HomeMy WebLinkAboutbocc.con.091.2014 RESERVED
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Pitkin County Health and Human Services PROVIDER#: 1637497
?O �ox^060
Eay e, CO 8't631
RECEIVED
Asae� r^:;4:�*_;,rocs
215 NoRh Ga:i�:isch St FEB 11 2014
Suite 5
' ASNE�1, CO 81611 HEALTH 6 HUMAN SERV[CES �
This Agree;rer•is e^*.��:r'into a^� bs.*.•,�^n Pi�dn Co!�nty, herei� re`er�ad tc a;"De�ar�menC'2^d A�nen
Mountai.�Tots, h°;ein ref2,^�d:c as°prcv��r wha v:�;proviCe ahild care ai the folio:t;n^y�d;ws:
215 North Garmisch St, Suite 5,Aspen. CO 81611. This Agreement shall be in effed from 2/17f2014 to
L%L25%ZO'I7.
Provider Agrees to:
- �. M'dti1L^'i^g yal.rt rhitrl r�m�IG?[]Sc 25�c��:'2i u�GOtqrgr?n$Lti�ta gnA:.�:n`,:r 2u dI�B�NIIC^ah�a
Shate, Fcz:zra� ReguiaGons and tocat iaw.
2. Report to the county if the providers license has been revoked, suspended, or denied within
[fi(°e(3)cale.^.�ar da_ys of r°�.'°i`!ifl� nc!ifi�aticn, a re���ery YJIi; 5C @Sid`viiSi!8G Cf 2u�=yllEflLS
made os of the e�feciive uote o�dosure.
3. Allow parents immediate access to the child(ren) in care.
4. Acc?pi ref�,-;als foe�h�:u a«v:'.f au?diserimina�on r^th re�ard L re^_e, GOEui: Rcu��!lfll O�yli'y
- BJ�..SG'X (B��'�ft7�; or physwa�oF ITiQfiidi iianu�CflN.. : ... � . .
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5. Provide children with adequate food,.shelter and rest
s. �.?9i�?3ii1?5 Si1'!CL`J COi 5�a,r,,fi�I 3ii lCfO.^:;1�U0�CGi�i;eiTilfl9 C}?IIu'iE!!3!l� ?.I??l�f3��1i85. , .-
7: Pruiact ciiiiu�e�� �iuin atii;se/regiect afid ie�,ort any susp2r,.2d child abuse and neglect to the
Departrnenti
8. Hold fhe Co?�(duC:D�°.�.2�ti2^t Of�'��i2.^. SENIC?S Z 1�U�C S!���C(IiOIOCa�O fQ:!,illC�_fV!2�y
loss o�a�urs ca;:s2d by the pe��ormar.ce of triis Agreemeni
9. Provider shall offer free, age-appropriate altematives to volunMary acdvi6es.
10. �i'v4:�8 GI?11.d G�i2 3l i�?E I3CiiiY� �����5^,IIC}p� �t�'f?2l/J C•'tSuie u�]8t c�rz is prcYld2d or�ly 5y the
F�ran or busiriess I!sted a�ove. r:o�vida care;or c�iidren ur:dar ihis ay^raemer•t only;f authorzed
by the Department in advance.
��. $ty i u ic G�iI�L1 C2:'` F`�°a =�/iy'.�B�TicRi d'�i o�i Q�h�r C6�_�`y Qi sta.e rq_ired forms..Deva�O�2 i
indiviGu�ize�ca:e�;�^fa�ch��:�^vr.Eh a_�::�anai c��ifd rz�e ne�ds.
12. Notity the Department of unexplained, frequent and/or consistent absences within cen(10)
�Jer.�ar��ays�f 9n�s.ab;ished ;,eram.
�3. filif{u215�ic icaL'i�cv':O CO�;ECt�fhB ft:ll E�icnEa;ee=sch monih. Parenial feeS i:t�t�.U.4. to ihe
provider from the parent or adult caretaker at fhe beginning of the month. Report non-payment of
�13(2ieu�i i�5 F!v i�r=rt:�3'L�i$�3s'da�;eft�e rc,���.€��rv��;c�:�:_;f2ya�pS.j1�r fe:�iVC-Q.
