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HomeMy WebLinkAboutC04-347 Colorado West Regional Mental Health.~, + ~;~. PURCHASE OF SERVICE CONTRACT 4 - COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH - 2004/2005 THIS PURCHASE OF SERVICE CONTRACT for Core Services (this "Agreement") made by and between the Board of County Commissioners of Garfield County, State of Colorado ("BOCC") and Colorado West Regional Mental Health Inc., a Colorado Corporation, whose address is 6916 Highway 82, Box 40, Glenwood Springs, Colorado 81602, and whose Tax Identification number is 84-0625890 ("Contractor"). WHEREAS, the BOCC is statutorily mandated to provide Core Services, through the County Department of Social Services ("GARCO DSS"), and has entered into an Intergovernmental Agreement ("IGA") for the provision of such services in a four (4} county region made up of Eagle County, Garfield County, Pitkin County, and Summit County ("4-County Region"); and WHEREAS, the IGA provides, among other things, that Garfield County shall be the coordinating County and the contracting and fiscal authority for mental health Core Services in the 4-County Region; and WHEREAS, Contractor is engaged in the business of providing mental health services and is willing to provide such services in a the 4-County Region. NOW THEREFORE, in consideration of the premises and the obligations, agreements, and promises contained herein, the parties agree as follows: I. SCOPE OF SERVICES. A. Services Clients Place of Service. Within the financial parameters described in Section IV., below, Contractor shall provide mental health services, as described in Exhibit "A" attached to and incorporated herein by this reference, to all clients referred to Contractor in the 4-County Region by the referring County Department of HumanlSocial Services ("County Department(s)") Director, or hislher authorized representative(s)("County Director (s)"), in Eagle, Garfield, Pitkin, and Summit Counties. Services shall be delivered at designated offices, clients' homes and other locations approved by the County Director. Contractor shall provide services in accordance with State Department of Human Services regulations, found at 12 CCR 2509-4, o ~ ~egional Core Services 1 ~~~~~~~~ ~~ oa-os ~/i6/aooa A T Section 7.303, as amended, and as described in that certain County Core Services Plan, executed~by the BOCC on April 30, 2004, on behalf of the 4-County Region. Services shall be provided in a satisfactory and proper manner, as determined in the sole discretion of the BOCC. B. Contractor's Reports. Contractor shall provide each County Director with reports on its provision of services, as follows: 1. Treatment Plan. Within four (4) weeks of initiation of services for an identified client, Contractor shall submit an individualized treatment plan, with stated objectives and target dates, to the appropriate County Director. Treatment plans shall be jointly developed by the client's social caseworker and mental health service provider, and shall be subject to the approval of the referring County Director. 2. Progress Reports. At monthly intervals from the time of initiation of services, Contractor shall provide the referring County Director with follow-up reports for each identified client. C. Confidentiality. It is specifically understood that only aggregated non-identifiable client services data shall be presented to the BOCC in public session. Client specific reports are subject to the confidentiality rules of Sections 19-1-101, et seq. and 26-1-101, et seq., C.R.S., as amended; the federal Health Insurance Portability and Accountability Act of 1996; 42 U.S.C. Section 290 dd-2, regarding confidentiality of alcohol and drug abuse patient records; and other applicable federal and state law and regulation. II. COUNTY RESPONSIBILITIES. The County Departments shall: (1) determine client eligibility; (2) provide Contractor, prior to scheduling clients for appointments, with written authorization for provision of services, specifying begin and end service dates; (3) provide Contractor, prior to scheduling clients for appointments, with referral updates detailing changes in service types; (4) provide Contractor with referral information, such as name, address, State ID number and social, medical and educational information as appropriate to the referral; (5) confirm case closure with Contractor, in writing, within 24 hours of County Department closure; and (6) input data in the Colorado computerized child welfare case management and provider payroll system ("Trails"}to authorize Contractor's provision of services to referred clients and to initiate payment ~g}}~a~o~}~t~y~$egional Core Services 2 bT eb' F'Y''04-05 7/16/2004 of Contractor for services provided, as detailed in Section IV., below. III. TERM OF AGREEMENT. The term of this Agreement shall begin, retroactively, on June 1, 2004, and shall terminate on May 31, 2005, no matter the date of execution. IV. COMPENSATION. A. Payment and Not-to-Exceed Amount. For performance of the scope of services set forth in Section I, above, the Contractor shall be paid on a fee for service basis in accordance with Exhibit "B", attached hereto and incorporated herein by this reference. In no event shall the compensation paid under this Agreement exceed Seventy Two Thousand Seven Hundred Fifty Dollars ($72,750.00). The not-to-exceed figure reflects a (3%) retained amount, from the State allocation of Seventy Five Thousand Dollars ($75,000.00), for administration by the BOCC of this Agreement on behalf of the 4~-County Region. B. No Fee-For-Service. Compensation in accordance with the terms of this Agreement represents full payment of fees for services provided to referred clients in the 4-County Region. Contractor shall not charge or collect fees from clients for services provided hereunder. C. Method of Payment. Contractor shall be compensated in accordance with the statewide "Trails Users Fiscal Calendar" and by means of the Trails provider payroll system as follows: 1. Roster. During the last week of the month, each County Department shall generate and provide to Contractor a Trails "Core Main Provider Roster" ("roster") which is based on authorized referrals; identifies referred clients by name, case number,. State identification number, sex, and birthday; and calls for completion by Contractor of specified information about service provision in the preceding service/pay period. 2. Contractor's Submittal. Upon receipt, Contractor sha11:(1) fill in all service 'information called for by the roster, e.g., number of days/units, unit type and amount, for each client identified on the roster; (2) add to the roster identification and service information for clients who do not appear on the roster but for whom the Contractor provided service during the pay period; and (3) return the completed roster, with an authorized ,gggg~~}} o~yg$r~yy ~egional Core Services 3 C25T~a~e~'t 8~ 04-05 7/16/2004 signature, to the referring County Department by the tenth (10) day of the month following the pay period. 3. Provider Remittance Advice. Upon receipt from the Contractor, each County Department shall input into Trails the information provided on Contractor's completed roster and generate a "Provider Remittance Advice" advising Contractor of the payment amount authorized for the services itemized on the roster. The Provider Remittance Advice for the pay period shall be provided to Contractor during the last week of the next month, along with that month's computer generated roster for the new pay period. 4. Adjustments. In the event that Contractor does not agree with the information and dollar amount presented on the Provider Remittance Advice or the authorizing County Department discovers an error, one shall contact the other and adjustments shall be made in future payment(s), if needed. 