HomeMy WebLinkAboutC05-199 Beth Harvey - Pura Vida Counseling
0tJ6 ~ /tj'q ~ ,:2,;).
AGREEMENT BETWEEN
THE COUNTY OF EAGLE, STATE OF COLORADO
AND
BETH HERVEY, PURA VIDA COUNSELING
THIS AGREEMENT made this 28th day of June, 2005, by and between the County of Eagle,
State of Colorado, a body corporate and politic, by and through its Board of County
Commissioners, "County" and, Beth Hervey, Pura Vida Counseling, hereinafter "Contractor."
1. AGREEMENT:
This Agreement shall commence on June 1,2005 and shall end on December 31,2005.
2. SCOPE:
Eagle County hereby contracts with the Contractor for services that stabilize family life and
promote family self-sufficiency. Specifically, the agreement is for professional services directed
toward family and interpersonal communication skill building; or intensive family centered
services that prevent out of home placement of the children.
The Contractor will provide one or more of the following services based on the written
authorization and request for services by the County:
> T ANF service group: Parenting and family communication skill building
> Mental health consultation for County HHS programs
The services will be reimbursed at the rate of $ 70 per hour for client family or staff consultation
face to face contact. Time spent in travel to and from a client family home for professional
service will be reimbursed at the rate of $20/hour. Mileage in travel from the office to a client
family home for professional services will be reimbursed at the rate of .345 cents per mile.
Non-reimbursable activities include:
> Participation in child protection, community treatment team for staffings.
> Travel, except to provide authorized in-home services.
> Paperwork and other in-direct administrative time.
> Supervision or staff development activities.
An additional fee may be assessed by the Contractor not to exceed the difference between the
amount of subsidy under this Agreement and the fee under the Contractor's Uniform Ability to
Pay Scale. Clients who do not appear for their scheduled appointment shall be responsible to pay
the Contractor full cost of that appointment.
The County is responsible for the determination of family eligibility for services. The County
will advise the Contractor in writing of the authorized service plan within three (3) working days
of receipt of the certification and service plan. There shall be no payment for services
provided without prior authorization for such services by the County. Such authorization
shall include the amount of services to be provided, the scope of services provided and time
frames in which these services are to be provided.
3. TERMINATION: The County may terminate this Agreement upon ten (10) days written
notice to Contractor if it is deemed by the County in its sole discretion, that the Contractor is not
fulfilling the program as specified in this Agreement, or for any other reason. Upon such
termination any unexpended funds shall be returned to the County. In addition, any funds not
properly expended according to project objectives shall be returned by Contractor to County.
In the event the Contractor becomes insolvent, is declared bankrupt or dissolves, the County may
declare in writing that this Agreement is terminated, and all rights of the Contractor and
obligations of the County shall terminate and cease immediately.
4. CONTRACTOR'S DUTIES: The Contractor shall comply with the following requirements:
A. All funds received by Contractor under this Agreement shall be expended solely for the
purpose for which granted, and any funds not so expended, including funds lost or diverted for
other purposes, shall be returned to County.
B. Contractor shall maintain adequate financial and programmatic records for reporting to the
County. The Contractor shall maintain all records pertaining to this Agreement for a minimum
of three (3) years and may be subjected to an audit by federal, state or county auditors or their
designees, as requested. If an auditor discovers misuse of funds, the Contractor shall return said
misused funds to the County. The Contractor hereby authorizes the County to perform audits or
to make inspections during normal business hours upon 48 hours notice to Contractor, for the
purpose of evaluating performance under this Agreement. The Contractor will allow access to
and cooperate with authorized Health & Human Services representatives in the observation and
evaluation of the program and records. The Contractor shall have the right to dispute any claims
of misuse of funds and seek an amicable resolution with the County.
C. Customer Service/Termination: In rendering its services, Contractor shall comply with the
highest standards of customer service to the public. Contractor shall provide appropriate
supervision of its employees to ensure the maintenance of these high standards of customer
service and professionalism, the performance of such obligation to be determined at the sole
discretion of the County. In the event that the County finds these standards of customer service
are not being met by the Contractor, the County may terminate this Contract, in whole or in part,
upon providing ten (10) days notice to the Contractor.
D. The Contractor shall comply with all applicable rules and laws governing counseling and
parenting support services in Colorado. The Contractor shall be solely responsible for ensuring
proper licensing and credentialing of those providing services under this Agreement.
The Contractor shall comply with all applicable rules and laws governing eligibility for services
and allowable costs under the Colorado WORKS IT ANF program for those families authorized
for services to stabilize family life and promote family self-sufficiency.