14. Mai.^.rW;^�':'6Qf 4T�S2-B��lG�i:'a`u:If17�:�URZ.��tiS fui Gie childia(t IR Lic FPu�u'c 3 Ca;c, If fEtii:!C-c'.:
by oounty policy. Immunization records shall be obtained from parents or adult caretakers either
3t�i e�-e�f a�s��:i`-si��n ar�:"�u`7Ii1 u�ii!�((��Q��.�e::•�3T��z}'S vi u'70�=C@ Gi au'T!i:5i��e::j SI?3II �
upda:ed a.^..^,uaity. F�;r c���Id�ei�t�usz parenis or aduit�raiakers object to i�„munizations on
religious grounds or for children whose medical condition conVaindicates immunization, providers
Sff3li reii:ra:±�2��_�[Tif�:Ifi tFE Chliti S fie Si3?i=4`vy G`iH j�n!er.6C 2'=1it C2fG�'�+��i Sic`�=iCf Gic
f885Ci17 fOf�iFii IR�i�'u�iiZri iy.
15. Shall not charge the counties more than the established private pay rates and keep lhe _
L'-r�?�i?AY�i:`��i;e�:�f�h8^�?S ii'1 ��e pmraie p?.�l�1tes-:vi�hin?en (t0)days Oi_�g u`an3e.
:;Y�ch a�o��vi v e cur[ent charge policies on rates, transporlation, activity, registration fees and
payment policies. Allowable rates end oqier associated charges shall be in accordance with State
RulES fn'Coius au��Gi eili C3 v A=:3'?.^.�=P�u3�aiT�. Th�EtGi+id?:(S'SLI4fG'l'.Y tit rLU V Cl y�if GZE
Fepc�«,p���aia aay ra�are lower fl'i8i�L"i2 8�ceu'll�iui�CGtilllY(c�Ttlllf C�:-t(2t6�
established in this Fiscal Agreement.
CCAP Licensed Provider Fispl Agreemenf(Rev.09/2011). 1 of 3 �
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16. Shall not charge parenfs or adule CBiEi?k;;5 fd�2�I(1 8X�85S Oi ihO�E 0y�2c� UpGf�����2 FIS•:.al
Agreement(this includes the agreed upon regisGation, activity and transportation fees if the
county pays these fees).The rate in the Fiscal Agreement is the maximum allowable rate of
reimbursement for�,e eare provi�ed and includes any porticn for which the p�rent or adutt
caretaker is responsible.
17. The provider understands that they must attend a county face-to-face training before the provider
will rece���e a Poir.t-�-Se^�ice(POSJ device.The pi GV(ucC IS C2y�!!CC�L,uss the PGS device te
record attendance ar.d 6il!for care p�ov�ded.
18. Maintain a land-based phone service to ensure that the POS terminal is able to submit
a�.andance information!o Lhe�er�:�:ent br p�yment on a,�eekly basis.
19. Provider is responsibfe to ensure tt�e rarent or adult caretaker swipes his/her card to check the
child(ren) into and out of care daily for attendance tracking and payment. Missed check-in and
check-oui s�ipes may be updai�u'vri�in nir�e(9j days e�tEte�r?of se�ice.TFa L��arhnent
does noi guarantee payneni to the P��vide�if the autho�rm status on lfe POS device is
"pending,°"denied,°or"not authorized.°If the child care is not authorized, the parent or adult
caret�ker;:`;,;I �e res;-,or,�iblz for paytr�ent and.'.:e De,�i ime�t shall not be heid lisble.
20. Provider is respo�s�bte to contact Affiliated Computer Service, Inc(ACS)at 1-877-779-1932 if the
Point of Service(POS)terminal stops working for any reason for troubleshooting or repair.
21. If U;e p,-o��3�r St�ys��.�fo�child.2^ti^�G�i C�eCa�o�'_Ghi!Q Czre Rssi�t?nce Program they
shali contact ACS to reyuest a self-address pu��agz paid re�;m labei to assist ir retuming the
POS device. If the POS device is not returned within thirty(30)days and in good shape(allowing
iOf T!�JTt??31:°i33f H.^.d i°3i}!o P.GS 3 !'?COVAty�idiil �0 Ect_hF�ho�j fQl'iYe C9�t 'vT i2��a�zRl6lt fOf
ihe POS device which is$365.
