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Home My WebLink About20143917.tiff MEMORANDUM 1s61 DATE: December 11 , 2014 � �VI1 ji TO : Douglas Rademacher, Chair, Weld Count B gt o of Commissioners lq c NTH FROM: Judy A. Griego, Director, H ��s'""DDDe 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, these additional provisions were reviewed under the Board's Pass-Around Memorandum dated October 30, 2014, and approved for placement on the Board's Consent Agenda. The additional provisions are to the following agreements: No. Facility Name/Term Facility Type/Location Daily Rate 1 Bethany Christian Services Child Placement Agency Services $ 16.73 - $40.44 July 1 , 2014 — June 30, 2015 Group Home/Group Center Care $83 .87 Denver, Colorado 2 Comitis Crisis Center/Aurora Residential Child Care Facility $94.80 July 1 , 2014 — June 30, 2015 Shelter Care Aurora, Colorado 3 CGL — CPA, LLC Child Placement Agency Services $ 134.89 August 1 , 2014 — June 30, 2015 Group Home/Group Center Care $ 125 .94 Aurora, Colorado 4 PSI Cedar Springs Hospital, Inc. Psychiatric Residential Treatment Facility Colorado Springs, Colorado 5 Rocky Mountain Kids (ID #' s Child Placement Agency Services $ 100.00 1599808, 1613088, 1599810, Group Home/Group Center Care 1619041 ) Colorado Springs, Colorado July 1 , 2014 — June 30, 2015 6 Top of the Trail, Inc. Child Placement Agency Services $ 16.73 - $40.44 September 1 , 2014 — June 30, 2015 Montrose, Colorado If you have any questions, give me a call at extension 6510. RECEIVED 11�r> da Hs D (94 ) DEC. 1 1 2014 CavrieLl 1a -nri4" � p7/tea / WELD COUNTY d, ws- COMMISSION 'e 2014-3917 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 El INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTE) D RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM H SHELTER CARE O SUBSIDIZED ADOPTION ❑ 1'RANSITIONMOME BASED AFTER-CARE(RCCF) o OTHER: 11 THIS AGREEMENT is made and entered into this/11 day of, ,20 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services,whose address is P.O. Box 758, hereinafter referred to as, "County,"and Bethany Christian Services,whose address is 3000 S. Race St.,Denver, CO 80210, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. W ITNESSETH: 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 O.2o/Z71 , 3 9/ 7 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-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 P Y P y 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 goal for the child. P fY a permanency Y 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 612014 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(H1PAA). 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 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 shalt 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 I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system,shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 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 he 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(Atm: 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 be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 13. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 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 arc 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: 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: I. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV,Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may he amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2)weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 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 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. 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 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 dseidivid ,`" A \ County,on behalf of the Weld County Department ATTEST: � `' of Human Services By. y Deputy lerk to,.the.Btrarti -t ;t� %! B oug as Rade cher, C airman DEC 1 7 2014 CONTRACTOR: Approval as to Substance: WELD COUNTY DEPARTMENT Bethany Christian Services OF HUMAN SERVICES 3000 S. Race St. Denver, CO 80210 By: -�'�.. ,, • By; r., _ _ l 1 LI- nixi ector's r ties nee's) Dire tor's (or designee's) Signatur nature and Date, and Date SS-23A Revised 6/2014 14 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County,"and Bethany Christian Services, hereinafter referred to as, "Contractor." 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 ID#45514. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Flabilitation Residential Program (CH-RP)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, but are not limited to; polygraph tests, plethysmographs,and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by 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 forward to County. 10. Contractor agrees to arrange a full evaluation of an individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement,the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. I 1. