HomeMy WebLinkAboutC21-279 EC Core Service PlanDocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 �r :7) ICDqHS Office of Children, Youth & Families Division of Child Welfare CORE SERVICES PROGRAM SECOND YEAR OF A THREE-YEAR PLAN SFY 2019 - 2020 SFY 2020 - 2021 SFY 2021 - 2022 FOR EAGLE COUNTY Please complete signature page, all corresponding Core Services Plan and budget pages, and then submit the original hard copy for approval. C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 REQUEST FOR STATE APPROVAL OF PLAN Since this is the second year of the three-year Core Services Plan, all signatures on this page are required. This Core Services Plan is hereby submitted for Eagle County[Indicate county name(s) and lead county if this is a multi -county plan], for the period contract years June 1, 2021, through May 31, 2022 fiscal years July 1, 2021, through June 30, 2022. The Plan includes the following: • Completed "Statement of Assurances"; • Completed program description of each proposed "County Designed Service"; • Completed "Information on Fees' form; • Completed "Overhead Cost" form (Optional); • Completed "State Board Summary"; • Completed "100% Funding Summary" form; and • Completed "Final Budget Page". This Core Services Program Plan has been developed in accordance with State Department of Human Services rules and is hereby submitted to the Colorado Department of Human Services, Division of Child Welfare for approval. if the enclosed proposed Core Services Program Plan is approved, the Plan will be administered in conformity with its provisions and the provisions of State Department rules. The person who will act as primary contact person for the Core Services Plan is Kendra Kleinschmidt and can be reached at telephone number 970-471-4679 and email at Kendra. Kleinschmidt@eaglecounty.us. If two or more counties propose this plan, the required signatures below are to be completed by each county, as appropriate. Please attach an additional signature page as needed. Megan Burch1 Digitally signed Megan Burch Date: 2021.07.13 0:52:41-06'00' Signature, DIRECTOR, COUNTY DEPARTMENT OF HUMAN/SOCIAL SERVICES DATE j er4 64. L4��7� r3 a oa./ Sign at , CHAIR, PLACEMENT ALTERNATIVES QOAMISSION DATE "DocuSigned by: � 8/17/2021 Signature, CHAIR, ARDLOFECOUNTY COMMISSIONERS DATE Please check here if your county does not have a Placement Alternative Commission: C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 CORE SERVICES STATEMENT OF ASSURANCES Eagle County(ies) assures that, upon approval of the Core Services Program Plan the following will be adhered to in the implementation of the Program: Core Services Assurances: • Operation will conform to the provisions of the Plan; • Operation will conform to State rules; • Core Services Program Services, provided or purchased, will be accessible to children and their families who meet the eligibility criteria set forth in Rule Manual Volume 7, at 7.303; • Operation will not discriminate against any individual on the basis of race, sex, national origin, religion, age or mental/physical disability who applies for or receives services through the Core Services program; • Services will recognize and support cultural and religious background and customs of children and their families; • Out-of-state travel will not be paid for with Core Services funds; • All forms used in the completion of the Core Services Plan will be State prescribed or State approved forms; • Core FTE/Personal Services costs authorized for reimbursement by the State Department will be used only to provide the direct delivery of Core Services; • The purchase of services will be in conformity with State purchase of service rules including contract form, content, and monitoring requirements; • Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual Volume 7, at 7.414,B); • Information regarding services purchased or provided will be reported to the State Department for program, statistical and financial purposes; • All providers of Core Services (through purchase of service contracts) must be registered with the Colorado Department of Regulatory Agencies (DORA). The provision of Life Skills is the only exception to this mandate; • County staff are responsible for monitoring their Program provider payments and for ensuring the county and providers are following all statutory and regulatory requirements; • All Core Services are made available, based on need of each child/youth/family; and • All contracts for services using Core Services Program funding will include all of the required language of the attached contract template. 