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Home My WebLink About20140721.tiff MEMORANDUM 1861 Tr DATE: March 6, 2014 TO: Douglas Rademacher, Chair, Weld Coun Bo of Commissioners r G O U T Y cyj FROM: Judy A. Griego, Director, RE: Agreements to Purchase -of-Home Place t Services between the Weld County Department of Human Services and Various Providers to be Placed on the Consent Agenda Enclosed for Board approval are Agreements to Purchase Out-of-Home Placement Services between the Department and Various Providers. This Agreement was reviewed under the Board's Pass-Around Memorandum dated February 24, 2014,and approved for placement on the Board's Consent Agenda. The boiler-plate agreement form was approved by Pass-Around Memorandum dated July 17, 2013, and approved by Bruce Barker. Below are the major provisions of the attached Agreements: No. Facility Name/Term Facility Type/Location Daily Rate 1 Evergreen Child Placement Agency Child Placement Agency Services $131.77 Group Home/Group Center Care November 1, 2013 —June 30, 2014 Longmont, Colorado 2 Southern Peaks Regional Treatment Center Residential Child Care Facility $181.64 Canon City, Colorado December 10, 2013 —June 30, 2014 If you have any questions, give me a call at extension 6510. 2014-0721 3-ro- &i9 5- T-a®i7 r I AGREEMENT TO PURCHASE OUT-OF-HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER-CARE (RCCF) ❑ OTHER(DESCRIBE): THIS AGREEMENT is made and entered into this/6 day of join cl OA , 20 14, by and between the Board of County Commissioners of Weld County, on behalf oft he Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Evergreen Child Placement Agency, whose address is 1436 Hilltop Dr., Longmont, CO 80501, 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: 1 SS-23A Revised 6/2013 I. TERM: A. The term of this Agreement shall be from November 1, 2013, to and until June 30, 2014. 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 2 SS-23A Revised 6/2013 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 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 pY g g 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: 3 SS-23A Revised 6/2013 1. Conform with and abide by all rules and regulations of the Colorado Department g P 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.) 4 SS-23A Revised 6/2013 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 J p 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 servi ces ces rendered, using the required form. This form is q 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 5 SS-23A Revised 6/2013 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. 6 SS-23A Revised 6/2013 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 7 SS-23A Revised 6/2013 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 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 placemen t p t 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 8 SS-23A Revised 6/2013 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, 9 SS-23A Revised 6/2013 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. 10 SS-23A Revised 6/2013 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, g p � P 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 11 SS-23A Revised 6/2013 Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies,procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended,proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local)transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 12 SS-23A Revised 6/2013 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 13 SS-23A Revised 6/2013 •1 • ; 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 • G County, on behalf of the Weld County Department ATTEST: of Human Services By: ,`` a Deputy erk to the fid' ouglasimacee0th ` MAR 1 Q 2014 �� ` I. ;' TRACTOR Approval as to Substance: WELD COUNTY DEPART x�-.z,,,,ib ergreen Child Placement Agency OF HUMAN SERVICES C. n i \ j 436 Hilltop Dr. Longmont, CO 80501 Litt Cif 4.2-0 By: ✓3 By: • ' ount' 'rector' (or designee's) Director's (or designee's Signat Signature and Date and Date 14 SS-23A Revised 6/2013 j170f 2/_t9 7O2/ , EXHIBIT "A" 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 Evergreen Child Placement Agency, 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$131.77,per day for children placed within the Group Home/Group Center identified as Provider ID #61317. 