HomeMy WebLinkAbout20152022.tiff OPTION LETTER
Date: Original Contract CMS#: Option Letter#3 ' CMS Routing#
05/01/2015 14 IHA 65516 16 IHIA 79963
1) OPTIONS:Change in amount of goods in conjunction with renewal for additional term.
2) REQUIRED PROVISIONS.
In accordance with Section(s)Exhibit A,Section VI of the Original Contract,routing number 14-IHA-
65516,between the State of Colorado,Department of Human Services,and Weld County Department of
Human Services,the State hereby exercises its option for an additional term beginning July 1,2015 and
ending on June 30,2016 AND an increase in the amount of goods'services as specified in the attached
Exhibit B-Option Letter#3 Contractor Budget,hereby incorporated by reference.
The contract value is increased by$150,000.00 as consideration for services/goods ordered under the
contract for the state fiscal year 16(SFY 16).The total contract value including all previous option letters
(Option Letter#1,routing number 15-IHA-69735;Option Letter#2,routing number 15-IHIA-77974)is
$355,846.13(FY 14: 50,599.13;FY 15: 155,247.00;FY 16: 150,000.00).The"Tern,","Contract Not To
Exceed Price"and the"Maximum Amount Available Per Fiscal Year",on page one of the Original Contract
are hereby modified accordingly.
3) Effective Date.The effective date of this Option Letter is upon approval of the State Controller or July 1,2015,
whichever is later.
STATE OF COLORADO
John W.Hickenlooper,Governor
Department of Human Services
Reggie B. , E utive Director
By:Mary Ann Sn r,Office of Early Childhood Director
Date: ��
T _.
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State contracts.This Option Letter is not valid until signed
and dated below by the State Controller or delegate.Contractor is not authorized to begin performance until such time.If i
Contractor begins performing prior thereto,the State of Colorado is not obligated to pay Contractor for such
performance or for any goods and/or servicespovided hereunder.
STATE CONTROLLER
Robe Jaros,CPA,MBA,JD
By:
i�
Clint Wood di ruffVdimple
Date: 09/434.5"
eOri1iYLu�I 2015-2022
7-g-au16
EXHIBIT A
SFY16 STATEMENT OF WORK
To Original Contract Routing Number 14 iHA 65516
•
Weld County Department of Human Services
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
Project Description(Description of Colorado Community Response program):
Weld County Department of Human Services in partnership with North Range Behavioral Health shall provide
comprehensive voluntary services for families reported to child protective services but screened out and/or closed
after initial assessment; shall increase enrolled families' protective capacities by promoting individual, family,and
community strengths; and shall address the link between poverty and child maltreatment by connecting enrolled
families to vital economic and other support services. By partnering with families th
e es in early stages es of child
maltreatment risk,a broader and richer child abuse prevention service continuum will be established for Colorado.
Weld County Department of Human Services shall provide intensive coordination of community based supports
(case management, financial decision making, social capital opportunities, and flex funding) based on family
identified goals primarily provided in families'own homes,or other locations convenient for the individual family.
II, Definitions(Explanation of acronyms):
CCR=Colorado Community Response
DHHS=Department of Health and Human Services
CCM:Community Case Manager
III. Performance(Work Plan and Requirements):
1. The Contractor's performance shall comply with Exhibits A, 8, C, and D of the contract. Exhibit A is this
Statement of Work(SOW), Exhibit B is the Contractor's Budget and Budget Narrative, Exhibit C H1P,4A
Business Associate Addendum,and Exhibit D is the Option Letter.
2. The Contractor shall act in a fiduciary capacity as the fiscal agent,whose duties include but are not limited
to the following;
a. Ensure the completion of duties, by itself or through subcontracts, as described in the SOW. The
Contractor shall ensure that any service provided by any service provider(subcontractors) in the
targeted area complies with the SOW.
b. Provide qualified staff to coordinate and oversee the appropriate and lawful obligation and
expenditure of CCR funds, receiving and distributing funds, keeping records, and auditing
procedures of sub-contractors.
c. .4s fiscal agent, disburse funds hereunder in compliance with State requirements to
agencies/individuals providing CCR services.
d Notify the State in writing of any anticipated or actual deviations from the agreed upon timeline,
or deviations within the SOW.Such deviations shall require the prior written approval of the State
through the amendment format as provided by the State.
e. Respond to and gather appropriate data for the State evaluation of CCR as determined by the
external evaluator.
f Maintain confidentiality of records.
g. Agree that any and all work products, which are the result of this contract(in whole or part), will
be the property of the State.Any product of this contract which is distributed to the public or made
available to the public must prominently acknowledge the use of CCR funds through the Colorado
Department of Human Services;Division of Community and Family Support.
h. Ensure participation with the State staff as requested, to allow for open discussions of progress.
problems encountered and problem solutions both at local and state level of operations.