5. Delivery Methods. Delivery of rosters and Provider Remittance Advice documents, and communication between referring County Departments and the Contractor regarding the Trails payment system, may be by means of U. S. Mail, private delivery service, facsimile transmission, telephone, hand delivery or by e-mail if electronic signature is available for use in the transaction. D. Billing Cut-off Date. Contractor shall not be reimbursed for billings received by the County Department two (2) months or more after the date of service. V. FUNDING CONTINGENCY. In accordance with X29-1-110, C.R.S., as amended, the BOCC is not authorized to expend monies which have not been appropriated. Payment pursuant to this Agreement is subject to and .contingent upon funds being appropriated, budgeted and otherwise made available by the BOCC, the State of Colorado, and/or federal funding sources, as applicable to this Agreement. VI. INDEPENDENT CONTRACTOR. The Contractor.shall provide the services identified in Section I, above, as an independent contractor providing supervision of its employees, agents and subcontractors. The Contractor represents that i"t has or will secure at its own expense all personnel required to perform the scope of services identified in Section I, above. Contractor shall ensure that its personnel are professionally licensed, as ~a~~sa~e~~~~§~o losal ~%i6/ioo ices 4 required by law, and meet applicable State Department of Human Services qualification requirements. Contractor's employees, agents and subcontractors are not employees or agents of and do not have a contractual relationship with the BOCC. Neither the Contractor, nor any of Contractor's employees, agents or subcontractors shall be entitled to any benefits or attributes of employment by the BOCC including, without limitation, workers compensation or health insurance coverage. VII. SUBCONTRACT AND ASSIGNMENT. Contractor shall not subcontract with another individual or entity for performance of the services described in Section I, above, and shall not assign or otherwise transfer its rights or delegate its obligations under this Agreement without the prior written approval of the BOCC. VIII. INFORMATION, AUDITS AND INSPECTIONS. At such times and in such forms as the BOCC may require, Contractor shall furnish statements, records, reports, data and information pertaining to the matters covered by this Agreement. At any time during normal business hours and as often as the BOCC may deem necessary, Contractor shall make available for examination and audit by the BOCC and the State Department of Human Services or authorized representatives thereof, all of the Contractor's records, materials, reports, information and data with respect to matters covered by this Agreement. All such information shall be maintained by Contractor for a period of seven (7) years after final payment is made to the Contractor. under this Agreement. IX. INDEMNIFICATION. The Contractor shall indemnify, hold harmless and defend the BOCC and its employees, agents, 'and officers, acting officially or otherwise, from and against any and all claims, damages, liability and proceedings of any kind, including attorneys fees, arising out of this Agreement, other then those resulting from the negligence or willful misconduct of the BOCC, its employees, agents, or officers. X. INSURANCE. ~ Contractor shall maintain insurance with companies authorized to do business in Colorado, on forms satisfactory to the BOCC, in at least the following minimum coverage amounts: GENERAL LIABILITY: $150,000.00 per person, $600,000.00 per occurrence AUTOMOBILE LIABILITY: $150,000.00 per person, $600,000.00 per occurrence WORKERS COMPENSATION:'As required by Colorado Law PROFESSIONAL MALPRACTICE INSURANCE: Contractor and its personnel, in a minimum amount of $1,000,000 per claim, $3,000,000 aggregate. ~gy}zaCo~pt~y`~egional Core Services 5 25Tt5 c6e tt FFYY'",04-OS 7/16/2004 Contractor shall name the BOCC as an additional insured on the general liability policy and, if Contractor's insurer determines that the BOCC has an insurable interest as a result of the contractual relationship created herein, on the automobile liability policy. Contractor shall deliver copies of policies or Certificates of Insurance to the BOCC through the Business Services Manager of GARCO DSS, within a reasonable time after execution of this Agreement and on each policy renewal date. XI. COMPLIANCE WITH LAWS. The Contractor shall comply with all laws, ordinances, codes and regulations of the federal, state, and local governments applicable to this Agreement, in its performance under .this Agreement. Without limiting the. generality of this Section XI., Contractor: (1)shall maintain client confidentiality, including confidentiality of records, in accordance with state and federal law, rules and regulations; and (2) shall not discriminate against any person on the basis of race, color, national origin, religion, sex, age or handicap. Any fine s paid or expenses incurred by the BOCC, due to Contractor's violation of applicable law or regulation, shall be reimbursed to the BOCC by the Contractor. XII. MUTUAL TERlr may terminate this upon thirty (30) party. Upon such compensation for termination. [INATION. FOR CONVENIENCE. BOCC anal Contractor Agreement, without cause and for convenience, days written notice to the non-terminating termination, Contractor shall be entitled to services performed prior to the date of XIII.- BOCC' TERMINATION FOR CAUSE. If the Contractor fails to fulfill its obligations under this Agreement in a timely and proper manner, as determined by the BOCC, or if the Contractor violates any of the terms or provisions of this Agreement, the BOCC shall have the right, in its sole discretion, to terminate this Agreement by giving written notice to the Contractor at least fifteen (15) days before the effective date of the termination and may provide Contractor, in the BOCC's sole discretion, an opportunity to cure within that fifteen (15) day notice period. Upon termination for cause, Contractor shall be entitled to receive just and equitable compensation for work satisfactorily completed prior to termination. Contractor shall not, however, be relieved ~of liability to the BOCC for damages sustained by the BOCC by virtue of any breach of this Agreement by the Contractor. The BOCC may withhold payments due to the Contractor for the purpose of set-off until such time as the exact amount of damages due the BOCC from Contractor is determined. $g}}~aCo}}~t~y~gegional Core Services 6 CSSTT a 04-OS 7/16/2004 XIV. CONTRACT ADMINISTRATORS AND CONTACT PERSONS, A. Contract Administrators. Contract administrators regarding contract administration, financial management, and evaluation of the performance of the scope of services described in Section I, above, are as follows: 1. BOCC and 4-County Region. Lynn Renick, Garfield County Department of Social Services Director. 2. Contractor. Ken Stein, Executive Director, Colorado West Regional Mental Health, Inc. B. Contact Persons. Contact persons for issues regarding an individual county or an individual client of a County Department are: 1. BOCC and 4-County Region. The referring County Director; and 2. Contractor. The Core Services administrator' for each county in the 4-County Region. XV. AMENDMENT. Any mutually agreed upon amendment, including without limitation any change in the scope of services, whether or not resulting in an increase or decrease in the amount of compensation, shall be incorporated in a written amendment to this Agreement. Amendments shall be executed with the same formality as •this Agreement, except as to change of address or name of contact person. Address and contact information shall not be considered an amendment to this Agreement and notice of such may be given by way of regular mail, telephone, or facsimile transmission. XVI. NOTICE. Notices required under this Agreement, other than changes in address or contact information, shall be delivered by way of certified mail, return receipt requested, to the addresses for signatories, written below. XVII. CONTROLLING LAW. This Agreement shall be governed by the laws of the State of Colorado and venue for any action arising out of or relating to performance of this. Agreement shall be in Garfield County, Colorado. XVIII. SEVERABILITY. If any term or provision is declared invalid or becomes inoperative for any reason, such invalidity or failure shall not affect the validity of any other term or $g}}Ka~o{}~t~y`~egional Core Services 7 C'2b5Tt5 eSS FFYY`"'04-OS 7/16/2004 provision, as long as the purposes of the Agreement can be effected. XIX. AUTHORIZATION. Each of the individuals signing below affirms that he/she is properly authorized to execute this Agreement on behalf of the governmental agency or private entity party to this Agreement. XX. INTEGRATION. The entire agreement of the parties is encompassed within this Agreement. No other oral or written representation or agreement shah be of any force or effect. IN WITNESS WHEREO the parties hereto have executed this document. ARD 0 CO ATTEST: GA IEL CO By: Ga field County Clerk J Date APPROVED: Garfiel un Social er is By' Department of nor Designee Lynn `E~~ Director P.O. Box 0 Glenwood Springs, CO 81602 Y OMMISSIONERS COL~RA]iJ a s `~ ~ ~BT~a~e~~~°f~~O4105a1 7116/20p4ices 8 CONTRACTOR: COLD D WEST REGIO MENTA HEALT , I By: en Ste n, Exec. Director Address: 6916 Highway 82 Box 40 Glenwood Springs, CO 81601 . Date: ACKNOWLEDGMENT STATE OF COLORADO ) ss. COUNTY OF GARFIELD) The foregoing instrument was acknowledged before me this ~"~ day of 2004 by Ken Stein, as Executive Director of Colora West Regional Mental Health, Inc. WITNESS MY HAND AND OFFICIAL SEAL. MY COMMISSION EXPIRES: ~~ I~OZo do Notary Public ~~~~a~e3'~~P~~O~lO5a1 7/16/20041°es g • ' :, SCOPE OF SERVICES PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH 2004 - 2005 Contractor shall provide mental health services, as authorized by County Departments for referred clients, including but not limited to individual counseling, family counseling, group therapy, psychological examination, psychiatric evaluation, psychiatric medication management, and care coordination-case management. Each County Director, directly and through his/her authorized representative(s), may approve other services for specific referred clients. Such other services may include, but are not limited to, crisis counseling and psycho-educational services. EXHIBIT A 4-COUNTY REGIONAL CORE SERVICES - MENTAL HEALTH PAGE 1 of 1 ~ ? ` + :y' FEE SCHEDULE PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH 2004 - 2005 Contractor and BOCC agree that the fee schedule for the services described in Exhibit A for the fiscal year 2004-2005 is based upon a thirty percent (30%) discount of fees otherwise charged by Contractor, as follows: SERVICE Individual Counseling Family Counseling Group Therapy Psychological Exam FEE $70/Hr. $70/Hr. $40/Hr. $76/Hr. Psychiatric Evaluation Psychiatric Medication Management Care Coordination/ Case Management $145/Hr., billed in 1/4 hr. increments $75/Event $35/Hr. Other services, not listed above and agreed upon between Contractor and a County Department, directly or through the authorized representative(s) of a County Director, shall be provided to referred clients at the agreed upon thirty percent (300) discount rate. EXHIBIT B 4-COUNTY REGIONAL CORE SERVICES - MENTAL HEALTH PAGE 1 o f 1 - , • ~ ' • '~ PURCHASE OF SERVICE CONTRACT 4 -'COUNTY REGIONAL AGREEMENT ~~~ ~ ~ C O P Y CORE SERVICES PROGRAM -'MENTAL HEALTH.