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 3 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 6/2013 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 6/2013 fk .. 4 : AGREEMENT TO PURIA.,'? OUT-OP-HOME PLACEMENT SERVICES- SS23A CHILD PLACEMENT AGENCY SERVICES(CPA) O CHILD RESIDENTIAL HABILITATION PROGRAM(CHRP) O GROUP HOME/GROUP CENTER CARE O INDEPENDENT LIVING [] PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY(PRTF) 1st RESIDENTIAL CHILD CARE FACILITY(RCCF) [] RESIDENTIAL DRUG/ALCOHOL PROGRAM O SHELTER CARE SUBSIDIZED ADOPTION TRANSITION/HOME BASED AFTER-CARE(RCCF) O OTHER(DESCRIBE): THIS AGREEMENT is made and entered into this day of 20 by and between the Board of CountyCommissioners of Weld County, on bhaIf of the Weld County Department of Human Services,whose.address is P1) Box 758,hereinafterreferitpd to as, "County,"and Southern Peaks RegionalTreatment Center,whose address is-700 Four Mile Parkway,Canon City,CO 81213,hereinafter referred to as,"Contractor." This Agreement rovers all'rChildren placed by County with Conttaotdr. WITNESSETH WHEREAS,the Colorado State Department of Human Services, hereinafter referred to as,"State Department"is authorized to provide human serviees to individuals and families through countydepartments ofhuman service-a,and WHEREAS, County is authorized to.purchase certain services for eligible children under State Department rules, and WHEREAS,County wishes to provide these ser,iees by purchasing them from Contractor, and WHEREAS,Contractor is licensed as a Child'Placement Agenoy,Residential Child Care Facility, certified Psychiatric Residential Treatment Facility,or meets Me requirements for other licensed service types: NOW, THEREFORE,in consideration attire mutual promises and covenants made herein,County and Contractor agree as follows: L TERM: A. The term of this Agreement shall be from December 10,2013,to and until June 30,2014. sS-23A Revised 6/24{3 B. Foch party shall have the right to terminate.this.Ag# nent: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 oftl:e terms of this Agreement shall thereupon use;however,the parties shall not be released from the duty to perform their obligations up to the date of termination. IL SERVICES TO'BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "AdditionatProvisions,"which is attached'hereto and referred to lterein.as"Exhibit A." B. County and Contractor agree and'understand that the reasons for referral,which necessitate purchasing services for.ehildren,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(S$23B). 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 fonnulate an Individual Plan of Care within 14 calendar days after admission for children in R.CCFs 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 beiggreed to in writing. D. County and:Contractor shall formulate an Initial Individual PlanofCare for children in.PRTFs.with'in 72 hours. Forehildren in a PRTR,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 wilting. 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,. ,:(.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., 2' SS-23A Revised 6/2013 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 3 SS-23A Revised 6/2013 Financing(if appropriate),the State ofColorado and any applicable federal laws and regulations,as such,which may 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 ofthe 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 ofthis Agreement a liability insurance policy of at least$25,000 for CPAs($400,000 for PRTFs and kCCFs)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 ofthis 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. 8L 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 4 SS-23A.Revised 6/2013 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 otherp authorized persons a horized in writing by the Executive Director of the Colorado Department of Human Services. I.I. In any instance of a potential adoption by a foster parent,,provide the initial home study,the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered,using-he required form. This form into 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 clays 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. 