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 EXHIBIT B NBC (NEEDS BASED CARE ASSESSMENT) Answers to the following questions will determine the NBC Care Payment. For each question below please select the closest rating for this child. The following seven L) questions are mutually exclusive. PI. How often does the child require transportation by the foster care provider for the following: Select One Therapy;Medical Treatment; Family Visitation; Extraordinary Educational Needs;etc.,as outlined in the treatment plan? P2. How often is the foster care provider required to participate in child's therapy or counseling Select One sessions? P3. How much time is the provider required to intervene at home and/or at school with the child in Select One conjunction with a regular or special education plan? P4. How often does the child require special and extensive involvement by the provider in scheduling Select One and monitoring of time and/or activities and/or crisis management? P5. Ilow much time is the provider required to assist the child because of impairments beyond age Select One appropriate needs with feeding, bathing,grooming,physical,and/or occupational therapy? Al. How often is CPA/County case management required?(Does not include therapy) Select One **Please Note: The Case Management level may be assessed on a combined basis if a sibling group or more than one County foster child is with the same provider. Ti. Flow often are thera services needed to address child's individual needs .er NBC assessment? Select One NBC (NEEDS BASED CARE ASSESSMENT)— Behavioral Assessment Assessment Areas: Comment: Rating: _ ❑ Aggression/Cruelty to Animals Select One ❑ Verbal or Physical Threatening Select One ❑ Destructive of Property/Fire Setting Select One ❑ Stealing Select One ❑ Self-injurious Behavior Select One ❑ Substance Abuse Select One ❑ Presence of Psychiatric Symptoms/Conditions Select One O Enuresis/Encopresis Select One O Runaway Select One ❑ Sexual Offenses Select One ❑ Inappropriate Sexual Behavior Select One Disruptive Behavior Select One ❑ Delinquent Behavior Select One ❑ Depressive-like Behavior Select One ❑ Medical Needs-(If condition is rated"severe",please Select One complete the Medically fragile NBC) 0 Emancipation Select One ❑ Eating Problems Select One O Boundary Issues — Select One ❑ Requires Night Care Select One ❑ Education Select One ❑-1 Involvement with Child's Family Select One Exhibit A to the SS23A 3 Revised 6/2014 EXHIBIT B WELD COUNTY DHS Requested Services from Agency Please indicate the sem ices that are rerluected for this child. The following„information will be reflected on the child specific contract. (Please be specific) ❑ Adoption Services ❑ Medical Services ❑ Other: NA ❑ Doctor/Dentist Appointment Coordination ❑ Provider agrees to work with family ❑ Medication Evaluation(not covered under fee for service) ❑ Therapeutic Services funded through Medicaid Fee for ❑ Medication Monitoring Service: (TRCCF) ❑ Individual Therapy ❑ Nursing Services/Coordination ❑ Group Therapy ❑ Physician Services/Coordination ❑ Interactive Group Therapy 0 Occupational Therapy ❑ Family Therapy ❑ Speech Therapy ❑ Psychological Testing ❑ Child Find ❑ Pharmacological Management ❑ Other: ❑ Treatment not funded by Medicaid Fee for Service: ❑ Education: 0 Home Based Intervention ❑ On-Grounds School ❑ MST Multi-S stemic"Them ❑ Coordinate Assessment for Special Education Offense Specific Treatment ❑ Public School Attendance ❑ Occupational Therapy ❑ Drug and Alcohol Treatment ❑ Speech Therapy ❑ Attend Special Education Meetings ❑ Urine Analysis/Drug Screening/Breathalyzer ❑ Other: ❑ Sexual Abuse Victimization Treatment ❑ Visitation Coordination ❑ Independent Living Skills Training (I Monitor phone calls and correspondence 0 Anger Management ❑ Transportation for family/parent/child visits ❑ Behavior Modification Services LI Other: ❑ Behavioral Assessment Li Other: ❑ Recreation Services ❑ Interpreter Services [J Case Management ❑ Other: Attend Court Hearings ❑ Transportation: To include: Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: V Comments: Exhibit A to the SS23A 4 Revised 6/2014 EXHIBIT C Weld County Department of Human Service Needs Based Care Rate Table (Effective 7/01/2014) • LEVEL OF CHILD ADMINISTRATIVE ADMINISTRATIVE MEDICAL RESPITE SERVICE MAINTENANCE MAINTENANCE ; SERVICES NEEDS Level. Daily Rate Daily Rate Daily Rate Daily Rate Daily Rate - $12.14 Count). Basic Age U-l(1...$t(i.73 }(o No crisis intervention.Minimal $0.00 Maintenance Age 11-14...S18.5(1 Not needed or cover ----- CPA involvement,one face-to- --• Rate Age 15-21...S19.75 face visit with child per month. under Medicaid. $15.51 $5.05 Minimal crisis intervention as Regularly Scheduled $10.'2 $.b6 needed,one face-to-face visit s3.39 therapy up to 4 per month with child,2-3 hours/month. contacts per month V, s2: 5.66 $17.19 518.88 $10.11 Occasional crisis intervention as Weekly scheduled 2 S'6.`)() 5 66 needed.two face-to-face visits therapy 5-8 hours a S4.89 with child.2-3 contacts per month with 4 hours of month group therapy. 