- 2004/2005 ' ~~ THIS .PURCHASE. OF SERVICE CONTRACT for Core Services (this "Agreement") •made by and between the Board of County Commissioners of Garfield County, State of Colorado (rBOCC~) and i ~/ q ~ a . ~ arado r ,~ whose' address is ':7•.58 ., and whose Tax Identification number is ~~ _ 11 151 I ~ _ ("Contractor") . _,. ~ • WHEREAS, the BOCC is statutorily mandated to provide Core Services, through the County Department.. of Social Services ("GARCO DSS"), and has entered into an Intergovernmental Agreement ("IGA") for the provision of .such 'services in a four (4) .county region made up ~of Eagle County, Garfield County, Pitkin County, and Summit County ("4-County Region"); and WHEREAS, the IGA provides, among other things,~that Garfield County shall be .the coordinating County and the contracting and fiscal authority for mental health Core•Services in•the 4-County Region; 'and • WHEREAS, Contractor is :engaged in the, business of providing mental health services and is willing to~~provide such services in NOW. THEREFORE, ~ ~ in , consideration of the . premises and the obligations,' agreements, and promises contained herein, the parties agree as follows: I. SCOPE OF SERVICES. A. Services, Clients, Place of Service. Within the financial parameters ~ described in Section IV., below, Contractor shall' provide mental health services, as described in•Exhibit "A" attached t~o and incorporated herein by this reference; to all clients referred to Contractor .in the 4=County•Region by the referring.County ,Department of Human/Social Services ("County Department(s)") Director, or his/her authorized representative (s) ~ ( "County ~ Director (s) ") , in Eagle,. Garfield, Pitkin, and Summit Counties. Services shall be delivered at designated offices, clients' homes and other.locations approved by the County Director.. Contractor shall provide' services in accordance with State Department of .Human Services regulations, .found at 12 CCR 2509- 4,Section 7.303, as amended, and as •. described in that certain County Core Services Plan, executed~by the BOCC on • . ~-- April' 30, 2.004, on behalf of the 4•-County Region. Services sha1~1 be • provided in ~ a satisfactory and proper manner, as determined in the sole•discretion of.the BOCC. B: Contractor's Re orts. Contractor shall provide each County Director with reports on its•provision~of• services, as follows: 1. Treatment Plan. Within four (4) weeks of initiation of services for an identified client, Contractor shall submit an individualized treatment plan, with. stated objectives and target dates, to the appropriate~County Director. Treatment plans shall be jointly developed by the client's social~•caseworker and mental health service provider, and shall be subject to the approval of the referring County Director. 2. Progress Reports. At monthly intervals from the time~~of initiation of services, Contractor shall provide the referring_County Director with follow-up reports for each identified client. C. Confidentiality. It:-is specifically understood that only aggregated non-identifiable client services data shall be presented to the BOCC.in public:session. Client specific reports are subject to the confidentiality rules of Sections 3-9-3-~A~-~---ems---sew:--~ncr-~=~1~I;- -~- seq.; Z.1~:~-:-, ~-as- -amended; the federal Health Insurance Portability and Accountability Act of 1996; 42 U.S.C. Section~~ 290 dd-2, regarding confidentiality, of alcohol and drug abuse patient records; and other applicable federal and state law and regulation. II. :COUNTY RESPONSIBILITIES. The County Departments .shall: (1) determine client eligibility; ~(2) provide ,Contractor, prior •to 'scheduling clients for appointments, with written authorization for provision of services, specifying begin and end service dates.;• {3j provide Contractor, prior to scheduling clients for appointments,. with referral updates. detailing changes in service ~ types; (4)~ provide ~ Contractor ~ with referral informatibri,. such as name, address, State ID number and social, medical and educational information as appropriate ~~to the referral;. (5) confirm case closure with Contractor, in writing, within 24 hours of County Department closure; and (6) input data in the Colorado computerized child welfare ca-se management .and provider .payroll system ("Trails")to ~ authorize Contractor's provision of services .to referred clients and to initiate payment 4-County Regional Core Services 2 Mental Health - Form Contract (04-OS) •, ; of Contractor for services provided,• as detailed in Section~IV., below. III. TERM OF AGREEMENT. The term of this Agreement shall begin, retroactively, on ~ and shall terminate °n ~ ~- l Sri • no matter the • date of execution. • IV. COMPENSATION. A. Payment and Not-to-.Exceed Amount. For performance of the scbpe~of services set forth in Section I, above, the Contractor shall 'be paid on ~.~ fee ..for service • basis in accordance with Exhibit "B",~ attached hereto and incorporated herein by .this. reference. .In no event shall the compensation paid under this Agreement exceed the amount set forth on. Exhibit B. 8. No ~'ee-For-Service. Compensation in accordance .with the terms of ~ this Agreement ~ represents full payment of fees for services provided to referred clients~in•the 4-County Region. Contractor shall not charge or collect fees from clients for services provided hereunder. C. ~Metliod of ' Payment. •~ Contractor shall be ~ compensated in accordance .with the statewide "Trails Users Fiscal Calendar" and~by means of the Trails provider payroll system as follows: -~ - -- *~--L--- - - ~uri~,g= the--~-~~st ~,;,ee~- o~ ~~e- -montTi; - -each County'Department shall generate and provide to Contractor a Trails "Core Main Provider. Roster" ("roster") which is based on authorized referrals; identifies referred clients by name, case number, State identification number, sex, and birthday; and calls for completion by Contractor .of specified .information about service provision in the preceding service/pay period. ~~ 2. Contractor's Submittal. Upon receipt,, Contractor shall: (1) fill ill all service information called for by the roster, e.g.,~ number of days/units, unit type and amount; for .each client identified on the roster; (2) add to the roster identification and service information for clients who do not appear on the roster but for whom the Contractor provided service during the pay period; and.~(3} return the completed roster, with an authorized signature, to, the referring County Department by the tenth (10) day of the month following the pay period. 4-County Regional Core Services Mental Health - Form Contract (04-05) 3 •',; 3. Provider Remit-taace Advice. ,Upon receipt from the' Contractor, each County Department shall input into Trails ., the information provided~on Contractor's completed roster and generate a "Provider Remittance Advice" advising Contractor of the -payment amount authorized for the -services itemized on the-roster.~ The Provider Remittance Advice for the pay period shall be provided to Contractor during the last week of the next month,- along with that - month's computer'generated~-roster for ,the new pay period. 4. Adjustments. In the event that Contractor does not agree with the information and dollar amount presented on the Provider Remittance Advice or the authorizing County Department discovers an error, one shall contact the other and adjustments shall be made in future payment(s), if. needed. - - 5. Delivery Methods. Delivery of rosters and Provider. Remittance Advice- documents, and communication between. referring County Departments and the Contractor regarding the Trails payment system, may be by~~means of~U.~S. Mail, .private delivery service, facsimile transmission, telephone, ~ hand delivery or by e-mail if electronic signature is available for use iri the transaction. - D. Billing Cut-off Date. Contractor shall not be reimbursed - - far -~-3~-1--3~g-s--~~~~~--~~i~-----eountp--D-egartm`~n~--~ ~~~ __montTis or•more after the date of service.