5 SS-23A Revised 6/2013 1 . .Caniraetor must have'in:Mama louble:entty acoouotiarayation and all finanejal, a+ctiotts-must be posted to this syateni. Financial.statt ents,prepared:from information provided by this system,shall presented iii oonlbrmity gen lly accepted annoantuig principles(GAS. Contractor must also have adequate taime limping and:nast*cation,systernatilalionale salary cost and indirect.ctist to appropriate c-Ost centers. Books and rds ofconttactor'shali be ,su jeet,at any reasonable time,to inspection,audit or 00:14 by.appropriate- Federal;:State or county personnel,or suet independent auditors fir.-iccountts.as age .digtaated 1):Y 4444e.personnel.:: Z. Ali l t loin ,by Contractor-Must be in a format apprOvc0yy the fiscal agent t r .county; Contractors-must bill the fiscai>agent and'county at least,once a month. .Contractors may bill twice a monthk.onthe i5th and last Aiay ofthe:month, for serOces rendered. Bills wtU be:returtied unpa01f e'biUs'do snot Morn to the appttive0 forinit Or the documentation:is inadegn . 3.: Al I ContractOra whose total annual-expenditures 40100,000 Or more shall .submit an annual audit of their financial statements':by.lot independent c €ied public accountant. Contractors with total annual expenditures less than 100,000 May submit an guditas.:,d_espi.boti ahove or may submit compiled or.reviewed **WO stateMents,:prepared,inaceortiance Ali generally acted accounting • .ritleitiles. If egnOnetOr isa government agent':t#tat'has alt,italeportilent audit •,fie by another;gency of that_go menu;.its audited'fina n l s#atdm ierits, *wad n accordance with:000g e ly.ae ted,accountingprinclpies:for state loolovomments meet this re cement. The anditek complied or:reviewed financial;statements.of PRTP-s,,I geft,;a n4CPAs mutt:he compieted'and a.00py providedtottcCol oc.Departitiefitoi4timairServlces(Attat -Admirtis.trator for PRA*arnd.RCCF$and Attn Audit_t)ivision Di tor'for.CPAs)within f80 days our tiSetiyearend Theauditeoffinanelalstatements`and supplementary information defined in regulation for various agencies shall be • presented aulesOribot m Section V],B(l),alove and must:cont in trident detail;to provide evidence•of f nancial.LannOnntability:under betels of this. AgreementAgreeitiontatid.0otttr0lling.stato regulations. Contractors That.are S$*bai llaty.Of a potent,orp nization must s bmit:sepal fnanccial.scents kr the subsidiary :that.detalteach ofCo traetors it anrl/ai amt tpro de ices:tor ltio•tolotado.Department of}Inman,:maces and also must provide a . .res tinciliationOfthese financial.s meats to the; nsotia :ftnarteial mtatemeut Otthe organization**whole;whole. •WhefilipplicabkCenttantorMust comply with Vie.audit requirements found In the single Audit Act of l9it4.and'the Single Audit ActA.mendments of 1996 end i„T,a..,Office of Management and Budget (OMB)Circular A3,Ag.;11*Audits?Of:Statea,tenal Governments,and Nnnr Profit Organizations includ g subsequent r visions,and appropriate audit and fnanoial reporting.requireinents: defined in'State taws,rttlesotOdrregulations,. 4:.. If Contractor does°:not::submnit tbeit tMr annual audit 0,-1141st-to-.00$040 ftigttcial int?onna Pion xegarcifng tlte:opetation.nftCte`progr-am in a timely manner;the Fiscal 6 % A Revised } Agent may withhold payment until; audit ancllbr requested itif cation is .subm.itted,. IContractor is.aCP 3.thett•sanctions of Contractor May Occur fbr *ere t#*u*Miit, • $4 :Incases:!*hcre docume*tion:does not ekis.to+support•audit iffor Cation or `vie4prov:ded,ConitaelOT ',hettiinireij repay all ds. hied•for. • *bleb'docinhentatio dos do e,dst. .• in.x les:where audit deficiencies.are noted,a plan of correctiVeaction shail:be: submitted to the State Pepartinenes Audit Division for approval within 'r(4) motes. fthedatc of't eaudit. Place to cornpty With any.ofthese i .ent4:ipclad items.on the addendum is;jtiOcation tot the'County to impose possible fiscal;S tio`ris, :penal o4 Otett00.1 the Ag ment. II t .P.A 17`'i`O;cOOTRAcTOR A. Th lottd rate•Ofpayment.for ouround soviet*wider Oft:Agreement shall AO a eeeed:. the.:establish4ratt fir.the PRO;for CPA;} cements.,:The negotiated rate.or the. Approved vendor rate;for t(CCF plaoememsi the established P.ee-for-Service rate and the negotiated orthe approved vender_rate,and, for CHRP placements;the afgeed upon service proposat tide, The total rate of payment fbr careand services for other,setvrce types will be as negotiated lvtween the County and Contractor. Medicaid rules Shall:govern activities to he