E. The County may request periodic written reports concerning services under this Agreement.
Contractor shall provide the County with an assessment and plan within thirty (30) days of
enrollment or participation in services by a family or child. This plan shall include the treatment
plan for the child's family, including specific objectives and target dates for accomplishment.
The treatment plan shall be subject to review and approval by County. Thereafter, at monthly
intervals, the Contractor shall submit reports that include progress and barriers in achieving the
goals and provisions ofthe treatment plan. Reimbursement for services is subject to the timely
receipt of written assessment, plan, and reports.
F. Contractor shall comply with the requirements of the Civil Rights Act of 1964 and Section
504, Rehabilitation Act of 1973 concerning discrimination on the basis of race, color, sex, age,
religion, political beliefs, national origin, or handicap.
G. Contractor shall assure that the service described herein is provided to the County at cost not
greater than that charged to other persons in the same community.
H. Contractor shall safeguard information and confidentiality of the child and the child's family
in accordance with rules of the Colorado Department of Human Services and Eagle County
Health and Human Services, and the Health Information Privacy and Accountability Act.
1. The Contractor will notify Eagle County Health & Human Services immediately of all reports
of suspected child abuse or neglect involving the Contractor, including, but not limited to,
employees, volunteers and clients. Health & Human Services contractors are considered to be
mandatory reporters for suspected child abuse and neglect and are to make those reports directly
to Eagle County Health & Human Services - Adult and Family Services Division -
(970) 328-8840.
J. The Contractor will provide information to all TANF eligible participants on the following:
Food Stamps - Every participant must be informed that they are categorically eligible to
receive at least some services and should be referred to Eagle County Health & Human Services
for more information on application for benefits.
Medicaid - Every participant must be informed they may be eligible and should be
referred to Eagle County Health & Human Services for information on application for benefits.
Disabilities and other Barriers - The Contractor must inform participants that they can
visit the Eagle County Health & Human Services offices to receive an assessment and
appropriate services that may better work with their disabilities or other barriers.
Appeal Rights - The Contractor must provide participants with notice of their right to
appeal to the Eagle County Department of Human Services. The Contractor will keep a record of
all participants served for documentation in case of an appeal.
K. The Contractor shall submit monthly billings to the County. Billings will be paid through the
County's usual bill paying process. Billings must be submitted by the fifth working day ofthe
subsequent month in order to be eligible for reimbursement, except that billings for services
provided through June 30, 2005 must be submitted by July 1, 2005; and billings for services
provided through December 31,2005 must be submitted by January 6,2006 in order to be
eligible for reimbursement.
L. Contractors shall participate in an annual training provided by the County regarding program
requirements and eligibility; child abuse and neglect reporting; and, financial and program
reporting to the County.
s. NOTICE:
Any notice required under this Agreement shall be given in writing by registered or certified
mail; return receipt requested which shall be addressed as follows:
THE COUNTY: THE CONTRACTOR:
Eagle County Health & Human Services Beth A. Hervey
Post Office Box 660 P.O. BoxJ!M1
Eagle, CO 81631 CO
Notice shall be deemed given three (3) days after the date of deposit in a regular depository of the United States
Postal Service.
6. ASSIGNMENT:
The Contractor shall not assign any of its rights or duties under this Agreement to a third party
without the prior written consent of County. Any assignment without the prior written consent of
County shall cause this Agreement to terminate.
7. MODIFICATION:
Any revision, amendment or modification to this Agreement, shall only be valid if in writing and
signed by all parties.
8. INSURANCE:
At all times during the term of this Agreement, Contractor shall maintain in full force and effect
the following insurance:
Tvpe of Insurance Coverage Limits
Professional Liability Insurance $ 500,000 per occurrence
Contractor shall purchase and maintain such insurance as required above and shall provide
certificates of insurance in a form acceptable to Eagle County upon execution of the Agreement.
9. MISCELLANEOUS:
A. The parties to this Agreement intend that the relationship of the Contractor to the County is
that of independent contractor. No agent, employee or volunteer of the Contractor shall be
deemed to be an agent, employee or volunteer ofthe County.
B. This Agreement shall be binding upon and inure to the benefit of the Contractor and the
County and their respective heirs, legal representatives, executors, administrators, successors and
assigns. Neither party may assign or delegate any of its rights or obligations hereunder without
first obtaining the written consent of the other party.
C. In the event of litigation in connection with this Agreement, it is agreed that the prevailing
party shall be entitled to recover all reasonable costs incurred, including attorney fees, costs, staff
time and other claim related expense.