22. The provider is required to maintain sign iNout sheets for children in their care. These records
shc?!t�rair��;ne�fo�t�`I�C£'yC=:a�`iiL:�lE Ci!T��_�c-ci._Zfa tv t2 �e:c 2:'?i��"g t0 ri"ic
Departmen[upart reqlest
23. The provider may manually bill the Department for services authorized, based on county payroll
'_..=icS� i'?3t Yi2iZ!10i?'c'Ii.*ihi�rcr�ai ijpmatir3'!y`?�?d Oil LhE �=S Lr�P.SSC!1C.^.S.Th?*�COV!�8f
shall provide sign injaut shzets to s��pFO�reGu�=_!s for manusl �2;:��nt ?he provider forfaits
payment for services if the original manual billing form is submitted more than sixty(60)calendar
day5 fO��G46�^g the ess�af the man���«servi:.2 �:�� EiiC�i'cs.
24. Never keEH in t�eir Fus:�aSiGii(v�es�arat the f&_[Lij(�7 1[1 2Rjf^vui8i a�:.�}8 C6ETiia CCAP
Card. Possession of any CCAP Card(s)will tertninate this F�scal Agreement and prevent the
�?OVi��ci�T}!I VYP��1:3 Chi d:ciB 855i5i�RG? 58i viCc''S 1I1 V1B firt��E riiih �ly�_•�uf�+y in Ge(c.rado.
25. Ti�e prov��r understan�s that if��e proviu'er co�mits`rzud or an inie:;?i�r:=_I proyrsm vioiation
the provider will be subject to disqualification from the Colorado Child Care Assishance Program
(CCGA�j as a provider for 12 mcr.�h�for the frs�ogere; 2�months for tf�:s2anu afrense x�•_
PeR^a??��fGi 1510 Gtifd O�iC�i9P..
26. The DepaRment and/or child care licensing shall have the authority to inspect the providers
F3Ciii�+fOf u`� pre_er.ce vf CCA?r�c�S v(8i�y llt�i°I'c�_c�inin��g hii;inr� i:�OtIi:3T'Ol. UyOfl
u'iSCuVefy Gf i1i2�TdiBiidlS u'10 Grov��,er unders���ds ei�her of L`��se :-.��u�BS haVB u 2 flQhl f0
seize these materials including the CCAP Cards and/or POS Device.
��..�a_.... a!�n. a i, t n_e.�A' ut r- _
' 27. � Il�:uc�a�c::u�1_'__'f OY..t"�J'2��T.8P. Y':':��.�fC''_ ' _ii��C�li%r��. �'_RG[iix:ilic•=i�. I:�dU_-u.ai%�Of
ff2UduiBli Gd`nflg. If�tltZ dRiB 8(fy OVBty&jriT�ei�i IS Bawuii5i iEv'WfiI�E yGiif fiSC3�BLJ�EEiii2liS IS
active, the amount of the overpayment will be deduded beginning with the next child care
i^.�fi''lEtiit 8.rt�2,Eljl reyTi�"iTi u:e!_-ii=f L;t��l u 8 GN°T�ey7lldit1:3��!d ifl !'�il. i(}+DU�fiSC3I
agreement is inactive, the county shall oollect the overpayment in accordance with standard
collection procedures which may inGude State Income Tau intercept. Freudulent billing will be
prasec�KC�.
28. The provider will be paid the rates agreed upon in this fiscal agreement listed below.
CCAP Licensed Provider Fiscal Apreement(Rev.09/2011) 2 of 3
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Fuli Tirrn Rs�=s
Rate T OMra!u BN-12M 12M-1&M 18M-24!!4 24!4!-3Q.Y. 3Q!!!-365! 3E!!!-SA SA
Re ular $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $0.00 $0.00
Part.Time A�*-_es
Rate T e JM�M 6lA-12M 12M-'!8M 18lA��MI 2;lJI-3�M 38:1f1�SM °_�`JISA SA
Re ular $39.05 $39.05 $38.50 $38.50 $38.50 $36.50 $0.00 $0.00
Pr3.'s�a;R:�Y'=:
1. When a pravider contends that the county has not made adequate payment based on program rules
for qre provided, the provider has the right to an informal conference with county sfaff pursuant to 9
CCR 2503-1 at Section 3.910, (D). .