covered in thedaily rate,pitid_too Pt TFs. Any child in ry be removed from the facility priOr to the end of the term by County: The amount Isakifor.purchased;care-and Services-kr less than a full:month.will:be. Upon d datiy rate, :. . t Payment for chd(1.4 tempotaryabsenet(rent Lho faet]aty,.ineludingabsence doe to ,46spitalitiitlimi wti.i.ite triadeinarcordancewith:SS..ate Department rules.,iti off, .Manual Volu.:ttta'tIJp 7.400:1,.f i 't< :R 094). •C. All'i�nvoi es fro.froth,..00ni#40_41,101.b0 sus reitted to andapp yed:hy iheappropriate County std 'PaymentfOtVateMentservices shall be`paid from the date of admission.up to, but not incl ng,:theday of discharge. Medicaid payments for PRTP and CiRP'pla .ents are permitted on the day Of discharge in compliance withregUlations promulgated:by. e Colorado Departinent of Health Care POO and P nanee l~ee for Service will l _ a.reimbursed perMedicaid regulations, Medicaid finds shall not he limited to fundsencumbered in s Agreement-and,.shall also inelude Medicaid funds for PI M' RCCF therapeutic services and CHRP services ;paid'.by the:Department of Health.Cane Policy and ploaning. Payment for placement services will not be provided fbr clients on"runaway"status unless;the County has previously approved it; lnvoiCcs(or therapy enatafor clients enrOiletir it PRO, RiC2CP;and CHRP pregrahnshalthe sulnnitted•to•t#•Medicaid Racal in 7 SS k Revised 4/2013 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 thosedollars 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 shalt not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. P. lfihis 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.TRAINSPORTATi®1N' 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 8 SS-23A Revised 6/2013 'Ttlanspnttetion May ineludd,;but,is not:Inked tol vises with flunilymembers, medicaltdentai or Mental health appointmeritkeXtraentriettlat tietivitleSo bea_rings.orOther specialized pr©gramming; '4000 rtion,expectationswill::be: decwiit me l SPetille A dde rghtitl;'' S . V, l...E.OAL STATps: istl?Av' kipa :' `IoNs:. Stich permission iStield-by the,Couniyiaberebygrant d tot ontractorFtOauthorize *Wilt.gr.eloer r medical and-dentsl,treatinell ,..extegthat; a, Medical or dental care shall be prcwided by personnel duly:liu rsed uy taw as i iMie 1.bY:the State ofColorado. b. It is mutually understodivrolhat.hospital,expenses,surprziopotamoko service,eyeglasses,orthodontlaorOffier wins*expenses at*not inelided lit the Monthly rate;, c. The:Costot any items not 4overed:by Medicaid u'rll be negotintedbetWeeil County tContrac r lwte a i lcs shall:0overn OtiVitiet Lo becovered in ihedailytate,.paid to PR"TPs.. . Cotiltr and Contractor shall.insure that:.t a child(re.)is.enrolied.iri the Fatly and Periodic'Screening, biagnfosis and Treatment grogram. a. It 4.4004 and permission is granted for the child(rei)to Pertieip in-Planned recreational and social activities ori''i retractor, including::supervised ottgro m excursions andextendettripaWithin the State*provided that Contractor has Written. *Oration from County acrd legal guardian for any tfipv out of Colorado fOr any 'mastitis*any planned:absence fromthe taellity of over v -'t,7)daYS within a cor secutwe.. kitty:p od.; Such Written p rmissioiinuiy be in the treattneittleervice l l rr. Further,Contractor-and County will also secure,where pet:tibia,OermiStion from parent*or guardians of the Child placed with Contractor, Any.planned absence Of More than:24 hears for.cii1dreu,placed: ..n a PRIV Ian,*Medicaidveinibursable .County and Contractor shall Inform each otherend e Iota].schoolschootdistrictotany changes in parental residen affecting educational statuSviliteheomesto their attention. S. 'Contact by Contractor with County regarding.emer icy medical,surgical Oderttal tate-Will be made In;person-to-person communication,not through phone Mail messages. During work Watt Contractor will tuakeevery effort to';notify tha assigned-caseworker,supervisor, or into screener of any.emergency medicaI surgical or dental issues prior to granting authorization Poring non-regular'work hours,weekends and:holidays,Contractor will,contOt theEntergeney.ThrtY Worker at the pager number(970).304.2749 ,9 SS-23A Revised o2o13 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. 1. 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. 