3 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7138C7C4 CORE SERVICES TO BE PROVIDED/PURCHASED List below "County Designed Service" that will be provided/purchased. Please indicate which, if any, of the County Designed Service are provided through the Evidenced Based Services to Adolescents earmarked funding: • Family Engagement Meetings • Trauma Informed Services, Nontraditional Therapies • Therapeutic Supervised Visits • Evidence based home visiting program - Healthy Families Vail Valley Eagle County will not utilize the allocation ($5,340) for Adolescent Evidence Based services. Program Area Three - PA3 Services - Prevention/Intervention Services If your county submitted a Program Area Three (PA3) Plan last fiscal year, and you wish to continue providing PA3 services using Core Services Program funding, please check the box below; X Yes, our county wishes to continue offering PA3 services using Core Services Program funding. If your county has not submitted a Program Area Three (PA3) Plan, and you wish to provide PA3 services, please complete and submit the PA3 Plan Addendum attached. Fundine for Evidenced Based Services to Adolescents If the county received funding for evidenced based services to adolescents, and is requesting the funding to continue to receive the same funding for the same expansion or creation of the evidenced based county designed program to adolescents, please indicate that above, as well as on the Core Plan under County Designed. • Multi -Systemic Therapy (MST) • Multi -Systemic Therapy - Contingency Management (MST -CM) MST is an evidence -based, intensive, in -home treatment for youth who are at risk for out of home placement. MST -CM is an evidence -based, intensive, in -home treatment for youth who are at risk for out of home placement and involved in delinquent behavior and substance use or substance abuse. See pages 14-15 for more information about this county designed service. 4 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 CORE SERVICES COUNTY DESIGNED SERVICE Service Name: Family Engagement Meetings Optional services approved as a part of the county's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. The information listed below is to be completed for each County Designed Service and included in the County(ies)' Core Services Program Plan. 1. Describe the service and components of the service; define the goals of the program. Eagle County Department of Human Services (ECDHS) recognizes the importance of involving family members, their identified support systems, and professional partners also working with the family in decision making about children and youth who need protection or care. The Family Engagement program at ECDHS actively collaborates with family members and their formal and informal support systems to create and implement plans that support the safety, permanency and well-being of children and youth. Family engagement meetings utilize the Consultation and Information Sharing Framework. Risk and goal statements are used to help family members and their support systems understand the Department's perspective. The conversation during family engagement meetings is focused on the three following areas: family strengths, danger/harm and complicating/risk areas, and next steps. Action plans are created from the next steps category. The meeting attendees plan around issues that are identified in order to keep children in the home whenever possible or return children to their home as soon as possible. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails. Service detail for this County Designed Program is already available in Trails. 3. Define the eligible population to be served. The eligible population includes children and youth between the ages of 0-18 years and their families who have open child welfare assessments or cases. 5 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 4. Define the time frame of the service. ECDHS requires Family Engagement Meetings take place: • During child welfare assessments when families score "High" on the Colorado risk assessment (for both High Risk Assessments Et Family Assessment Response) • During assessments when a safety concern has been identified and a safety plan implemented (for both High Risk Assessments Et Family Assessment Response) • At the time of child welfare case opening (within seven business days) • Every 3 months during a child welfare case when a child in the family is placed in out of home care • Every 6 months during a child welfare case when the family remains intact • At the time of child welfare case closure 5. Define the workload standard for the program: • number of cases per worker: Trained employees of Eagle County DHS or contracted service providers facilitate family engagement meetings. • number of workers for the program: There are no specific workers for the family engagement program, but currently ECDHS has five (5) trained employees to facilitate family engagement meetings. • worker to supervisor ratio: At ECDHS in the Division of Children, Family Et Adult Services, the number of workers to supervisors is four to one. 6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for guidelines. ECDHS employees and contracted service providers who facilitate family engagement meetings will have attended and successfully completed a family engagement meeting facilitation training. 7. Define the performance indicators that will be achieved by the service, see 7.303.18. The family engagement service prevents out of home placement for children and adolescents and secures permanency for those in out of home placement. Additionally, the family engagement service program is a 2Gen approach to services and engagement for children and their parents identifying a plan for them to make progress together. 