•~ - V. FUNDING CONTINGENCY.- ~ In accordance with .§29-1-110, C.R.S., as amended,, the BOCC is-not authorized to. expend monies which have not been appropriated. Payment pursuant to this Agreement ~ is 'subject to and contingent upon funds being appropriated, budgeted and otherwise made available by the BOCC, the State of Colorado; and/or federal, funding sources, as applicable-to.this Agreement. VI. ~ INDEPENDENT CONTRACTOR.--The Contractor shall provide the services identified in Section I, above, .as an independent contractor providing .supervision of its employees, agents and subcontractors. The Contractor represents that it has or will secure at its own expense all personnel- required to perform the scope of services identified in Section I, above. Contractor shall ensure that its personnel are professionally licensed, as required by law, - and .meet applicable State Department. of Human Services qualification requirements. Contractor's employees, agents and subcontractors are not employees or agents of and do 4-County Regional Core Seivices 4 Mental Health - Form Contract (04-05) -~ ~ • not have ~a contractual relationship with the BOCC. Neither the Contractor, nor any of Contractor's .employees, agents or subcontractors shall be entitled to any benefits or. attributes of employment by the BOCC including, without limitation, workers compensation or health insurance coverage. VII. SUBCONTRACT •AND ASSIGNMENT. Contractor. shall .• riot subcontract with another individual or entity for performance of~ the services described in Section I, above, and shall not assign or otherwise transfer •its rights~or delegate its obligations under this• Agreement without the prior written approval of the BOCC, unless authorized to subcontract for specific services as set forth in Exhibit "A". VIII: INFORMATION, AUDITS AND~INSPECTIONS. At such. times and in such forms as the"BOCC may require, Contractor shall furnish statement~~s, records, reports, data and information pertaining to the matters covered by this Agreement. At any time during normal business hours and as often as the BOCC may deem~•necessary, Contractor shall make available. for•examination and audit by the BOCC and the State Department of Human Services or authorized representatives thereof, all of the Contractor's records, materials, reports,"information and data with ~respect~to matters covered by this Agreement. All such information shall ~be maintained_by Contractor for a period of seven (7) years after final payment is made to the Contractor under this Agreement.' IX. INDEMNIFICATION. The Contractor shall indemnify, hold harmless and~•defend• the.B000 and its employees, agents, and officers; acting officially or otherwise, from and against any and all claims, damages, liability and,proceedings of any. kind, including attorneys. fees, arising out of this Agreement,. other then•those resulting from the negligence or willful misconduct of the BOCC,.its employees, .agents, or officers. X. INSURANCE. Contractor shall maintain insurance with companies authorized to do, business •in Colorado, on forms satisfactory to the BOCC, in at least the following minimum coverage amounts: ~ " GENERAL LIABILITY: $150,000.00 per person, $600,000.00 per occurrence AUTOMOBILE LIABILITY:•$I50,000.00 per person, $600,000.00 per occurrence WORKERS COMPENSATION: As required by Colorado Law _. PROFESSIONAL MALPRACTICE INSURANCE: Contractor and its personnel, in a minimum amount of $1,000,000 per claim, $3,000,000 aggregate. 4-County Regional Core Services 5 Mental health - Form Contract (04-OS') XIV: CONTRACT ADMINISTRATORS AN'D CONTACT PERSONS. A.. Contract Administrators. Contract :administrators regarding contract administration, financial management, and evaluation of the performance of the scope of services described in Section I, above, are as foilows:~~ 1. BOCC and 4-County Region. Lynn Renick, Garfield County Department of Social'Services Director. • 2. ' ~ Contractor. B. Contact~Persons. .Contact persons for issues regarding an individual county or 'an individual client of .a County Department are: 1. BOCC and 4-County Region. The referring County Director; and 2~. Contractor. The Core•Services administrator for each county in the 4-County Region. ~• AMENDMENT. Any mutually agreed upon amendment, including without limitation any change in the scope of services, whether or. not•resulting in an increase or decrease in the amoun_t_ of ~p~nsat~~~- .. s~lat~ ~ ~-~-,-incorporaf:ecT~--in a written amendment to this Agreement, '.Amendments. shall be executed. with the same formality. as~this Agreement~,'~except as to change of address or name~of contact person: Address and contact information shall not .be considered an amendment to this,'Agreement azld notice of such may be given by way of regular. mail, 'telephone, or facsimile transmission. .~ XVI. ~ NOTICE. Notices required under.this Agreement, other than changes in address or contact information, shall be delivered by way of certified mail, return receipt requested, to the addresses for signatories, written below. . XVII.~~ CONTROLLING•LAW~. This~Agreement shall be.governed by the laws of.~the State of Coloraao~and venue for any action arising 'out .of or relating to performance of this Agreement shall be in Garfield County, Colorado. ' XVIII. SEVERABILITY. If any term or provision is declared invalid or becomes inoperative for any reason, such invalidity or failure shall not affect the validit of an 4-County Regional Core Services Y Y other term Or Mental Health - Form Contract (04-05) 7 ^, provision, as long as the purposes of the Agreement can be effected. XIX. AUTHORIZATION. Each of .the individuals signing below affirms •that he/she is properly authorized ~to execute this . Agreement on behalf of the governmental agency or private entity party to this Agreement: . ~: INTEGRATION. 'The entire agreement of the, parties is encompassed within this Agreement. No other oral or written representation or agreement shall be of any force or effect. . = - :, 4-County Regional Core Services ~ g Mental Health - Form Contract (04-OS) IN [~IITNESS WHEREOF the parties hereto have eXecuted,~this document. _(IF OVER $10,000.00) BOARD OF COUNTY COMMISSIONERS ATTEST: GARFIELD COUNTY, COLORADO . By: Clerk to the Board ~ ~ John Martin, Chairman 'Date: ' ~ (IF~ UNDER $10, 000 .00) ~. BOARD'OF COUNTY COMMISSIONERS GARFIELD COUNTY, CO ' Green,.County Manager Date : S/ / ~~© 4c , ~._____ APPROVED: GARFIELD COUNTY~DEPARTMENT OF SOCIA S R ~ ,~OR DESIGNEE Lynn enick,.Director P.O.x'850 Glenwood Springs, CO .81602 CONTRACTOR: ~ ~ ~~ f~J White River •Caunselir~ B ~` Y~ Warren Humble, Director/President Type Name and Title Date : ~ 08/26/04 Address : _ 758 Railroad Ave . Rule, co 81650 4-County Regional Core Services 9 Mental Health - Form Coatract .(04-OS) ACKNOWLEDGMENT STATE OF COLORADO ) ss. COUNTY OF GARFIELD ) The foregoing instrument was acknowledged before me this 26th day of At~,ust 2 0 04 by Warren ~Humbl ~ as Tlirarfinr/ (Title) of White River Co sell ~"--T~'esident WITNESS MY HAND AND OFFICIAL SEAL, MY COMMISSION EXPIRES : -~~~L1k - . ,~~~~aeu~~~~~ ... ~`~R~~SL~,S~~~~ No ry Publ . ~QjA~~ s~~ ~t/BL1G ~'I#~ jO` ~ Q~Q i 4-County Regional Core Services ~O Mental Health - Form Contract (04-05) EXHIBIT ~~Ari SCOPE OF SERVICES PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH Contractor shall provide mental health services, as authorized by County Departments for referred clients, including but not limited to: X Individual Counseling X Family Counseling Psychological Examination Psychiatric Evaluation Psychiatric Medication Management X Care CoordinationfCase Management X f~th~r - Other Each County Director, directly and through his/her authorized representative(s), may approve other services for specific referred clients. The BOCC grants approval for Contractor to subcontract with NSA (Name of for the provision of Company) services under the terms of the Core Services Program - Mental Health Agreement. 4-County Regional Core Services Mental Health - Exhibit "A' 04-OS - Form EXHIBIT "B" FEE SCHEDULE PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM! - MENTAL HEALTH Contractor and BOCC agree that the fee schedule for the services described in Exhibit "A", for the term set forth in Paragraph III. of the Agreement, are as follows: SERVICE Individual Counseling Family Therapy Care Coordination Domestic Evaluation FEE $70.DOjhour $70.00/hour $30.00/hour $175.00/Episode In no event shall compensation paid under this Agreement exceed: Four thousand Eight hundred fifty ($ 4,850.00 ). The not-to-exceed figure represents a three percent (3%) amount retained by the BOCC from the Core Services ($5,000.00 ) presently designated to this Agreement, from the CDHS Core Services allocation, for administration of this Agreement on behalf of the 4-County Region. 4-County Regional Core Services Mental Health - Exhibit "B" 04-05 - Form t ;;, ~~~~:~ ~ COP Y PURCHASE OF SERVICE CONTRACT 4 -'COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH.- 2004/2005 THIS PURCHASE• OF SE "Agreement") made by Commissio ers of Garfield --~C.o'~" ~z i era _ L .