10. SS-23A Revised 6/2013 X11: P ERAI„Ii Rt3 :IONS.; A. Contractor agues that ContMotor is an independent=contractor and that.neither Contractor nor Contractor's agents or employees wet or shall be deemed to'he.a is or employees Odle County for a nypu ipose. Contractor shall have n0 otlation, dress.cor inVfiedi to bind the:County to any agreementliability,or underStiOing. The parties agree that Contractor will not become an employee of .y,nor-it Contractor entitled to any employee bend its from Coun₹yas a result of thethevteeptiOn of this Agreement. Contractor shall be solely and entirely responsible:fir its ads or ofany agent,employee, servants and sub-contractors during lite performance of,this. Agreement. g. Payment pursuantto:thisAgreement,.Win State:ofCplor o entinty: or federal funds, Whether in wholeor•in part,is•subject to and contingent upon the eontmulog avaiiabiiity•c3fState'Of COiorati ,county,.and federaModslOrthe purposc Thereof C. .it:-1$agreed tits!,a r investigation,it is.sh whit atteaSonabin.tom:was given to ONO and'.piote ct PerSbnaliiteMS broughttto Contractor by the eitildren,r0ontnietor shall.be:,released from rbspon'sSi .irlity for losS ord age•to i►persbnat items. Q. This Agreement:it.intended to be applied;in coq u on With Exhibit A and the S'SPO aslite.pompleteintegOOn ofall understandingsbet een,the parties; No prior or contemporaneous addition,deletion or other amendment hereto shall have any tbrce or affect whatsoever,unless embodied herein in writing. No subsequent notation,renewal, addition,deletion,or other amendment:hereto shall'have any fine or effect unless embodied as:*part ofthis written Agreement. This section shall not he Construed as prohibiting the periodic amending of tnis.Agreement,,Tfthibit:A.and the Sg23 iit writing,if agreed to by both parties. This Agreement, Exhibit.A and the SS2313 are intended to be 7n lien of and supersedes all.prioragreem ents betwee ..the parties hereto and relating t.O.the.care and services herein*scribed. E. 'DO State:-cifColorado:Department.of Human Services shalt be and hereby is perinittod to monitor.:service progatio fiscal and other roads gif ienWtoassure the purchase of services in. is Agreement are carried out fot lendi t Ofthe .aftrcineptioned'elient ++to titoring may o+cur:thr ►gh.retry Oprograni reports,. on'sitevrstts wilere..npplicnlearn-ottrer Agreements deemed necessary. Con of r understands thattheStatel partment'mayprovide-:,,,olitstiltatIqn to Co. Orte assure.satisfa_atory performance in the.provisipn:Olpurchased services under this Agreement F.. County Shalt haven a .to.00ptra sr's:inancial re0Ords'a$they rolateto this A;gaeeOent for.purposeso:faudit; Such records:shall be complete°and available Air audit:' .days after.final payment hereunder and,shall be retained and'available for *talk purposes for.at least five years after-final:payment-hereunder. . Time is of the•essence in each and,all of the provisions•of this.Agreement. 1.1: SS!23A Revised•ri/2n13 14. `.l eitl er..party#O_tAgreement;shall.he liable%#it0>t. :fctr•de ays:ht.del3*er:o failure to deliver op otherwise to perform any obiigatiofl under this went,whet such fails xs due to any cause.heyOnd its reasonable stmt,�itieludm.g blot not lim ted icy:Acts of God,.tires,.strikes',war,,flood,earthquakes:or.;Oiw mentat actin. AnymAibe t+egiiireel to be.given:under this-Agreement:shall-he lit writing and shall be Mailed orIeiivered to the other party at that party's*MOSS AS Stated;hov to J'. This A ent and the provision of services hetenticletshall lidstkiectio the laws •otCOlorado and he in::accordance with the policies,px tires :tnd 1p z tices of 0007,- K. This Agreement.is::non usiveutut`County,may et a$e cense oilier contractors or persona to perktM service atilt s e lar uatd :. L. ,Contractor Certifies 010-Contractor is not an illegal immigrant;and mrtlier, Contractor represents,warrants,and agrees that it has:verified guit.Coigrat4tOr.does not employ any wool aliens, if it:is,discovered:that contractor is an Illegal immigrant employs ill is ietls'o$t#beontracts*ith illegal sliena,.County i *win*. lis Agreementand nt tormay be held liable for damages o .P9Otra0OrContractor assures;40'00100;1W lt:nncl i priri i 1. Are not prprosottyilebarratla.:sns d4prop ised r de ran t;and:declared: IneligibleIneligli40•VOluntertlyexcluded frOntionvere0 transactions by. feller ,i, partritent:,or agency. 