6 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 8 Identify the service provider. This is a direct service provided by ECDHS employees or various contracted service providers. 9. Define the rate of payment (e.g., $100.00 per session/episode). ECDHS employees: • Caseworker(s)- 10% of FTE • Payroll worker- 5% of FTE • Supervisor(s)- 10% of FTE • Manager- 5% of FTE • Contracted service providers- $75/hour 7 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 CORE SERVICES COUNTY DESIGNED SERVICE Service Name: Trauma Informed Services, nontraditional therapies Optional services approved as a part of the County's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. The information listed below is to be completed for each County Designed Service and included in the County(ies)' Core Services Program Plan. 1. Describe the service and components of the service; define the goals of the program: Eagle County Department of Human Services (ECDHS) uses specialized therapies to address grief, loss and trauma experienced by children and families in the child welfare system. These specialized therapies use an integrative healing therapeutic approach and may be very helpful when traditional talk therapy has not led to improved symptomatology. Trauma Informed Services may include: • Music therapy • Yoga therapy • Play therapy • Art therapy • Dance therapy • Equine Assisted therapy • Talk therapy utilizing trauma informed evidence based practices 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails: Service detail is already an option in Trails 3. Define the eligible population to be served: The population for trauma informed practices, nontraditional therapies includes children, youth (ages 0-18) and their parents, legal guardians or caregivers who have an open child welfare case and who meet the CORE Services Eligibility Criteria. 4. Define the time frame of the service: Children, youth and families are eligible for this service twice a month or as recommended by the service provider. 8 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 5. Define the workload standard for the program. • Identify the number of cases per worker: N/A, purchased service • Identify the number of workers for the program: N/A, purchased service • Identify the number of workers to supervisor ratio: N/A, purchased service 6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for guidelines: ECDHS employees do not provide this service. Contracted service providers will meet the Core Services requirements by having a bachelor's degree or higher in the human services field, such as counseling or social work and they will have current licensure through DORA. 7. Define the performance indicators that will be achieved by the service, see 7.303.18: The performance indicators achieved by this service will often be determined in the treatment plan written and agreed upon by the contracted service provider, the family member and the ECDHS Caseworker. An example of a performance indicator is increased parent competency: parent will show the ability to provide care for their child(ren) as evidenced by providing proper discipline. 8. Identify the service provider: Various providers 9. Define the rate of payment: $90/hour in office services and $100/hour for in home/off site/bilingual services 9 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 CORE SERVICES COUNTY DESIGNED SERVICE Service Name: Therapeutic Supervised Visitation Optional services approved as a part of the County's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. The information listed below is to be completed for each County Designed Service and included in the County's Core Services Program Plan. 1.Describe the service and components of the service; define the goals of the program: Eagle County Department of Human Services (ECDHS) recognizes the importance of supervised visitation to maintain and improve the parent/child relationship when a child is placed outside of the family home. Therapeutic supervised visitation is sometimes required when working towards family reunification. During therapeutic supervised visitation, a mental health professional supervises the visitation. The mental health professional creates a safe, therapeutic environment, works directly with parents to improve parenting skills and eliminate safety concerns during the visitation. The mental health professionals have the authority to end the parent/child visit if safety concerns arise. The mental health professionals supervising therapeutic visits submit monthly reports summarizing the service along with their invoices. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails: Service detail is already an option in Trails 3. Define the eligible population to be served: The eligible population includes children and youth between the ages of 0-18 and their families who have an open child welfare assessment or case. 4. Define the time frame of the service: This service would be provided when a child is in out of home placement and the family is working towards reunification but active safety concerns exist which require an extra layer of therapeutic oversight during parent/child interactions. 