2 !4 $30.33 $ $20.56 $22.24 $15.16 Regularly scheduled Ongoing crisis intervention as weekly,multiple 3 $33.70 S.r,c, needed,weekly face-to-face sessions,can include 56.39 visits with child,and intensive more than 1 person, coordination of multiple i.e. family therapy.for services. 9-12 hours/monthly. .5 1/2 $37.iu, $.(,t, $23.93 $25,61 Ongoing crisis intervention as 4 needed,which includes high R('CF $40.44 level of case management and Negotiated Drop Down CPA involvement with child and provider and 2-3 faee-to face contacts per week minimum. kssessment/ Emergency $26.96 S.o6 $18.88 Level Rate Exhibit A to the SS23A 5 Rev ised 6;2014 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 Bethany Christian Services, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$83.87, per day for children placed within the Group Home/Group Center identified as Provider 1D#74864. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Hahilitation Residential Program (CHRP)waiver eligible children, the County agrees to pay the federal SS1 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 (lEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. lithe 1EP is due while the child is in placement,the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 1 1. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 APPROVED AS TO SUBSTANCE: SEE f?2EVtoAS <r AG>= Elected Official or Department Head NIA Director of General Services APPROVED AS TO FUNDING:: R! (/7ZY_I!� Controller APPROVED AS County Attorney 02 (39/ 7 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) • RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: THIS AGREEMENT is made and entered into this t day of \IAt , 20 , by and between the Board of County Commissioners of Weld County, on behalf'of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Comitis Crisis Center/Aurora,whose address is PO Box 919, Aurora, CO 80040, 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 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 child's presenting clinical and other needs including the 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: 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-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 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 I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 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 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 i 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: 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 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 I I G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 1. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local)transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local)terminated for cause or default. 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 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 L County, on behalf of the Weld County Department ATTEST: V r[LGgb;-r .of Human Services BY: I�/�Z r.- "' BY' CV 1 1!eiPvt 4� Deputy lerk to the Board Dou las Rademacher, Chairman DEC 1 7 2014 CONTRACTOR: Approval as to Substance: WELD COUNTY DEPARTMENT Comitis Crisis Center/Aurora OF HUMAN SERVICES PO Box 919 Aurora, CO 11L1 By: 1 By: C ty Dir ctor's ( r desi ee's) Director's ( nee's) Signature Sirg ature a d Date( and Date SS-23A Revised 6/2014 14 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Comitis Crisis Center/Aurora, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45127,agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of$94.80 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 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 TEP 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. II. 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 APPROVED AS TO SUBSTANCE: St ?Rtv,ous ? 6c Elected Official or Department Head Director of General Services APPROVED AS TO7NDING: �Bt {<di(C�Lf WO. Controller APPRO ED AS TO FORM: County Attorney 020> - 3917 N PURCHASE AGREEMENT OUT-OF-HOME PLACEMENT SERVICES SS23A © CHILD PLACEMENT AGENCY SERVICES(CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) © GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE O SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: A` �/1n i THIS AGREEMENT is made and entered into this / / day of 'Peet/it/36o/ , 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 CGL- CPA, LLC,whose address is 1420 Kenton Street,Aurora, CO 80010, 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: SS-23A Revised 6/2014 1 02-0 / — 391/ 7 I. TERM: A. The term of this Agreement shall be from August 1, 2014,to and until June 30, 2015. 