Page I of 11
Exhibit A-Statement of Work
CCR--Apnl 2015
EXHIBIT A
i. Ensure participation with the other CCR sites in aspects of the ongoing technical assistance
provided by the State. specifically; hut not limited to, monthly peer conference calls. Annual
training,and annual Grantee Meetings.
j. Ensure participants are informed of the short-term nature of benefits and ensure participants are
not financially harmed by this program.
Primary Task 1.0:Shall provide comprehensive voluntary services for up to 50 families with a screened out child welfare
referral and/or referral closed after initial assessment during the 2015-2016 grant year.
Activity Quarter ' Measurement j Deadline Position of Person/Agency
of i
action' Responsible
1.1 Referrals provided to program weekly Q -Q4 Referrals received by CCR Ongoing County worker. RED Team
via secure method. program. Supervisor-
1.2 Referred families are assigned to QI-Q4 CCR Referral Log data fields 06/30/16 Prevention Programs
CCR staff and CCR case manager will completed for each referred i Supervisor
outreach to referred families. family on weekly basis- CCM
1.3 Families will voluntarily enroll in the QI-Q4 Up to 50 unduplicated 06/30/16 CCM
CCR program, shown by completing families will complete CCR Family Engagement
Caregiver pretest data instruments Caregiver pretest Facilitator
instrumentation.
1.4 Families will voluntarily engage in QI-Q4 CCR Worker Pretest, CCR 06/30/16 CCM
prevention sendce areas identified by the Caregiver posttest and CCR Prevention Programs
family during the goal setting phase of Worker posttest will be Supervisor
program. completed with up to 50
L unduplicated families.
1.5 Participate r u crpate in reporting CDHS I- 4Submit P g Q Q u completed pretest and Ongoing Prevention Programs
designated outcomes and measures, and posttest instruments to Supervisor
comply with CDHS reporting deadlines external evaluator on at least
using designated data collection a monthly basis. Data
methodology and systems reporting shall be completed
no later than the 10`h of the
month following data
collection.
1.6 Submit mid.year and year-end t Q3& Reports submitted in timely 01130/16 Prevention Programs
programmatic progress reports to CDHS. Q4 fashion and include all 07130//6 Supervisor
Report shall contain descriptions of requested information.
accomplishments with reporting
standards provided by CDHS.
Primary Task 2.0:Shall increase enrolled families protective capacities by promoting individual,family,and
community strengths during the 2015-2016 grant rar.
Activity of
Quarter Measurement Deadline Position of Person/Agency
actiVih° Responsible
2.1 Families•existing strengths will be QI-Q4 Up to 50 unduplicated 06/30116 CCM
identified and acknowledged. families will complete CCR
Caregiver pretest and
posttest instrumentation.
2.2 Strengthening Families Protective QI-Q? Existing and new CCR staff 06/30/16 CCM. Prevention Programs
Factors are integrated throughout all will complete die online Supervisor
CCR services offered. Strengthening Families
training.
Primary Task 3.0:Shall address the link between poverty and child maltreatment by connecting enrolled families to vital
economic and other support services during the 2015-2016 grant year.
Activity Quarter Measurement
Deadline Position of Person/Agency
or
activity Responsible I
Page 2 of 3
Exhibit A-Statement of Work
CCR--Apnl 2015
EXHIBIT A
3./ CCR program will assess famines' Q1-Q4 A completed CCR Worker 06/30/16 1 CC1l
eligibility for public benefits and help Pretest and CCR Worker
families apply fur these benefits, posttest will be completed
with up ro 50 unduplicated
families. Appropriate benefit
•
•
related applications are
completed.
3.2 Connect enrolled families to one-time Ql-Q4 Complete fiend request 06/30/16 I CCLM, Prevention Programs
flexible fluids to address concrete documentation lie CCR Flex Supervisor
economic need that has child well-being Funds form).
and/or amity stability int lications. j Funds distributed.
IV. 'Monitoring:
CDHS's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the Colorado Community Response Program Coordinator-at CDHS. Methods used will
include a review of documentation determined by CDHS to be reflective or-performance to include programmatic
progress reports,other fiscal and programmatic documentation as applicable,and data quality assurance methods.
The State reserves the right to make changes to the data collection methodology and systems as warranted, When
possible,a thirty(30)day notice prior to a change will be provided.
V. Resolution of Non-Compliance:
The Contractor will be notified in writing within 30 calendar days of discovery of a compliance issue. Within 45
calendar days of discovery, the Contractor and the State will collaborate, when appropriate, to determine the
action(s) necessary to rectify the compliance issue and determine when the action(s) must be completed. The
action(s)and time line for completion will be documented in writing and agreed to by both parties. If extenuating
circumstances arise that requires an extension to the time line,the Contractor must email a request to the Colorado
Community Response Program Coordinator and receive approval for a new due date. The State will oversee the
completion/implementation of the action(s) to ensure time lines are met and the issue(s) is resolved, If the
Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may
exercise its rights under the provisions of this contract.