D. The invalidity or unenforceability of any provision ofthis Agreement shall not affect the
other provisions hereof, and this Agreement shall be construed as if such invalid or unenforceable
provision was omitted.
E. Contractor shall indemnify and hold harmless the County, its Board of Commissioners, and
the individual members thereof, its agencies, departments, officers, agents, employees, servants
and its successors from any and all demands, losses, liabilities, claims or judgments, together
with all costs and expenses, including but not limited to attorney fees, incident thereto which may
accrue against, be charged to or be recoverable from the County, its Board of Commissioners,
and the individual members thereof, its agencies, departments, officers, agents, employees,
servants and its successors, as a result of the acts or omissions of Contractor, its employees or
agents, in or in part pursuant to this Agreement or arising directly or indirectly out of
Contractor's exercise of its privileges or performance of its obligations under this Agreement.
F. The Contractor shall comply with all applicable laws, resolutions, and codes.
G. Notwithstanding anything to the contrary contained in this Agreement, the County shall have
no obligations under this Agreement, nor shall any payments be made to Contractor in respect of
any period after December 31st of each calendar year during the term ofthis Agreement, without
the appropriation therefore by the County in accordance with a budget adopted by the Board of
County Commissioners in compliance with the provisions of Article 25, Title 30 ofthe Colorado
Revised Statutes, the Local Government Budget Law (C.RS. 29-1-101 et.seq.) and the TABOR
Amendment (Colorado Constitution, Article X, Sec. 20).
H. This Agreement shall be governed by the laws of the State of Colorado. Jurisdiction and
venue for any suit, right or cause of action arising under, or in connection with this Agreement
shall be exclusive in Eagle County, Colorado.
1. This Agreement supersedes all previous communications, negotiations and/or agreements
between the respective parties hereto, either verbal or written, and the same not expressly
contained herein are hereby withdrawn and annulled. This is an integrated agreement and there
are no representations about any of the subject matter hereof except as expressly set forth in this
Agreement. No alterations, amendments, changes or modifications to this Agreement shall be
valid unless executed by an instrument in writing signed by both parties.
J. This Agreement does not, and shall not be deemed or construed to, confer upon or grant to any
third party or parties any right to claim damages or to bring any suit, action or other proceeding
against either Contractor or the County because of any breach hereof or because of any ofthe
terms, covenants, agreements and conditions herein.
K. Contractor hereby certifies that it has read the Agreement, understands each and every term
and the requirements set forth herein, and agrees to comply with the same.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first set
forth above. The parties hereto have signed this Agreement in triplicate. Two counterparts have
been delivered to County and one to the Contractor.
COUN 0 EAGLE, STATE OF COLORADO
thr u I h its Board of County Commissioners
,
0$:A
Cle~ t~ thr fq~~d of County Commissioners
,.)-li "4,U, ~Y\,rJI11)I.~ "
' CONTRACTOR: Pura VIda Counselmg
Beth A. Hervey
ATTACHMENT A
T ANF Services Family Application
Please circle the answer that best describes you and your family.
1. Is the person to receive this service a US citizen or legal resident? Yes or No
2. Do you have a dependent Child in your home that is related to Yes or No
you to the fifth degree of kinship who will be receiving services?
(son, daughter, niece, nephew, cousin, grandchild)
3. Is your household's gross income less than $75,000 a year? Yes or No
4. Are you employed? Yes or No
What service are you requesting?
Signed: Date:
For use by service provider
Accepted for T ANF service: Date
Must meet all the qualifiers cited above
Not Accepted for service: Date
Reason not accepted for service:
Date the applicant/participant provided a written notice of their rights.
For the Service Provider : Date:
This application is to be completed by the participant family and kept on file by the provider in
accordance with the provisions of record retention in Section 4- B Contractor's Duties.
TANF Service Participant Notice
For your protection it is important to read the following carefully.
You are categorically eligible for Food Stamps. Please contact Health and Human Services at
(970) 328,..8840 for information regarding the fmancial eligibility requirements for Food Stamps
or to request an application.
You may be eligible for Medicaid. Please contact Health and Human Services at (970) 328-
8840 for information regarding the financial eligibility requirements for Medicaid or to request
an application.
Disabilities and Other Barriers: If you have a disability or other barrier for participation in
services, you can contact Health & Human Services to receive an assessment and to be
connected to appropriate services that may better work with your disability or other barriers.
Appeal Rights: If you think your service provider or Eagle COUflty Health & Human Services
has been unfair or has made a mistake concerning your eligibility or the amount of your benefits,
you have the right to appeal either verbally or in writing.
This means you will be given a chance to present your case for a review by persons not
responsible for the original decision to be sure the provider or county action was a proper one.