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 REOUIREMENTS 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 25O9-8)together with clinical and other needs including the child's presenting problems, physical SS-23A Revised 6/2014 2 health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitionalafter-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: SS-23A Revised 6/2014 3 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub- Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least$25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and$600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy&Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) SS-23A Revised 6/2014 4 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 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 SS-23A Revised 6/2014 5 and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements,prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for 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. SS-23A Revised 6/2014 6 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four(4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. 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 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 SS-23A Revised 6/2014 7 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 CHAP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. 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 SS-23A Revised 6/2014 8 specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 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, SS-23A Revised 6/2014 9 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. 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 SS-23A Revised 6/2014 11 Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. My 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. SS-23A Revised 6/2014 12 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit 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 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 SS-23A Revised 6/2014 13 Director. The term "litigation"includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 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 a County, on behalf of the Weld County Department ATTEST: as : of Human Services By: l _ Deputyk to the Board Do4glas Rademacher, Chairman DEC 1 7 P014 CONTRACTOR: Approval as to Substance: WELD COUNTY DEPARTMENT CGL- CPA, LLC OF HUMAN SERVICES 1420 Kenton Street Aurora, CO 8001 • By: . By: l qty Di ector's ( desi ee's) irector's (or designee's) S gnature atur nd Date and Date SS-23A Revised 6/2014 14 02-0 �� ✓ / EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A,by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and CGL-CPA,LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$134.89, per day for children placed within the Group Home/Group Center identified as Provider ID #1619053. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (C HRP) el igible eli ible children, the County agrees to pay the federal SS1 rate to Contractor and all other service costs will be billable under the CHAP 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 S. 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. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services,"hereinafter referred to as, "County,"and CGL - CPA,LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$125.94, per day for children placed within the Group Home/Group Center identified as Provider ID#1620076. 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(IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services,"hereinafter referred to as, "County," and CGL- CPA, LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services,which are listed in this Agreement at a rate of$125.94, per day for children placed within the Group Home/Group Center identified as Provider ID#1620241. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. 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 I 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 (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 APPROVED AS TO SUBSTANCE: See P2&vious pg&€ Elected Official or Department Head NIA Director of General Services APPROVED AS TO FUNDING: (j. A91 Controller APPROVED AS TO FORM: County Attorney as / Ln/ 7 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES(CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE LI INDEPENDENT LIVING O PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) L7 RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: THIS AGREEMENT is made and entered into this/"/ {day o /Meg, 201q , 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 PSI Cedar Springs Hospital, Inc., whose address is 2135 Southgate Rd, Colorado Springs, CO 80906-2605, 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 02-0 i,71'/ 7 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: 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 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 I. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (I),above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non- Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 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 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. P g 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: 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 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 he 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: I. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non- Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any 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 612014 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 I I G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 1. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant,employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 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. 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 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 9 P Y Agreemen t, agreements County or other between 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 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 "` a ' County, on behalf of the Weld County Department ATTEST: ,M s, .Lc of Human Services By: fA t By: Deputy lerk to the Bpa4d , Dou las Rade acher, Chairman DEC 1 7 2014 CONTRACTOR: Approval as to Substance: WELD COUNTY DEPARTMENT PSI Cedar Springs Hospital. Inc. OF HUMAN SERVICES 2135 Southgate Rd //�� Colorado Springs, CO 80906-2605 By: £2 By: Jtiu 779,014 Al G! /010-N my ector's des' ee's) Director's (or designee s) Signature nature and Date and Date SS-23A Revised 6'2014 14 c,2-b/ /- 3 9/ 7 APPROVED AS TO SUBSTANCE: SCE' PREVIOUS PA6E Elected Official or Department Head Director of General Services APPROVED AS TO FUNDING: '-3,,Z4 Ail 0141,1./ Controller APPR�TO FORM: County Attorney moo/ c39/ 7 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A ❑x CHILD PLACEMENT AGENCY SERVICES (CPA) E CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) E GROUP HOME/GROUP CENTER CARE E INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) E RESIDENTIAL CHILD CARE FACILITY (RCCF) E RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE E SUBSIDIZED ADOPTION E TRANSITION/HOME BASED AFTER-CARE(RCCF) E OTHER: THIS AGREEMENT is made and entered into this/ 7 day ofi ite*20 / by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Rocky Mountain Kids, whose address is 2210 E. LaSalle Street, #219, Colorado Springs, CO 80909, hereinafter referred to as, "Contractor." This Agreement 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 O2-O/ c,57// 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: 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 hearings or reviews when provided with thirty prior to judicial or administrativeg Y (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, S150,000 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 MI 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. 1 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 and Contractor, for review, at a location agreed upon the County oby the g p h County 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 5100,000 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 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 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 fiords 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: 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 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 I I 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. 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 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 dia/Livul �,,►. County, on behalf of the Weld County Department ATTEST: ' ►a''. +ap/`, of Human Services ,' fir+ ‘ • By= _ RYA c 1Lc..)i Vr_ �at Deputy C rk t • t tfoap,.:',.P Dou las Rademacher, Chairman DEC 1 7 2014 CONTRACTOR: Approval as to Substance: WELD COUNTY DEPARTMENT Rocky Mountain Kids OF HUMAN SERVICES 2210 E. LaSalle Street, #219 Colorado Springs, CO 809 -77 By: ' By: -`7,, - .. - 2//g/ Co ty Dire or's(or lesi�.�n e's) Director's (or design e's) Signature ~ Sign Lure an Date and Date SS-23A Revised 6/2014 14 ao 3 9) 7 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Rocky Mountain Kids, hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1599808. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. 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, service delivery staff, which may include but administrative overhead, support overhead, 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. o2C / 39 '7 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 (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 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 SS23A by and between the Board of County Commissioners Out-of-Home Placement Services . of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Rocky Mountain Kids, hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1613088. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. 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 (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services,"hereinafter referred to as, "County," and Rocky Mountain Kids, hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1599810. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. 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 m ntation of these examinations shall be forward to the County. .e Y 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) b g 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. II. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Rocky Mountain Kids, hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of$100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1619041. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. 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 I 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 (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. I I. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Revised 6/2014 APPROVED AS TO SUBSTANCE: see P.2&vtot,ss PA 6C Elected Official or Department Head (t//A Director of General Services APPROVED AS TO UNDING: Controller APPROXED AS TO FORM: a County Attorney oza /4 3V7 AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A • CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILDREN'S HABILITATION RESIDENTIAL PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE(RCCF) ❑ OTHER: THIS AGREEMENT is made and entered into this /7 day ofLen vet-tag:6; 20 if, by and between the Board of County Commissioners of Weld County, on behalf of the We d County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Top of the Trail Inc., whose address is 300 N Cascade, Montrose, CO 81401, hereinafter referred to as, "Contractor." 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: cc 714 RPVICP/1 RriAld 1 / 13 9/ 7 A. The term of this Agreement shall be from September 1, 2014, to and until June 30, 2015. 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. CG71A Ppviccrl R/91114 I 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 (I 5) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. 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 CS-21A Revised 519014 1 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 CC-71A Reviced R/7(114 A full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee-for-service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty(30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. 1. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. cc-94A Rnvicad R/9nla 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-29A Revised S/2014 A 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 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 CC-91A Ppviced Rama I 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. QCA1& PPvicpA 2/7Ald 0 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-71A Reviced 5/7014 O 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. CC-21A RPvicpd R/7614 I n 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. cc-97A Revised R/7(lld 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 connection with obtaining, attempting to obtain, or performing criminal offense in P g 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. CC-71A Rrvicpd R/7llld 11 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 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 Bement is intended to circumvent or replace such and agree that nopart of this Agreement p g g 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-21A Revised R/2014 11 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. �C COUNTY: ATTEST: W v' '(04. BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Bo d WELD COUNTY, COLORADO By:( ..€42/.12— Deputy Cier tot e Board uglas ademac , Chair APPROVED AS TO FUNDING: APPROVED AS TO SUBSTANCE: vY�l L aL Q ( .1 14.261 Controller E q d Offi ial or artme Head APPROVED AS TO FORM: ir /fi Director of General Services County Attorney CONTRACTOR: Top of the Trail Inc. 300 N Cascade Montrose, CO 81401 By. CA1/4 - Contractor's rdesignee's) Signature and Date By: Contractor's (or designee's) Signature and Date 020) 47— 3f7 SS_97A Rrvicrd R/7014 IA EXHIBIT A to the SS23A Additional Provisions for the Agreement to Purchase Out-of-Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out-of-Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services,"hereinafter referred to as, "County," and Top of the Trail Inc., hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated in this exhibit 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 I D#28112. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHAP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHAP 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, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the g service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in Family Engagement or Team Decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. Exhibit A to the SS23A 1 Reviced F/7014 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit A to the SS23A 2 Reviced 6O014 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. P1. How often does the child require transportation by the foster care provider for the following: Select One Therapy;Medical Treatment;Family Visitation;Extraordinary Educational Needs;etc.,as outlined in the treatment plan? P2.How often is the foster care provider required to participate in child's therapy or counseling Select One sessions? P3. How much time is the provider required to intervene at home and/or at school with the child in Select One conjunction with a regular or special education plan? P4.How often does the child require special and extensive involvement by the provider in scheduling Select One and monitoring of time and/or activities and/or crisis management? P5.How much time is the provider required to assist the child because of impairments beyond age Select One appropriate needs with feeding, bathing,grooming,physical,and/or occupational therapy? Al.How often is CPA/County case management required?