10 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 5. Define the workload standard for the program: Identify the number of cases per worker: N/A, ECDHS employees would not provide therapeutic supervised visitation Identify the number of workers for the program: N/A Identify the number of workers to supervisor ratio: N/A 6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for guidelines: ECDHS contracts with mental health professionals who would provide the therapeutic supervised visitation. 7. Define the performance indicators that will be achieved by the service, see 7.303.18: Therapeutic supervised visitation works to reduce the length of stay in out of home placement and supports the safety, permanency and well- being of children and youth. Identify the service provider: This is a direct service provided by various contracted service providers. 8. Define the rate of payment: Contracted service providers: $90/hour for in office visits and $100/hour in home/off site/bilingual services. 11 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31DEA7B8C7C4 CORE SERVICES COUNTY DESIGNED SERVICE Service Name: Evidence Based Home Intervention Optional services approved as a part of the County's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. The information listed below is to be completed for each County Designed Service and included in the County's Core Services Program Plan. 1.Describe the service and components of the service; define the goals of the program: Evidence Based Home Intervention is a voluntary evidence -based home visiting program serving pregnant women and families of infants and young children. Evidence Based Home Intervention is a prevention program dedicated to supporting families in their quest to be the best parents they can be. Program services are designed to strengthen families during the critical first years of a child's life. Services are focused primarily on prevention through education and support in the homes of new parents. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails: Service detail is already an option in Trails 3. Define the eligible population to be served: The child's age at Evidence Based Home Intervention enrollment is prenatal to age 24 months, up to the child's 5th birthday. 4. Define the time frame of the service: Intensity of services is based on each family's needs, beginning weekly and moving gradually to quarterly home visits as families become more self-sufficient. 5. Define the workload standard for the program: Identify the number of cases per worker: N/A, ECDHS employees would not provide services through Early Childhood Partners. Identify the number of workers for the program: N/A Identify the number of workers to supervisor ratio: N/A 12 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for guidelines: ECDHS contracts with community providers who implement the program in Eagle County. 7. Define the performance indicators that will be achieved by the service, see 7.303.18: Therapeutic supervised visitation works to reduce the length of stay in out of home placement and supports the safety, permanency and well- being of children and youth. Identify the service provider: This is a direct service provided by Early Childhood Partners through a county specific contract. 8. Define the rate of payment: $100 per hour/in home/bilingual services. 13 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 CORE SERVICES COUNTY DESIGNED SERVICE Service Name: Multi -Systemic Therapy (MST) and Multi-Systemtic Therapy - Contingency Management (MST CM) Optional services approved as a part of the County's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. The information listed below is to be completed for each County Designed Service and included in the County's Core Services Program Plan. This county designed service is intended to utilize funding for Evidence Based Services to adolescents. 1. Describe the service and components of the service; define the goals of the program: MST is an evidence -based, intensive, in -home treatment for youth who are at risk for out of home placement. Treatment is designed to be short term, lasting 3-5 months with high frequency of sessions: 2-3 times per week. Families have access to an MST therapist 24 hours per day through a crisis phone. MST -CM is an evidence -based, intensive, in -home treatment for youth who are at risk for out of home placement and involved in delinquent behavior and substance use or substance abuse. Families receive two (2) therapeutic visits per week and have access to the MST therapist 24 hours per day through a crisis phone. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails: Service detail is already an option in Trails 3. Define the eligible population to be served: Adolescents are eligible for this service. 4. Define the time frame of the service: Treatment is designed to be short term, lasting 3-5 months with high frequency of sessions: 2-3 times per week. Families have access to an MST therapist 24 hours per day through a crisis phone. 