2� Have not,**in a.titi j ';per of preceding this.Agreement,l Convicted of or had.a: jnttoMent renderedagamat,them for commission of tauctor a criminal&fense in Connection pith obtaining,attempting.to obtain,'or. rforming. . 40,17,414#01001.state,or local)transactitm or ix ntract under a public transaction, violatlonof federal or state antitrusts tea orr mission:h embezzlement„ theft,fotom btlbery, faisification o‘pfleitrildtbit of r nds,.making false statenI.en ;,:or-rocei ingstojenprt p y 3... Art not•pratontly Indic "kr,Or O11.Vtwise.Criminally:or ctvillyc ae .e&::by a .gOvOteMttil°entity:(fecterarl>) ,orlvcaly commissjon oratty of theoran.,y of the Dffenses .entoteratecl if paragrap..I,(ove. 4• tillVe.not within a th y .period,pre ding this•Agreem.ant,had one or more publiettinsattunts(tWerals ate,and ora0 t mlftated for so or default: Pl. In addition.to terminating this Agreement, in accordant'With the provision.Of $ cion 1.,.above, County may exercise the following remedial actions County find 12. SS-23A revised 6120 t and determine that Contractor ha§.subsrarmally.failed..to'satisfy The scope.of work found in this Agrgenlefit ExhibitAandthe%% B. Substantial failure to-satisfy the scope o.f work sIall'l*defned to mean incoMet p proper activities:or-inaction by the Co tor: These;0 ,dial actionshichide,but are not limited to;•any one or inerc-Of the followinw 1. Wi'rhholdpayment:toC.nnractort until:the necessity-soy leo or corrections performance aresatlsfactprily completed.s . Deny payment or recover-reimbursecti fort hose serViees or•deliye€ables which have.nsttbeen performed and whichWhichduemuntstancescat sed:by a r :r .not'be performed or-if performed;would tootno,value to,Wit, Denial of the mount:of payment shall'bh reasPiniblytelated to.the amount Otiyork or deli s,lost to•C0004.% 004.. . 3. Recover fiotn t"csrttf toc�a3 y incorrect p nefit'to� ?t°aatOodue to'omission,- entr, fraud,and/or defalcation by deducting.from sithSequent payments.undcr this Agreement,,or other agreements between Oomityunty and Con�*r,or as s a.debt to •County,or of iiseas provided'by.law:. 0.. It is•expressly 0040000 and,agreetithattheenforcementOtheleritialiiid eOnditions, of tills.Agree rerit and all:41100 is>o' action relating to,such enforcement,s'ha11'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 ofthe undersigned,parties.that,any entity other titanthan...the undersigned;purl ,or their • assignees receiving services Or benefits under this Agreement Shall:.be an incidental. *Oddly only.. • P o portico of this Agreetnent.shall be leetneei lttoonsstitutea waiver of'any immunity fheparties:•Or their OffiperSr.OremplOyeas.may poasesk tier shall-any portion of this A ment be deemed to.have-created,atdi.ity of Care thatdid not previously exist with. .fes.pectto any person riot apart)rto:this.Ag!eement, ` he parties hereto., cnowi e and:agre0tliat,noo pat-Pi: has.Agreeitient is intended to circumvent or-0 la ..such tmtninuties;, Q� .Contractor shall promptly notify County in the event in which it•is•a party defendant -or respoldentiti$otisk Which involves scr ees idedt WOO the agreem r� ent, L he .C4ti' to;" ithi�n five(5)calendar dayeafter being served with a summotes, complai[ntt:or other.pleading which has been filed.in an)?federal:or state court or administrative agency,shall deliver copies of such document(s)10 the.County. Director..the term"litigation"includes.anassignment for tire°benefit:pf ditors, and-filings in benitt0PteN:reor,ganizations and/or fO l . :13. SS.23A Revised 612013 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 s ada T C.1 ,,, do;� County,on behalf of the Weld County Department S �j G W �CJL� of Human Services By:c tai (4-Cr k�aclir- 1 `t\—J' ..rn ut C1,f�' to the Board Douglas RaaAmacher, �� '�" "P Y g Chairman CONTRACTOR: v al as to Substance: ELD COUNTY DEPARTMENT Southern Peaks Regional Treatment Center OF HUMAN SERVICES 700 Fou Mile Parkway Canon ty, 81212 By -111-0144Q, By: I (v /4- � y+untyrector's r d nee's) tor's (or designee's) Signature en Signature and Dat and Date t�,G Q Vc� "6fr�,;n� *� 14 SS-23A Revised 6/2013 ,;?c/q-&22/ . , EXHIBIT"A''' Additional Provisionta0 the Agreement to ttirehate Out-otrla me dement Services For the Purchase of Residential OM Carefacility Setvi ceS. The following idditionalprovisions apply tothe:agreement entitled, "Agr_.eementto:-Purchase 0uf-o1.Home