At your hearing you may have legal counsel, a relative, a friend or you may represent yourself.
If you want a hearing, call Kathy Reed at (970) 748-2005 for a county hearing or conference. If
you still disagree after the hearing or if you wish to skip the county hearing, write to or request
the county department to write to:
Division of Administrative Hearings
1120 Lincoln, Suite 1400
Denver, Colorado 80203
If you think that the service provider or Eagle County Health & Human Services treated you
differently from others because of race, color, sex, age, religion, political belief, national origin,
or handicap, let us know by writing to:
Eagle County Health & Human Services
Attn: Kathleen Forinash, Director
P.O. Box 660
Eagle, CO 81631
or
Division of Administrative Hearings
1120 Lincoln, Suite 1400
Denver, Colorado 80203
or
The Secretary of Health and Human Services
370 L'Enfant Promenade, S.W.
Washington, D.C. 20447
Departamento de Salud Publica y Servicios Humanos
del Con dado de Eagle
Solicitud para TANF (Asistencia Temporal para Familias Nececitadas)
Favor de indicar la respuesta que mas Ie corresponda a su familia.
1. (,La persona que va recicibir estos servicios es ciudadana 0 residente legal? Si 0
No
2. (, Tiene un nino que usted sostiene en su hogar que tiene un parentesco a1
quinto grado con usted? (hijo(a), sobrino(a), primo(a), nieto(a), tio(a))
Si 0 No
3. (,Los ingresos anuales (antes de impuestos) de su hogar son menos de
$75,000? Si 0 No
4. (,Esta usted trabaj ando? Si 0 No
(,Que servicio esta usted solicitando?
Firma: fecha:
Para uso del proveedor de servicios
Aceptado para el servicio: fecha
No fue aceptado para el servicio: fecha
Razon por la qual no fue aceptado:
fecha cuando el solicitante/participante otorgo una nota escrita de sus derechos.
Para el proveedor de servicios: fecha
J:\CONTRACTS\TANF CW\TANF app SPA.DOC
Noticia para el Participante de los Servicios de TANF
Para su proteccion es importante que lea 10 siguiente.
Usted es categoricamente eligible para Estampillas de Comida. Llame al departamento de Salud
Publica y Servicios Humanos al (970) 328-8840 para informacion sobre los requisitos
financieros para Estampillas de comida 0 para solicitar una solicitud.
Puede ser que usted sea elegible para Medicaid: Llame al Departamento de Salud Publica y
Servicios Humanos al (970) 328-8840 para mas informacion sobre los requisitos financieros para
Medicaid 0 para solicitar una solicitud.
Desabilidades y Otros Obstaculos: Si usted tiene una desabilidad 0 otro obstaculo que no Ie
permita participar en los servicios, usted puede comunicarse con Departamento de Salud Publica
y Servicios Humanos para recibir una evaluacion y ser relacionado con los servicios apropiados
que Ie funcionarian mejor con su desabilidad 0 obstaculo.
Derechos de Apelacion: Si usted piensa que el proveedor 0 el Departamento de Salud Publica
han sido injustos 0 se han equivocado referente su elegibilidad 0 en la cantidad de los beneficios,
tiene el derecho de apelar por escrito 0 verbalmente.
Esto significa que usted tendra la oportunidad de presentar su caso para ser revalorizdo por
personas que no fueron responsables por la decision original, para asegurar que la determinacion
fue la correcta. En su audencia puede tener consejo legal, un familiar, un amigo 0 se puede
representar a si mismo.
Si quiere una audencia, Hame a Kathy Reed al (970) 748-2005 para una audencia del condado 0
conferencia. Si despues de la audencia no esta deacuerdo 0 no qui ere una audencia en el condado
de Eagle, escriba 0 puede solicitar que el departamento del condado escirba a:
Division of Administrative Hearings
1120 Lincoln, Suite 1400
Denver, Colorado 80203
Si usted piensa que el proveedor 0 el Condado de Eagle Departamento de Salud Publica y
Servicios Humanos la trato diferente por su raza, sexo, edad, religion, crencia politica, origen
nacional, 0 incapacidad fisica, dejenos saber escribiendo a:
Eagle County Health & Human Services
Attn: Kathleen Forinash, Director
P.O. Box 660
Eagle, Co 81631
or
Division of Administrative Hearings
1120 Lincoln, Suite 1400
Denver, Colorado 80203
or
The Secretary of Health and Human Services
370 L'Enfant Promenade, S.W.
Washington, D.C. 20447
J:\CONTRACTS\TANF CW\TANF app SPA.DOC