14 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 5. Define the workload standard for the program: Identify the number of cases per worker: N/A, ECDHS employees would not provide services through Health Families Vail Valley. Identify the number of workers for the program: N/A Identify the number of workers to supervisor ratio: N/A 6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for guidelines: ECDHS contracts with community providers who implement the program in Eagle County. 7. Define the performance indicators that will be achieved by the service, see 7.303.18: Therapeutic supervised visitation works to reduce the length of stay in out of home placement and supports the safety, permanency and well- being of children and youth. Identify the service provider: This is a direct service provided by Savio House through a county specific Core contract. 8. Define the rate of payment: $2309 per month for two (2) visits per week 15 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7138C7C4 INFORMATION ON CORE SERVICE FEES Please check all that apply: X Fees will not be assessed for Core Services Program Services. If the above line is checked, STOP. Remainder of information does not need to be completed. El Fees will be assessed for the following services: Check those that apply: ❑ Home Based Intervention ❑ Intensive Family Therapy ❑ Life Skills ❑ Day Treatment ❑ Sexual Abuse Treatment ❑ County Designed Service (List Services Below) ❑ Special Economic Assistance ❑ Mental Health Services ❑ Substance Abuse Treatment Services ❑ Fee assessment formula is the same for all services. State the formula here (attach additional sheets as needed). LIFee assessment formula varies with service. State formula used for each service (attach additional sheets as needed). 16 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 C� G O m W N P, 0 0 w a N LLJ U OTC LLJ N 0 Z in Z LL O N 0 00 N N O N W ,-. 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Ln L > C (� L N L � iLX °0 L..N L o� a O� p a; _ NO J O d� V H �v1 V Htni u W 2 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 O O M OO O Ln t/} 10 00 41 D O 2 O Ln C On u � N 4 N U� 00 C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 � N N W O a N l7 W 0 > O Z w N =)I W LL LA LL. o ce O O U N L Q O O IT O 1.0 �+ N O r,� O O O M Lr) O Lf) cV cV U O C O O cp 00 L U c L O ° cG ° L Lr) 00 000 v rn Ln a O 00 .o 00 0 o V a` M r Lrn M M Ln AA- V-r {/} V'r V'r iJT c a) i a = � -0 C O O V N Ln 'T fV �O OM �O to N L M O C LL_ ::E Oztt Ln N Ln o o v Ln (V O N !E on Q V 00 00 00 00 O ao O O O O U Ln Q O L W N Ln W O N O M 0 L ° O N O v° aU - W H a o a i ° E Li- N ° W N ° a_ Ln ° O O LnZ N O O i �, O O i Nra i t% fV i > C !' M M 4� N a) Ln O N 0 E an U O Q '° c N = N c C > O2� E E O 4J v O NQ W N O L C N Ln J O (0 C v V LL W::E 4-' LL a U H Ln W Q d N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 i LU aN0 t`oa LLJLLI � N U Do— OoN> Q ILL Vf Z LU LL 0 u Q 0 0 =) LL O o .o o O 0 0 0000 0000 0 C 7,.o V:, N t/T t/%r t/T t/} t/T a) N u m ++ 7 O O COLL U_ _2 O c6 00 O O O 78 N N aJ — 00 CD CD2 O 0 C) O O Lri LU ON Q y 0 N O O � O O O 00 O 10 0000 LL. 00 O N N dd V on c o� L`� ctj Jou �>v��� � N O i U r i N N O U +.+ ; U Ln co i a) Li U O > 'O L a) 00 C E _0 to N to C (o c '� o"N:5Ln > 'O L N cn u v> J 6 0-� O ; E u L a) '�, ai r to an a!1 i6 C a) E m ant M �Lum2 >u�� �LLIaLL. <u LUCO N Z Q a1 O O _0 4 Y U� C N +�+� N� a1 O U) 0 u3ooacbua O to O Q C v N (UE N N VI Z aJ c >, H � c E a) � on a, a) U- � aLn `n m co > -0 Q v Y ro a) E _ ro aJ ( v N Ec X (U = roE O f L O 2 to V) a U H O Ln �� �� "TOCV ::Ecv f 11 7 0 N 00 (V 00 N 00 N 00 UL-U X X X X� 0 N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 O O onon O M N ct� ct� O O N Ln N O O M O 00 Q Q Ln N M ON t/} tR th VT Z Z t/? M N 0O Ln N O 06 Ln fV M O O N CD M Lb 41 > >+ _U OA 7 O 4' on Z cd O 4= �, M dd N dd N Cd N Q , c N N O > O a-J O a)O On cd O O On 5; O c6 4-1 In > Lfa � fO No u �van tfC ca on t> C a LL- ai LuCOM: �L2 UmumuLu<Lu �L=ov)Li c O L U N O u3mQ O v u ate--, VI D -0 LnLn `n Q E c Q v 2 v u O a� N u 2 on cn o 4 c o on v on on N 'aU^., OU Ln m O O LU O LU = N N O v C +�+ >' C +�++ O l6 l6 U U O }, O 7 N _ (� �Q a, O' Ulli O' Ulli O O N L � Cv O -C .� V) Cv v �, u LL L U i V) C Cl:� C/1 U� V) U LL 00 Oq- OLn 00 'IT Ln 'IT M- N 00 N 00 N 00 X � X N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 0 O M lJ} LR fV .%O fV O O (V � N V L O CI4 O 07 0 06 (/} 5; Q) L V V L ; N a)a) N Q O u o 3 qua) L C QJ O O 00 O n N � ltS � � N I— O O �+ Ln C O J E C X X LL on f-, 000 p N `-- N N N 4� V FL V u u N V ::E O O O i+ Z; i+ u u u N C C C J Q Li Li li N N N ~ V V V N N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 Ma r O ■ M a L s H a O N O O N ti O O N I- O O N ti N E L CL 0 CD O 0 cm r- cn 0 U 0 CD CL m E m m c� m H Z O U W J Q W M N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 0 ,7 3 U- c a� E a) 0) a3 C cv m co O c6 O U xi 1 a) cn U- U) CO d cn U- cn O I— U) U) Q U) Izt N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 C 0 Of C C U- m V d co L O V L O U- 0 W cn Q 2 U a 0 w f� 0 w a W in 0 U O U CD _O Q C cu CD � E NN _0 m U) a)O O U m a 00 > N C O N _ fn x� x� x� U) CD U N U) N U C N C U Q E U co m Vj W = C H (J) V � O C � _O 0 J w (n xl xi xil x� C21-279 O C O O U cu -0 cn � E =_ O E C fB U- E �— _ N DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 ca cG G w _U w N G w 0 > 0 w a J H ci w r Z D 0 L) N N O N T N O N LL U) N Q 0 U� U� 0 C a� o U0- 0 0 7 t o Z U U) o E E Z ZLLU) C �aC: t a>U� Q O U O c L O� n E w � H ^O LL Z LL N E N f0 U 0 0 z N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 U) :i .2: C y+ C d d C C ca C O C N L IL M IL, d d L d L E O L a- W a H W D m J Z M N N O N T— N O N U- M N O H Z cl M M M M OCI)LL 63 6, 6' 6q 61) Q 63 U � O 7 O O LL O O O H U « 63 �O '0 N O LL 00 N CV CV CV CO N M M M M M M CO m M M t0 0 HU 6q � > c mE -a)E O LL U 0 N O O O O co 7— C mnU�d O O O N �c 6`k � � � C !E .2 �Um C � 7 � LL 0 f0 M 7 M >a) CU)> Cli LO 6, L � L L L L L a) a) U -0 7-0 (0 a) 770 v) a) 770 a) a) 7-0 a) a) 7-0 a) a) 7-0 .