Pia( tnerit.Services:SS23A,by and:between.the Board,of Many CoriunissiOners of Weld County,On.'L,eh ofthe Weld County Departmentol}tu ian l vhtes;"hereinafter referred to as,."County,"and Southern teaks tegional Treatment Center hereinafter referred to as," tractor_, , 1, County ees WPOrehase and Contractor,1 15267 .;.age to-pi vii e: a, Child Viainte.nanee,_.Administrative.Mauitena tee and Services,which are listed iii this Agreement*a rate of" 81.1%4 day�u es g - $1 . per y. titl, s ot1etWiSe negotiated based on the needs afthe individuail.Child placed within„tbe Residential Child Care Facility; :b. Additfopal services not: erect by.Medicaid or considered Within the above vendor rate, These additional services/MOS may be negotiated on a child by child basis,. based on the needs of the child and in accordane with the Colorado Department of Human Services Agency Litter CW-Obi 1-1 dated June 8,2006. These services will be.for children.y,flic have been deemed eligible for social services under the statutes;rules and regulations of the State Of 2: County considers the agreed,upcnrate,outlined in the Weld CountyAddendum'tothis contract,to be all inclusive and shall not pay for additional treatment fees, i.e. Drug/Alcohol and Sex 0ffenderserVleeS. 3. All bed hold autligrizationsand payments:are subject ton 3 day maximum fbr a child's temporary absence from ility,including:hospitalization, fed hold requests must have prior written authorization from the Department Arbninistrator before:payment Will be release to provider: Reimbursement rates for bed hold days may not exceedlhe state: standard rate for administrative maintenancee and administrative services or May larva reduced rate that is mutually agreed`upen. 4. T e ser.vices purchased under this .enientaS Child`Maintenance,Administrative Maintenance and Services for Residential Child Cate Facilities include,but .net limited to: rood, shelter,clothin personal needs'.and allowance,administration; adnumstrative overhead,support staff; support overhead,sleep-over staff,direct child Care,transportation;therapeutic reaction,service delivery staff,parent training for teens, independent living training,menter/advocate,supervised visitation and all other services as outlined in the Child'SpecifcAddendum. The anticipated minimum percentage for each item is as follows and will be:subject to County monitorittgas Exhibit'� to The SS 3A 1. R:at,ised,:Ram . . outlined in Section W.bfthis-contract: a. Food, including meals and snacks(25%). b. Clothing(39 ). c.. Shelter,including utilities and use of household furnishing and equipmentand:daily supervision,including those activities that a parent would nOrmally early cut to assure protection,emotional support and care of the child(30%). d. Petunia'items.and grooming care for the child,such as tot paste,toothbrushes, soap,combs,haircuts,and':ot'her essentials (2%). e. Otherliniscellaneous 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,;plethysrnographs,and urinalysis screens,that is>not provided within the vendor r_ate or attached Scope.of Service,wilt need be negotiated and authorized,.in wr_ iting 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:l4 days,and:.dental examinations scheduled within S weeks,of the child being placed with Contractor: All documentation of these examinations shall be forward to the County; IA 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 yeara . If the IEP is due while the child is in placement,the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County, II.Children in Residential Child Care Facilities and ChildPlacement Agencies are not eligible to reeeiVe clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit"A"to the,023A 2 Revised 8/2013 . . . 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 Wj,, 8„ 4 County, on behalf of the Weld County Department ATTEST: of Human Services By: /�� $'d�t Deputy C rk to the •" —CV Douglas Radema her,Chairinan 7' itt NTRACTOR: 1 0 2014 Approval as to Substance 1461 WELD COUNTY DEPA T t them Peaks Regional Treatment Center OF HUMAN SERVICES',` tIii ec 0 Four Ile Parkway ' jt' Sr�^ -�.r.�. Canon Ci ,CO 81212 . (/ ' I a D U. �7 By: ,; gv By: LL / (v ount jr-Director' or de tgnee's) Dir c is(or designee's)Signature Signature and Date and Da e. 9 o.�z ,, a_ c,T,y;s;&2ca V.ck OI 1 Exhibit"A"to the 5823A 3 Revised 8/2013 0.W .-- 2,e)7/a Hello