~, ~r`~iLt ~2, ~~~nt~ ~~2.. C~ l ~, .arc number is. 3~Q~ (a$T91a~ RVICE CONTRACT for Core Services (this and between the Board of County County, State of Colorado ("BOCC") and a • whose address is ~j. , and whose Tax Identification ("Contractor"). WHEREAS, the BOCC is statutorily mandated to provide Core Services,• through the County Department of Social Services ("GARCO DSS"), and has entered into an Intergovernmental Agreement ("IGA") for the provision of such services in a four (4)..county region made up of Eagle County, Garfield County, Pitkin County, and Summit County ("4-County Region"); and • WHEREAS, the IGA provides, 'among other things, that Garfield County shall be the coordinating County and the contracting and fiscal authority for mental health Core~Services in•the 4-County Region;•and _ . WHEREAS, Contractor is. engaged in the business. of providing mental health services and is willing to provide such services in a the 4 - Cou-nty ~-gion . ~ ~ .. ~ . NOW. THEREFORE, in, consideration of the premises and the obligations, agreements, and promises contained herein, the parties agree as follows: ~ • I. SCOPE OF SERVICES. A. Services; Clients, Place of Service. Within the financial parameters ~ described in Section IV., below, Contractor shall' provide mental health services, as described in Exhibit "A" attached to and incorporated herein by this reference; to all clients referred to Contractor .in 'the 4=County~Region by the referring County Department of Human/Social Services ("County Department(s)") Director, or his/her authorized representative(s) ("County~Director(s)"), in Eagle,. Garfield, Pitkin, and Summit Counties. Services shall,be delivered at designated offices, clients' homes and other locations approved~by the County Director.. Contractor shall provide services in accordance with State Department of .Human Services regulations, .found at 12 CCR 2509- 4,SeCtion~ 7.303, as amended, and as described in that certain County Core Services Plan, executed by the BOCC on • '{ Apri1~ 30, 2004, on behalf of the 4•-County Region. Services shall be provided in~a satisfactory and proper manner, as determined in the sole discretion of.the BOCC. B. Contractor's Reports. Contractor shall provide each County Director with reports on its provision of services, as follows: 1. Treatment Plan. Within four (4) weeks of initiation of services for an identified client, Contractor shall submit an individualized treatment plan, with stated objectives and target dates, to the appropriate County Director. Treatment plans shall be jointly developed by the client's social• caseworker and mental health service provider, and shall be subject to the approval of the referring County Director. 2. Progress Reports. At monthly intervals from the time~~of initiation of services, Contractor shall provide the ref erring. County Director with follow-up reports for each identified client. C. Confidentiality. It: is specifically understood that only aggregated non-identifiable client services data shall be presented to the BOCC.in public session. Client specific reports are subject to the confidentiality rules of Sections 19-1-x.91, et ~~~ 26-1-~41, ~:t• secy., C.R.S., as amended; the federal Health Insurance Portability and Accountability Act of 1996; 42 U.S.C. Section 290 dd-2, regarding confidentiality. of alcohol and drug abuse patient records; and other applicable federal and state law and regulation. II. COUNTY RESPONSIBILITIES. The County Departments .shall: (1) determine client eligibility;~(2) provide .Contractor, prior 'to 'scheduling clients for appointments, with written authorization for provision of services, specifying begin and end service dates.; (3)~ provide Contractor, prior to scheduling clients for appointments,. with referral update s. detailing changes in service types; (4) provide Contractor with referral informatibri, such as name, address, State ID number and social, medical and educational information as appropriate to the referral;, (5) confirm case closure with Contractor, in writing, within 24 hours of County Department closure; and (6) input data in the Colorado computerized child welfare case management and provider payroll system ("Trails")to ~ authorize Contractor's provision of services .to referred clients and to initiate payment 4-County Regional Core Services 2 Mental Health - Form Contract (04-OS) 1 of Contractor for services provided, as detailed in Section~IV., below. III. TERM OF AGREEMENT. T e term of this Agreement shall begin, ret• o ctively, on ~ ;. •i o~ ~ and shall terminate on ~-; )~, ~ no matter the~date of execution.• IV. COMPENSATION'. A.~ payment and Not-to-Exceed Amount. For-performance,of the scope'of services set forth in Section I, above; the Contractor shall be paid on 'a fee for service basis in accordance with Exhibit "B",• attached hereto and incorporated herein by .this reference. .In no event shall the compensation paid under this Agreement exceed the amount set forth on Exhibit B. 8. No Fee-For-Service. Compensation in accordance .with the terms of this Agreement represents full payment of fees for services provided to referred clients~in•the 4-County Region. Contractor shall not charge or collect fees from clients for services provided hereunder. C. Method o£~ Payment.' Contractor shall be compensated in accordance with the statewide "Trails Users Fiscal Calendar" and by means of the Trails provider payroll system as follows: 3.. _ . F.o~-t~,r~ Dur~nrg ~ thy. ~ iast w~ o~ die z~-ontli, each County•Department shall generate and provide to Contractor a Trails "Core Main Provider. Roster" ("roster") which is based on authorized referrals; identifies referred clients by name, case number, State identification number, sex, and birthday; and calls for completion by Contractor .of specified information about service provision in the preceding service/pay period. 2. Coatractoz's Submittal. Upon receipt, Contractor shall:(1) fill in all service information called for by the roster, e.g.,~ number of days/units, unit type and amount; for .each client identified on the roster; (2) add to the roster .identification and•service information for clients who do not appear on the roster but for whom the Contractor provided service during the pay period; and.~(3) return the completed roster, with an authorized signature, to.the referring County Department by the tenth (10) day of the month following the pay period. 4-County Regional Core Services 3 Mental Health - Form Contract (04-OS) 3. Provider Remittance Advice. Contractor, each County Department the information provided•on Contra and generate a "Provider Remitt Contractor of the payment amour services itemized on the~roster.~ Advice for.~the pay period shall be during the last week of the next month' s co~mputer~ generated •~roster f 4. Adjustments. In the event agree with the information and the Provider Remittance Advice Department discovers an error,: and adjustments shall be made needed. Upon receipt from the 3ha11 input into Trails :tor's completed roster once Advice" advising t authorized for the I'he Provider Remittance provided to Contractor month,' along with that ~r.the new pay period. that Contractor does not dollar amount presented on or the authorizing County one shall contact the other in future payment (s) , if . 5. Delivery Methods. Delivery of rosters and Provider Remittance Advice documents, and communication between. referring County Departments and the Contractor regarding the Trails payment system, may be by means of~U. S. Mail, private delivery service,. facsimile transmission, telephone, ~ hand delivery or by e-mail if electronic signature is available~~or use in the transaction. D. Billing Cut-off Date. Contractor shall not be reimbursed for billings received by the C~aunty Department two (2) months or more after the date of service.- V. FUNDING CONTINGENCY. In accordance with .