VI. Term and Renewal:
The State may require continued performance for a period of one year for any services at the rates and terms
specified in the contract. The State may exercise the option by providing written notice to the Contractor within 30
days prior to the end of the current term in a form substantially equivalent to Exhibit D. if the State exercises this
option, the extended contract will be considered to include this option provision. The total duration of this
contract, including the exercise of any options under this clause shall not exceed three years. Notwithstanding the
state contract term, the Contractor shall have a continued obligation to provide the final report stated in Paragraph
111.2.6 and Activity 1.6 of this Exhibit A.
Page 3 of 3
Exhibit A-Statement of Work
CCR Apnl 2015
Option Letter#3 Contractor Budget-Exhibit B
Applicant Name: Weld County Department of Human Services Budget Period: July 1,2015-June 30,2016
PERSONNEL EXPENSES
rercent
of AOtual Additional
Gross or Time
Personnel Services Annual Fringe (FTE)on Resources Amount Requested
Salary r:nntrartI from CDHS
Purchase (not
Order required)
Description of Work
Position Title/Employee (for hourly employees,please include
Name the hourly rate and number of hours in
your description)
Community Case Manager Provide case management and education
to families referred to them 4.200/m o. 1,550/mo. 100% $0 00 $69.000.00
Family Engagement Provide facilitation to all families within the
Facilitator grant 4,100/m o. 800/m o. 87% $0.00 $50,962.00
$0.00 $0.00
$0.00 $0.00
Total Personal Services
(including fringe benefits) E119,9$2.00
SUPPLIES&OPERATING EXPENSES
Additional
Item Description of item Rate Resources Amount Requested
(not from CDHS
Printin /Co , required) ,
g pyinq office expenses $200.00
Postage/Shipping
$0.00
Phone/Fax/Internet
$0.00
Supplies educational materials $419.00
Meeting $0.00
Other(Please list below by item) $0.00
Total Supplies
&Operating Expenses S819.00
TRAVEL
Item Description of Item Rate Quantity Amount Requested
from CDHS
Mileage-Other Travel-Training/Home Visits Average 350 Miles per
Month $0.545/Mile 4255 $2,319.00
$0.00
Total Travel
$2,319.00
OTHER COSTS
Item Description of Item Rate Quantity Amount Requested
from CDHS
Equipment $0.00
Flex Funds($5,000 req uired in first year and $10,000
required in second year) $10,000.00
Other(Please detail each item) $0.00
$0.00
Total Other Costs $10,000.00
1.of6
CONTRACTUAL(payments to third parties or entitles)
Item Description of Item Rate Quantity Amount Requested
from CDHS
Consulting $0.00
Consulting-Training Quarterly:Skills and Reflective North Range $75/Hour 20 $1,500.00
Training-Infant/Early Mental Health North Range $75/Hour 208 $15,600.00
$0.00
Total Contractual $17,100.00
SUB-TOTAL BEFORE INDIRECT tlso,00a.00
INDIRECT
Item Description of Item Amount Requested
from CONS
Indirect(other) Please list specific indirect costs in
description-NOT TO EXCEED 15%of Total Personnel. $0.00
Total Indirect $0.00
TOTAL AMOUNT REQUESTED FROM CDHS $150,000.00
2of6
Colorado Community Response (CCR) Budget Justification
Applicant Name: Weld County Department of Human Services
Budget Period: July 1,2015-June 30,2016
Performance Duty and/or Activity
PERSONNEL EXPENSES from Statement of Work(ie 2.a-k;
1.3&3.2)
Community Case Manager will provide case management and education services to referred families.