> a) OL fL6 OL m OL ca OL (0 2 (L6 L N 2 U) I i CD-i O- O- O- i O O_ N c � C a) E a) U E 7 ac ) c 70 o E co m .L+ H a) LU N d E U U) � a) a) Z a) a) (D m U m E U L 70 'o 70 2 to U C !A U rn — :2 a3 +T' E � E a) .- ._ a) U) a) O U O a) U m a) a) U) U) 7 (D U) cn O t` N C21-279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7B8C7C4 PURCHASE OF SERVICE CONTRACT Core Services Program THIS CONTRACT, made this day of , 21_by and between the County Department of Human/Social Services at , hereinafter called "County" and (address) , (name) , (address) , hereinafter called "Contractor". (Tax I.D. or Social Security Number) 2. This contract will be effective from until 3. County agrees to purchase and Contractor agrees to provide (Core Service) To at at other such (population to be served) (location service is to be provided) location as shall facilitate the provision of such services. This service is described in Rule Manual Volume 7, Section 7.303.1 , and, if appropriate, the State approved County Core Service Plan. 4. County agrees to purchase and contractor agrees to furnish units of service at the cost of per unit of service for a maximum amount of this contract of $ 5. The parties agree that the Contractor's relationship to the county is that of an independent Contractor. 6. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing availability of funds for the purpose thereof. County agrees: a) To determine child eligibility and as appropriate, to provide information regarding rights to fair hearings. b) To provide Contractor with written prior authorization on a child or family basis for services to be purchased. c) To provide Contractor with referral information including name and address of family, social, medical, and educational information as appropriate to the referral. d) To monitor the provision of contracted service. e) To pay Contractor after receipt of billing statements for services rendered satisfactorily and in accordance with this Contract. Contractor agrees: a) Not to assign any provision of this Contract to a subcontractor. b) Not to charge clients any fees related to services provided under this contract. c) To hold the necessary license(s) which permits the performance of the service to be purchased, and/or to meet applicable Colorado Department of Human Services qualification requirements. d) To 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. e) To provide the service described herein at cost not greater than that charged to other persons in the same community. f) To submit a billing statement in a timely manner, no later than forty-five (45) days after services. failure to do so may result in nonpayment. g) To safe guard information and confidentiality of the child and the child's family in accordance with rules of the Colorado Department of Human Services and the County Department of Human/Social Services. h) To provide County with reports on the provision of services as follows: • Within weeks of enrollment/participation, submission of a treatment plan for the child/child's family with specific objectives and target dates. The treatment plan is subject to county approval. • At intervals of months, from the time of enrollment/participation, submit reports that include progress and barriers in achieving provisions of the treatment plan. C21279 DocuSign Envelope ID: DE6522A0-2F98-4EA7-AFA5-31 DEA7138C7C4 i) To provide access for any duly authorized representative of the County or the Colorado Department of Human Services until the expiration of five (5) years after the final payment under this Contract, involving transactions related to this Contract. j) Indemnify the County and the Colorado Department of Human Services from the action based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violation of any statue, regulation, and the defense of any such claims or actions. 9. In addition to the foregoing, the County and Contractor also agree: 10. Termination: Either party may terminate this Contract by thirty (30) days prior notification in writing. 11. All payments will be paid through the State's approved automated system, as appropriate. Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (As set forth in Rule Manual Volume 7, at 7.414, B (12 CCR 2509-5). ADDITIONAL PROVISIONS: County Director's Signature Contractor's Signature Date Contractor's Title Original to Contractor Copy to the Case File Copy to County Bookkeeping Copy to State Accounting Date C21-479