~29-1-110, C.R.S., as amended, the BOCC is not authorized to expend monies which have not been appropriated. Payment pursuant to this Agreement ~ is subject to and contingent upon funds being appropriated, budgeted and otherwise made available by the BOCC, the State of Colorado, and/or federal funding sources, as applicable~to this Agreement. VI. ~ INDEPENDENT CONTRACTOR. The Contractor shall provide the services identified in Section I, above, ,as an independent contractor providing supervision of its employees, agents and subcontractors. The Contractor represents that it has or will secure at its own expense all personnel required to perform the scope of services identified in Section I, above. Contractor shall ensure that its personnel are professionally licensed, as required by law, and ,meet applicable State Department. of. Human Services qualification requirements. Contractor's employees, agents and subcontractors are not employees or agents of and do 4-County Regional Core Sei^vicea ,4, Mental xealth - Form Contract (04-OS) ~ . not have a contractual r"elationship with the BOCC. Neither the Contractor, nor any of Contractor's .employees, agents or subcontractors shall be entitled to any benefits.or. attributes of employment by the BOCC including, without limitation, workers compensation or health insurance coverage. VII. SUBCONTRACT 'AND ASSIGNMENT. Contractor, shall ~" not subcontract with another individual or entity for performance of . the services described in Section I, above, and shall not assign or otherwise transfer its rights or delegate its obligations under this Agreement without the prior written approval of the BOCC, unless authorized to subcontract for specific services as set forth in Exhibit "A". VIII: INFORMATION, AUDITS AND INSPECTIONS. At such. times and in such forms as the•BOCC may require, Contractor shall furnish statemenl~s, records, reports-, data and information pertaining to the matters covered by this Agreement. At any time during normal business hours and as often. as the BOCC may deern~ necessary, Contractor shall make available for examination and audit by the BOCC and the State Department of Human Services or authorized representatives thereof, all of the Contractor's records, materials, reports, information and data•witYi respect~to matters covered by this Agreement. All such information shall •be maintained by Contractor for a period of seven (7) years after final payment is made to the Contractor under this Agreement. IX. INDEMNIFICATION. The- Contractor shall indemnify, hold harmless and" defend the.B000 and its employees, agents, and officers, acting officially or otherwise, from and against any and all claims, damages, liability and .proceedings of any. kind, including attorneys. fees, arising out of this Agreement, other then those resulting from the negligence or willful misconduct of the BOCC,.its employees,-agents, or officers. ~ " X. INSURANCE. Contractor shall.maintain insurance with companies authorized to do, business in Colorado, on forms satisfactory to the -B000, in at least the following minimum coverage amounts: GENERAL LIABILITY: $150,000.00"per person, $600,000.00 per occurrence AUTOMOBILE LIABILITY: $150,000.00 per person, $600,000.00 per occurrence WORKERS COMPENSATION: As required by Colorado Law ." PROFESSIONAL MALPRACTICE INSURANCE: Contractor and its personnel, in a minimum amount of $1,000,000 per claim, $3,000,000 aggregate. 4-County Regional Core Service8 5 Mental Health - Form Contract (04-05~ Contractor shall name the BOCC as an additional insured on the general liability policy and, if Contractor's insurer determines that the BOCC has an insurable interest as a result of the contractual relati,.onship created herein, on• the automobile liability'policy.~ Contractor shall deliver copies of policies or Certificates of. Insurance to the BOCC through the Business Services Manager of GARCO DSS, within a reasonable time after execution of this Agreement and on~each,policy renewal date. XI. COMPLIANCE WITH LAWS .. ,The Contractor shall comply'with all laws, ordinances,' codes and regulations of the federal, state,.and local governments applicable to this Agreement, in its performance under this Agreement. Without limiting the generality of this Section XI., Contractor: (1)shall maintain client confidentiality, including confidentiality of records, in accordance with state and federal law, rules and regulations; and (2) shall not discriminate against -any person on the. basis• of race,. color, national origin, religion, sex, age. or handicap. Any dines paid or expenses- incurred by the BOCC, due to Contractor's violation of applicable law or regulation, shall be reimbursed to the BOCC by the Contractor. XII. MUTUAL TERN? may terminate this upon thirty '(30) party. Upon such e~ge-r~satioh far termination. ,INATION FOR CONVENIENCE. BOCC~and Contractor Agreement, without cause and for convenience, days written notice to- the non-terminating termination, Contractor shall be entitled to service-s performed prior to the date of XIIi. -TERMINATION FOR CAUSE. If•the Contractor fails to fulfill its obligations under this Agreement in a timely and proper manner, as determined by the BOCC, or if the Contractor violates any of the terms•or'provisions of this Agreement, the BOCC shall have the right, in its sole discretion, to ,terminate this Agreement by giving written notice to the Contractor at, least fifteen (15) days before the effective date of the termination and~may provide Contractor, in the.B000'.s sole discretion, ari opportunity to cure within that fifteen '(15) day notice period. Upon termination` for• cause, .Contractor shall be entitled to receive just~and equitable .compensation for work satisfactoril~,r completed prior to termination. Contractor shall not, however, be relieved of liability to the BOCC for damages•sustained by the BOCC by virtue of any breach of this Agreement by•the Contractor. The BOCC may withhold payments due to the Contractor for the purpose of set-off until such time as the exact amount of damages due the BOCC from Contractor is~determined. 4-County Regional Core services Mental Health - Form Contract (04-05) XIV. CONTRACT ADMINISTRATORS AND CONTACT PERSONS. A. Contract Administrators. Contract :administrators regarding contract administration, financial management, and evaluation of the performance of the scope of services described in Section I, above, are as follows: 1. BOCC and 4-County Region.' Lynn Renick, Garfield County Department of Social•Services Director.• 2.Contractor. B. Cont3ct~Persons. .Contact persons -for issues regarding an individual county or an individual client of .a County Department are: 1. BOCC and 4-County Region. .The referring County Director; and ~ . 2. Contractor. The Core•Services administrator for each county in the 4-County Region. ~~ XV. AMENDMENT. Any mutually agreed upon amendment, including without limitation any change in the scope of services, whether or not•resulting in an increase or decrease in the amount of comp~nsatiz~n, , ~llall be • , incorporated in a writt-en a~nd~en~ to this Agreement. .Amendments shall be executed. with the same formality as this Agreement,' except as to change of address or name of contact person: Address and contact information shall not be considered an amendment to this.•Agreement and notice of such may be given by way. of regular mail, 'telephone, or facsimile transmission. XVI. NOTICE. Notices required under this Agreement, other than changes in. address or contact information, shall be delivered by way of certified mail,•~return receipt requested, to the addresses for signatories, written below. XVII.~~ CONTROLLING LAW. This Agreement shall be governed by the laws of.~the State of Colorado and venue for any action arising out .of or relating to performance of this Agreement shall be in Garfield County, Colorado. XVIII. SEVERABILITY. If any term or provision is declared invalid or becomes inoperative for any reason, such invalidity or failure shall not affect the validity of any other term or 4-County Regional Core Services 7 Mental Health - Form Contract (04-05) provision, as long as the purposes of the Agreement can be effected. XIX. AUTHORIZATION. Each of the individuals signing below affirms that he/she is properly authorized ~to execute this Agreement on behalf of the governmental agency or private entity party to this Agreement: _ XX. INTEGRATION. The entire agreement of the parties is encompassed within this Agreement. No other oral or written representation or agreement shall be of any force or effect. .~ 4-County Regional Core Services g Mental Health - Form Contract (04-OS) EXHIBIT "A" SCOPE OF SERVICES PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH Contractor shall provide mental health services, as authorized by County Departments for referred clients, including but not limited to: X Individual Counseling X Family Counseling Psychological Examination Psychiatric Evaluation Psychiatric Medication Management X Care Coordination/Case Management Other Other Each County Director, directly and through his/her authorized representative(s), may approve other services for specific referred clients. The BOCC grants approval for Contractor to subcontract with N/A (Name of Company) for the provision of services under the terms of the Core Services Program - Mental Health Agreement. 4-County Regional Core Services Mental Health - Exhibit "A" 04-OS - Form .~ EXHIBIT ~~Brr FEE SCHEDULE PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH Contractor and BOCC agree that the fee schedule for the services described in Exhibit "A", for the term set forth in Paragraph III. of the Agreement, are as follows: SERVICE Individual Counseling Family Therapy Care Coordination $ 70.00/hour $70.00/hour $30.00/hour ~ - FEE In no event shall compensation paid under this Agreement exceed: Four thousand Eight hundred fifty ($ 9,850.00 )• The not-to-exceed figure represents a three percent (3~) amount retained by the BOCC from the Core Services {$5,000.00 ) presently designated to this Agreement, from the CDHS Core Services allocation, for administration of this Agreement on behalf of the 4-County Region. 