SUBSTANCE: SEE PREVIOUS PAGE Elected Official or Department Head N/A Director of General Services APPROVED AS TO FUNDING: Contro e 1� (/�J AP.i • FO' Cou . itorney EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County,"and Turning Point Center for Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID# 1616504, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of$183.36 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-1 I-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 7 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep-over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks(25%). Exhibit A to the SS23A I Revised 6/2014 b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials(2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include,but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will he denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations scheduled within 14 days and dental examinations scheduled within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement,the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled,"Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County,"and Turning Point Center for Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, 1D#45179,agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of$183.36 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will he for children who have been deemed eligible for social services under the statutes. rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 7 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter,clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep-over staff,direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). Exhibit A to the SS23A 1 Revised 6/2014 b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials(2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation,recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services,which include,but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations scheduled within 14 days and dental examinations scheduled within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement,the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 Hello