1 FTE at$20,125 prorated for 1.5 months of salary 1 3-1.5;21.2.2;3.1-3.4
Family Engagement Facilitator will facilitate Family Engagment Meetings and Team Decision Making
Meetings at the onset and throughout the case. 1,4
SUPPLIES&OPERATING EXPENSES Performance Duty and/or Activity
from Statement of Work(ie 2.a-k;
Community Casemanager(s)will complete finanicai planner certification course thorough National
Financial Education Council. 3.1-3.3
TRAVEL Performance Duty and/or Activity
from Statement of Work(ie 2.a-k;
Mileage-Denver Training-5-day Training 2.i;2.j
Mileage-Other Travel-Training I Home Visits 1.3-1.5
Meals during Training and Home Visits 2 i,2.j
OTHER COSTS Performance Duty and/or Activity
from Statement of Work(ie 2.a-k;
Flex Funds are required by CDHS to provide one-time fund disbursement to families to allievate an
acute economic stressor 3.4
CONTRACTUAL(payments to third parties or entities) Performance Duty and/or Activity
North Range Behavioral Health will provide workforce development training to CCR worker through 1)
direct education on the following topics:training-Intro to Infant/Early Mental Health-Research related
to Children's Mental Health-Toxic Stress/ACES-Intro to Infant Mental Endorsement-Infant Mental
Health Portfolio Preparation-Reflective Practice:Ghosts in the Nursery-Reflective Practice:Angels in
the Nursery-Diagnostic Classification birth to three(DC:0-3R)-Diagnostic Classification birth to three
(DC:0-3R-Case Study)-Developmental Screening Tools(electronic tablet for the purpose of 2.d;1.5;
screening will be provided)-Reflective Supervision,and 2)1:1 consultation regarding mental health
topics in general and/or specific to individual families,3)guidance related to the infant mental health
health endorsement process.North Range Behavioral Health will provides Infant/Early Mental Health
consultation to referred families and/or onoing mental health services as needed,
INDIRECT
N/A Link expense with specific project
3 of 6
Colorado Community Response (CCR) Budget Form
Sub-Contractor Name: North Range Behavioral Health
Budget Period: July 1,2015-June 30.2016
PERSONNEL EXPENSES
Percent
of Actual Additional
Gross or Time
Personnel Services Annual Fringe (FTE)on Resources Amount Requested
from CDHS
Salary Contract/
Purchase (not
Order , required)
Description of Work
Position TitlelEmployee (for hourly employees,please Include
Name the hourly rate and number of hours
in your description)
Early Mental Health Providing diagnostic training to CCR
Consultant/Noelle Hause, worker$75/hr for 20 hours $1,500.00
Early Mental Health
Consultant/Amanda Child Mental Health Services$75lhr
Kearney,MA IMH-E(I)
208 hours $15,600.00
$0 00 $0 00
$0.00 $0.00
Total Personal Services
(Including fringe benefits) $17,100.00
SUPPLIES&OPERATING EXPENSES
Additional
Item Description of Item Rate Resources Amount Requested
(not from CDHS
Printing/Copying required)
$0.00
Postage/Shipping $0.00
Phone/Fax/Internet $0.00
Supplies
Meeting $0.00
Other(Please list below by item) $0.00
$0.00
Total Supplies
&Operating Expenses $0.00
TRAVEL
Item Description of Item Rate Quantity Amount Requested
from CDHS
Mileage
$0.00
Lodging
$0.00
Meals
Other Travel $0.00
$0.00
$0.00
Total Travel
$0.00
OTHER COSTS
Item Description of Item Rate Quantity Amount Requested
Equipment from CDHS
$0.00
Training
$0.00
Flex Funds($5,000 required in first year and$10,000
required in second year) $0.00
Other(Please detail each item) $0.00
$0.00
Total Other Costs $0.00
4of6
CONTRACTUAL(payments to third parties or entitles)
Item Description of Item Rate Quantity Amount Requested
from CDHS
Consulting $0.00
Other sub-contract(Please list each additional sub-
contract individually) $0 00
$0.00
$0.00
$0.00
Total Contractual $0.00
SUB-TOTAL BEFORE INDIRECT $17.100.00
INDIRECT
Item Description of Item Amount Requested
from CDHS
Indirect(other):Please list specific indirect costs in
description-NOT TO EXCEED 15%of Total Personnel.
Total Indirect $0.00
TOTAL AMOUNT REQUESTED FROM COUNTY $17,100.00
Colorado Community Response (CCR) Budget Justification Sub-Contractor
Sub-Contractor Name: North Range Behavioral Health Budget Period: July 1,2015-June 30,2016
Performance Duty and/or Activity
PERSONNEL EXPENSES from Statement of Work(le 2.a-k;
1.3&3.Z)
Include narrative justifying the budgetary expense Link expense with specific project
activity.
Include narrative justifying the budgetary expense Link expense with specific project
activity.
Performance Duty and/or Activity
SUPPLIES&OPERATING EXPENSES from Statement of Work(ie 2.a-k;
1.3&3.2)
Include narrative justifying the budgetary expense Link expense with specific project
activity.
Performance Duty and/or Activity
TRAVEL from Statement of Work(ie 2.a-k;
1.3&3.2)
Include narrative justifying the budgetary expense Link expense with specific project
activity.
Performance Duty and/or Activity
OTHER COSTS from Statement of Work(ie 2.a-k;
1.3&3.2)
Include narrative justifying the budgetary expense Link expense with specific project
activity.
Performance Duty and/or Activity
CONTRACTUAL(payments to third parties or entities) from Statement of Work(ie 2.a-k;
1.3&3.2)
N/A Link expense with specific project
activity.
Performance Duty and/or Activity
INDIRECT from Statement of Work(ie 2.a-k;
1.3&3.2)
N/A Link expense with specific project
activity
6:D F 6
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