4-County Regional Core Services Mental Health - Exhibit "B" 04=05 - Form .IN WITNESS WHEREOF the parties hereto have executed this document. ATTEST: (IF OVER $10,000.00) BOARD OF COUNTY COMMISSIONERS GARFIELD COUNTY, COLORADO . By: Clerk to the Board ~ John Martin, Chairman Date APPROVED: GARFIELD COUNTY DEPARTMENT OF SOCIA SE ~S,~OR DESIGNEE By: .. Lynn 'ck, Director P.O. Box 0 Glenw rings, CO .81602 (IF~UNDER $10,000.00) BOARD OF COUNTY eOMMISSIONERS GARFIELD COUNTY, COh,C1B~D0~ E~"een,.County Manager Date: CONTRAC'~OR: By: ~. Sco'~ ~Ziur'~+ ~cPHsP~ Jo~esF9c~ol wHspir9v'. . Type ame and Title Date : ~ ~ u.c~ ~ ~ ~ '2- o© . ~ ~ Address: ~2~ ~~~-- ~~-va~.J~-v~ yr- l e ~ ,~.oa ~l Sp ,. ~ .~•rf, C~ ,$l60- 4-County Regional Core Services 9 Mental Health - Form Contract ,(04-05)' ACKNOWLEDGMENT STATE OF COLORADO ~ ) ss. COUNTY OF GARFIELD ) The foregoin instrument was ac nowledged before me this da of 2004 b ~ a~ Y Y ~~ ~7 ~u~ (Title) Of ~ r i~7 s 1.1 +('a WITNESS MY~HAND AND OFFICIAL `SEALG. MY COMMISSION EXPIRES: ~1` D ~~ o ary Public IRMA E ABRIL NOTARY PUBLIC STATE OF COLORADO My Commission Expin~ April 18, 2007 4-County Regional Core Services 1 O Mental Health - Form Contract (04-05) it ' ~ T L~Q ~l l , PURCHASE OF SERVICE CONTRACT 4 -COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM -'MENTAL HEALTH.- 2004/2005 " THIS PURCHASE. OF SERVICE CONTRACT for Core Services (this "Agreement") .made by .and between the Board of County Commissioners of Garfield County, State of Colorado ~("BOCC")~aizd. ~,~Od U d r y ~ ~ a •_ . ,~ whose' address is ' ~~ and whose Tax Identification number is . $N (a~7~~g ~ ("Contractor') . WHEREAS, the BOCC is statutorily mandated to provide Core Services, through the County Department of Social Services ("GARCO DSS"), and has entered into an Intergovernmental Agreement ("IGA") for the provision~of such'servi~ces in a four (4)...county region made up of. Eagle County, Garfield County, Pitkin County, and Summit County ("4-County Region"); and • WHEREAS, the IGA provides, 'among other things,~that Garfield County shall be ,the coordinating County and the contracting and fiscal authority for mental health Core•Services in•the 4-County Region;~and WHEREAS, Contractor is :engaged in 'the. business o~ providing mental health services and is willing to~provide such services in a the 4 -County Region . -~ ~ . NOW. THEREFORE,'~in.consideration of the. premises and the obligations, agreements, and promises contained herein, the parties agree as follows: _ ` I'. ~SCQPE OF SERVICES. A. Services, Clients,' Place of Service. Within the financial parameters 'described in Section IV., below, Contractor sha11~ provide~• mental health services, as described in~Exhibit "A" attached t~o and incorporated herein by this reference; to all clients referred to Contractor _in the 4=County~Region by the referring.County Department of Human/Social Services ("County Department(s)") Director, or. his/her authorized representative (s}' ("County Director(s) ") , in Eagle,. Garfield, Pitkin, and Summit Counties. Services shall be delivered at designated offices, clients' homes and other.locations approved~by the County Director.. Contractor shall provide services in accordance with Stake Department of .Human Services regulations, .found at I2 CCR 2509- 4, Section 7.303, as amended, and as • .described in that certain County Core Services Plan, executed by the BOCC on ~, . .April' 3~, 2.004, on~ behalf of the 4•-County Region. Services shal•1 be ~ provided in • a satisfactory and proper manner, as determined in the sole discretion of.the BOCC. B. ~ Contractor's Reports. Contractor shall provide each County Director with reports on its•provision of~ services, as follows: 1. Treatment Plan. Within four (4) weeks of initiation of services for. an identified ~client,~ Contractor shall submit an individualized treatment plan, with. stated objectives and target dates, to the appropriate~County Director. Treatment plans shall be jointly developed by the client's ~social•~caseworker and mental health service provider, and shall be subject to. the approval of the referring County Director. 2. Progress Reports. At monthly intervals from the t•ime~•of~ initiation of services, Contractor shall provide the referring. County Director with follow-up reports for each identified client. ~. Confidentiality. It::is specifically understood that only aggregated non-identifiable client services data shall be presented to the BOCC.in public session. Client specific reports are subject to. theconfidentiality rules of Sections 19-1=101,• et seq. •and' 26-1-101, e,t~ seq.., C.R.S., as amended; the federal Health Insurance Portability and Accountability Act of 1996; 42 U.S.C. Section 290 dd-2, regarding confidentiality..of alcohol and drug abuse patient records; and other applicable federal and state law and regulation. II. COUNTY RESPONSIBILITIES. The County Departments .shall: (1) determine client eligibility;•~(2) provide .Contractor, prior 'to ~scheduling~ clients for appointments, with written authorization for provision of~ services, specifying begin and end service dates.; (3)' provide Contractor, prior to scheduling clients for appointments,. with referral updates. detailing changes in servicetypes; (4)~ provideContractor with referral information,. such as name, address, State ID number. and social, medical and educational information as appropriate ~•to the referral;. (5) confirm case closure with Contractor, in writing, within 24 hours of County Department closure; and (6) input data in the Colorado computerized child welfare case management and provider .payroll system ("Trails")to ~ authorize Contractor's provision of services.to referred clients and to initiate payment 4-County Regional Core Services Mental Health - Form Contract (04-OS) of Contractor for services provided,• as detailed in Section•IV., below. III. TERM OF AGREEMENT. The term of this Agreement shall begin, retroactively, on (Q•~..~ ~ and shall terminate on `~j . 3l • 05 no matter the ~ date of execution. " IV. COMPENSATION". A.' Payment and Not-to-.Exceed Amount. For performance" of the scope'of services set forth in Section I, above, the Contractor shall 'be paid on ~ ~ fee , for service "basis in accordance with Exhibit "B",• attached hereto and incorporated herein by .this reference. .In no event~•shall the compensation paid under this . Agreement exceed the•amount set forth on Exhibit B. B. No Fee-For-Service. Compensation in accordance.with the terms of~this Agreement"represents full payment of fees for services provided toreferred clients • in • the 4-County Region. Contractor shall not charge or collect fees from clients for services provided hereunder. C.Method of Payment.'" Contractor shall be• compensated in~ accordance •with the statewide "Trails Users Fiscal Calendar" and•by means of the Trails provider payroll system as follows: 1.. .Roster. During ~ the ~ last week of the month, each County'Department shall generate and pr"ovide to Contractor a Trails "Core Main Provider. Roster" ("roster") which is based orl authorized referrals; identifies 'referred' clients by name, ease number, State identification number, sex, and birthday; and calls for completion by Contractor .of specified .information about service provision in the preceding service/pad period. ~. 2. Contractor's Submittal. Upon receipt, Contractor shall: (1) fill i~. all service information called for by the roster, e.g.," number of days/~znit.s, unit type and amount; for .each client identified on the roster; (2) add to the roster identification and'service information for clients who do not appear on the roster but for whom the Contractor provided service during the pay period; and.~(3) return the completed roster, with an authorized signature, to"the referring County Department by the tenth (],0) day of the month following the pay period. 4-County Regional Core Services 3 Mental Health - Form Contract (04-05) ~, i 3 . Provider, Remit.taxice Advice . . Upon receipt from the• Contractor, each Caunty Department shall- input into Trails the information ~provided~ on Contractor's completed roster and generate a "Provider Remittance Advice" advising Contractor - of the -payment amount authorized for the services itemized on the•roster.~ The Provider Remittance Advice for •the pay period shall be provided to Contractor during the last week of the next month,' along with that month's computer•generated•-roster for .the new pay period. 4. •Adjustments. In the event agree with the information and the Provider Remittance Advice Department discovers ari error, and adjustments shall.be made needed. - that Contractor does not dollar amount presented on or the authorizing County >ne shall contact the. other in future payment (s) , i f . 5. Delivery Methods. Delivery. of rosters and Provider Remittance Advice documents, and communication between. referring County Departments and the Contractor regarding the Trails payment system, may be by •means of ~ U. • S. Mail, :private delivery service, facsimile transmission, telephone, hand delivery .or by e,-mail if electronic signature is available for use iri the transaction. D. Billing Cut-off Date. Contractor shall not be reimbursed for billings received by the County Department two (2) months or more after the date of service . ~ ~ ~ - - ~ - V. FUNDING CONTINGENCY. In accordance with .