(Does not include therapy) Select One **Please Note: The Case Management level may be assessed on a combined basis if a sibling group or more than one County foster child is with the same provider. Ti. How often are thera. services needed to address child's individual needs .er NBC assessment? Select One NBC (NEEDS BASED CARE ASSESSMENT) — Behavioral Assessment Assessment Areas: Comment: Rating: U Aggression/Cruelty to Animals Select One _ Verbal or Physical Threatening Select One U Destructive of Property/Fire Setting Select One Stealing Select One ❑ Self-injurious Behavior Select One IJ Substance Abuse Select One ❑ Presence of Psychiatric Symptoms/Conditions Select One ❑ Enuresis/Encopresis Select One ❑ Runaway Select One .] Sexual Offenses Select One ❑ Inappropriate Sexual Behavior Select One JJ Disruptive Behavior Select One ❑ Delinquent Behavior Select One _U Depressive-like Behavior Select One E Medical Needs-(If condition is rated"severe",please Select One complete the Medically fragile NBC) ❑ Emancipation Select One ❑ Eating Problems Select One ❑ Boundary Issues Select One ❑ Requires Night Care Select One ❑ Education Select One ❑ Involvement with Child's Family Select One Exhibit A to the 5523A 3 Reviced 6O014 EXHIBIT B WELD COUNTY DNS Requested Services from Agency Please indicate the services that are requested for this child. The following information will be reflected on the child specific contract. (Please be specific) ❑ Adoption Services U Medical Services Other: NA ❑ Doctor/Dentist Appointment Coordination ❑ Provider agrees to work with family ❑ Medication Evaluation(not covered under fee for service) ❑ Therapeutic Services funded through Medicaid Fee for ❑ Medication Monitoring Service: (TRCCF) ❑ Individual Therapy ❑ Nursing Services/Coordination ❑ Group Therapy ❑ Physician Services/Coordination ❑ Interactive Group Therapy ❑ Occupational Therapy O Family Therapy LJ Speech Therapy ❑ Psychological Testing ❑ Child Find ❑ Pharmacological Management 0 Other: ❑ Treatment not funded by Medicaid Fee for Service: ❑ Education: ❑ Home Based Intervention ❑ On-Grounds School ❑ MST Multi-Systemic Therapy ❑ Coordinate Assessment for Special Education ❑ Offense Specific Treatment ❑ Public School Attendance ❑ Occupational Therapy ❑ Drug and Alcohol Treatment ❑ Speech Therapy ❑ Attend Special Education Meetings O Urine Analysis/Drug Screening/Breathalyzer 0 Other: ❑ Sexual Abuse Victimization Treatment ❑ Visitation Coordination Independent Living Skills Training ❑ Monitor phone calls and correspondence ❑ Anger Management ❑ Transportation for family/parent/child visits ❑ Behavior Modification Services 0 Other: ❑ Behavioral Assessment ❑ Other: Recreation Services Interpreter Services ❑ Case Management ❑ Other: ❑ Attend Court Hearings ❑ Transportation: To include: ❑ Other: Levels of Care: Provider Level: Case Management Level: Therapy Level: Date Staffed: Participants: Comments: Exhibit A to the 5523A 4 Revised 6/2014 EXHIBIT C Weld County Department of Human Service Needs Based Care Rate Table (Effective 7/01/2014) } ' 4 t yit Y e y i .nl J i9„ .1i trill i � E drptiaN:@i r (. ; i 7.:";.,,",„„ � yr ,„,.:' -t 7'f@NiDHfr' lai ' i u:il@�d ley �.9.9rt1rrsa � r- hrp+�'�2& d.ltl 3��r,e ? `j � YYnt,ltlr,t,rtlPJAthtk.i -'� 1 1 r �,r�,�-. , I0Ch,eb E - _ f a h k _\ .1- .s '-�rae91 `6lut'/46 1, iGtlt6,v.4r- j In111¢ ih T 1UE i74r7,c�t- c lst6 c:u, $12.14 $0.00 County Basic Age 0-10...$16 73 $,66 No crisis intervention,Minimal Maintenance Age 11-14...$18.50 Not needed or cover CPA involvement,one face-to- under Medicaid. Rate Age 15-21...$19.75 face visit with child per month. $15.51 • $5.05 Minimal crisis intervention as Regularly Scheduled 3.39 66$ face-to-face visit 1 $20.22 needed one therapy up to 4 per month with child,2-3 hours/month. contacts per month 1 +/� $23.59 $.665 $17.19 $18.88 $10.11 Occasional crisis intervention as Weekly scheduled 2 $26.96 $.66 needed,two face-to-face visits therapy 5-8 hours a $4.89 n5 with child,2-3 contacts per month with 4 hours of month group therapy. , 2 Ys $30.33 $.66 $20.56 k $22.24 $15.16 Regularly scheduled Ongoing crisis intervention as weekly,multiple 3 $33.70 $.66 needed,weekly face-to-face sessions,can include $6.39 visits with child,and intensive more than 1 person, coordination of multiple i.e.family therapy,for services. 9-12 hours/monthly. 31/2 1 $37.06 5 $.66 I $23.93 $25.61 Ongoing crisis intervention as 4 needed,which includes high R C C F $40.44 $.66 level of case management and Negotiated Drop Down Ii CPA involvement with child and provider and 2-3 face-to face contacts per week minimum. • Assessment/ Emergency $26.96 $.66 $18.88 Level Rate Exhibit A to the SS23A 5 Revised 6/2014 Hello