§29-1-110, C:R~.S., as amended,, the BOCC is-not authorized to expend monies which have not been appropriated. Payment pursuant to this Agreement ~ is subject to and contingent upon funds being appropriated, budgeted and otherwise made available by the BOCC, the State of Colorado-; and/or federal funding sources, as applicable to this Agreement. VI. INDEPENDENT CONTRACTOR.. -The Contractor shail~provide the services identified in Section I, above; .as an independent contractor providing supervision of its employees, agents and subcontractors. The Contractor represents that•~ it has or will secure at its own expense all personnel required to perform the scope of services identified in Section- I, above. Contractor shall ensure that its personnel are professionally licensed, as required by law, and.meet applicable State Department•.of. Human Services qualification requirements. Contractor's employees,- agents• and subcontractors are not employees or agents of, and do 4-County Regional Core Seivicea !~ Mental Health - Form Contract (04-OS) Contractor shall name the.BOCC as an additional insured on the general liability policy and, if Contractor's insurer de.terrnines that the BOCC has an insurable interest as a result of the contractual. relationship created herein, on~.the automobile liability'~policy..~ Contractor shall deliver copies o~ policies or Certificates of. Insurance to the BOCC through the Business Services Manager of GARCO DSS, within a reasonable time after execution of this Agreement and on~each policy renewal date.' XI. .COMPLIANCE WITH LAWS.~• ,The Contractor shall.comply'with . all laws, ordinances,' codes and regulations of the federal, state,.and local governments applicable to this Agreement, in~its performance ~ under this ~1~greement. Without limiting the generality of this Section XT., Contractor: ~(Z)shall maintain client confidentiality, including confidentiality of records, in accordance with state .and federal law, rules and regulations"; and (2) shall not discriminate .against any .person on the. basis of race,, 'color, national origin, religion, sex, age.~or handicap, Any fines.-paid or expenses incurred' by~ the BOCC, due to Contractor's violation of applicable law or regulation, shall~be reimbursed to the BOCC by the Contractor. XII. • MUTUAL. TERN may terminate this upon thirty ~(30) party. Upor~•such compensation for termination. ~INATION FOR CONVENIENCE. BOCC'and Contractor Agreement, without cause and for convenience, days written notice to~~ the non-terminating termination, Contractor shall be entitled to services performed prior to the date of XIIi. TERMINATION FOR CAUSE. If~the Contractor fails to fulfill "its obligations under this Agreement in a -timely and.. proper manner, as determined by the BOCC, or if the Contractor violates any of the terms'or'provisions of this"Agreement, the BOCC shall have the right, in its" sole discretion, to .terminate 'this Agreement by~~giving written notice to the Contractor at. least fifteen (15) days before the effective date of the .termination and may provide Contractor, in the .B000'.s sole .discretion, an opportunity to cure within that fifteen '(15) day notice. period. Upon termination for cause, .Contractor shall be entitled to receive }ust~and equitable ,compensation for work satisfactorily completed prior .to termination, Contractor shall not, however, be relieved of liability to the BOCC for damages sustained by the BOCC by virtue of any breach of this Agreement by•the Contractor. The BOCC may withhold .payments due to the Contractor for 'the purpose of set-off until such time as the exact amount of damages due the BbCC from Contractor is 'determined. 4-County Regional Cora Services Mental Health - Form Contract (04-OS) ,, XIV. CONTRACT ADMINISTRATORS AND CONTACT PERSONS. A. Contract Administrators. Contract :administrators regarding "contract administration, financial management, and- evaluation of the performance of the scope of services described in Section I, above, are as follows:~~ • 1. _ BOCC and ~ 4-County Region, ~ Lynn Renick", Garfield County Department of Sbcial'Services Director: 2. ~ ~ Contractor. ~~ ca ~ ~,,~~ I~P,La l5 B. Cont3ct~Persons. .Contact persons for issues regarding an individual county or 'an individual client of .a County Department are: 1. BOCC and 4-County Region. ,The referring County Director; and ~ " .2~. Contractor. ~Th~e Core~Services administrator for each county iri the 4-County Region. ~ _ ~. XV. AMENDMENT. Any mutually agreed upon amendment, including without limitation any change iri the scope of services, ~whetlier or. not .resulting in an increase or decrease in the amount of compensation, .shall .. be~•incorporated in a written amendment to this Agreement. Amendments. shall be executed. with the same formality. as ~ this Agreement~,~except as to change of address or name"of contact person: Address and contact "information shall not be considered an ~amendmeilt to this; Agreement"and notice of such may .be given by way of regular, rriail,~ 'telephone, or facsimile transmission. XVI._ NOTICE. Notices required under.this Agreement, other than changes in address or contact information," shall be delivered by way of certified"mail,~ return receipt requested, to the addresses for signatories, written below. " XVII .• ~ CONTROLLING" LAW'. This • Agreement shall be .governed by the laws of.~the State of Colorado 'and venue for any. action arising out .of or relating to performance of this Agreement shall be in Garfield County, Colorado. XVIII. SEVERABILITY. If any term or provision is declared invalid or becomes inoperative for any reason, such invalidity or failure shall not affect the validity of any other term or 4-County Regional Core Services 7 Mental Health - Form Contract (04-OS) ~ - ~, provision, as long as the purposes of the •Agreement can• be effected. XIX. AUTHORIZATION. Each of .the individuals signing below affirms that he/she is properly authorized 'to execute this . Agreement on behalf of the governmental agency or private entity party to this Agreement: ~, . XX: INTEGRATION. ~ The entire agreement of •the parties is . encompassed within this Agreement. No other oral or written representation or agreement shall be of any force or effect. 4-County Regional Core Services ~ g Mental Health - Form Contract (04-OS) • ~,~ . •IN WITNESS WHEREOF .the parties hereto have executed.•this document. • ATTEST: • - By: Clerk to the Board • •(IF OVER $10,000.00) • BOARD OF COUNTY COMMISSIONERS GARFIELD COUNTY, COLORADO - t APPROVED: GARFIELD COUNTY•DEPARTMENT•OF SOCIAL S ~-S, • OIZ DESIGNEE gy : •_ - . . Lynn ~3~ck, .Director ~ - P.O.' Box 850 Glenwood-Springs, CO •81602 4-County Regional Core Services Mental Health -Form Contract •(04-OS) John Martin, Chairman Date: (IF- UNDER $10, 000 . Q0) BOARD•OF COUNTY EOMMISSIONERS GARFIELD COUNTY, CO ~ , __.--- B .,_ -~Oreen,.County Manager Date : ~~ f~~~ ~ CONTRACTOR: BY ~ •• ~-ate . ~ ~,~~~ ~~T3i~ • Type Name and Title Date : - Address : ~-.~~~ ~ c`~S r~ 9 r~ ' ACKNOWLEDGMENT STATE OF COLORADO ss. ~ _ COUNTY OF GARFIELD ) ~~The f regoing instrument was acknowledged before me this ~~ ~ day of 2004 by as • (Title) O f WITNESS MY•HAND AND OFFICIAL, SEAL. ~. MY COMMISSION EXPIRES: Q ~5 .Q " ~ ~ otary Public'Y 4-County Regional Core ServicQS 1 0 Mental Health - Form Contract (04-05) • EXHIBIT "B" FEE SCHET~ULE PURCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAI, AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH Contractor and BOCC agree that the fee schedule for the service described in Exhibit "A", for the term set forth in Paragraph III, of the Agreement, are as follows: sERVZCE FEE Individual Counseling $90.00/hour Family Counseling $90.00/hour In no event shall compensation paid under this Agreement exceed: One thousand nine hundred forty dollars ($1,940.00 ). The not-to-exceed figure represents a three percent (3°s) amount retained by the BOCC from the Two Thousand dollars ($2,000.00) presently designated to this Agreement, from the CDHS Core Services allocation, for the administration of this Agreement on behalf of the 4-County Region. 4 - County Regional Core Services Mental Health - Exhibit "B" 04-OS - Form - Jody Andrews • EXHIBIT "Arr SCOPE OF SERVICES PT7RCHASE OF SERVICE CONTRACT - 4-COUNTY REGIONAL AGREEMENT CORE SERVICES PROGRAM - MENTAL HEALTH Contractor shall provide mental health services, as authorized by County Departments for referred clients, including but no limited to: X Individual Counseling X Family Counseling Psychological Examination Psychiatric Evaluation Psychiatric Medication Management Care Coordination/Case Management Other Other Each County Director, directly and through his/her authorized representative(s), may approve other services for specific referred clients. The BOCC grants approval for Contractor to subcontract with N/A (Name of Company) for the provision of services under the terms of the Core Services Program - Mental Health Agreement. 4 - County Regional Core Services Mental Health - Exhibit ^A" 09-05 - Form - Jody Andrews