• Providers may request a conference in writing within 15 days of the date of the adion.
• This request shuuid `ue add:as�d io the county d�r�c':.=of the co�nty Dzpartrnznt of
SociaUHuman services responsible forthe action.
• Provider may request that STate CCCAP staff participate in the conference. That participation
may be by:�!�;,hone con'arence.
• The c;.nference shall be held within;r✓o vrceks of the da:e ihe rzyuest for a;.o�terence is
received by the county.
• The p��p�sa of uye confe:e:�:x is lim�ceu'iu diycuss�en aC�u?�e F+aym=r:E�ir,�i;pute a.^.d G�e
relevant rules regarding paymenL
• The final decision of the county shall be mailed to the provider within 15 days of the
cui�ference date.
2. A provider may request an informal conference if s/he disputes the termination of a Fiscal Agreement.
• Provi�e,�may.�y::2�t a ccn G�er�ce in w.::::ng w��in 15 d=_y=o���e da'e ef the action.
• This request should be addressed to the county directar of the counry Departrnent of
SociaVHuman services responsible for the action.
• The ccr�ererce s!?all be held;��ithir�,vo�deeks o���e d�!e iiia reyueat far a:,cr,farence is
received by the county.
• -:T'he purpose of the conference is limited to discussion about the tertnina6on of the fiscal
89C@?(i12R2�R1�8�12.^.Y tQ 9 CCIC 2505-1 2'$?CC�on 3.306, (D�.
• The final decision of the county shall be mailed to the provider w�Siir 15 days ot the
conference date.
rt�_�:io:t m-.-�2s to:
_ 'y"
1. Provide face-to-face training to the providar on how to use the ?oint of Szrvice(POS)device prior to
entering into a Fiscal Agreement with the provider.
2. Enter the Fiscai Ay��s«�nt into U;e Ch��l�are A;1`��a��1 Trackng S;s:����(GH:.7S)w�.�{n five(5)
busiress day�of receipt of the completed Fiscal Agreement and all suppu�iiny documentation.
3. Determine clienPs eligibility for child care services within fifteen(15)days of receiving the complete
apalication ?ac1<et ir�c��di,-�g verification.
4. Send Chiid Care Authorization Nodces to the provider within seven (7)working days of the
DepartmenCs initial approval or prior to making any changes in eligibility for each child such as
pa•e^;a;�Ees,2 riorizeQ a.��uuni o:ca;_. z�?r.�u or GCtCt�CCI�Ed;en, zn,'iv�2ny otiier c.`:a-ges to
child ca2 arrangements.
5. Reimburse the provider for authorized child care in accordance with Colorado Child Care Assistance
Program rules. Payment to the licensed provider is the total cost of authorized care based on rates
set by this Agreement minus the parental fee.
TF:is Agreement:�ay be te:r^isat�d by_'s,;`;ar�arty by yiving;he o:her patf iiPeen (15) da,s i,c:i;z. This
Agreement may be termina:ed without advance notice if a child's health or safety is endargered, if the
provider is under a negative licensing action, or if the Departrnent verified the provider possesses any
CCAP card(s).
CCAP License0 Provider Fiscal AAreemeM(Rev.09120171 3 of 3
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By signing this Agreement, the provider acknowledges receipt of information regarding the rul_s and
policies of the Colorado Child Care Assistance Program.The effective date of this contract is fhe date
that the county receives and signs the Fiscal Agreement The provider shall receive a copy of the signed
Fiscal Rg;e2ment.
CHILD CARE DIRECTOR or OWNER �
Y�WN '�-`t f�N 2-"l-�y
AuthorizeC Rep:�.er.�„!_�e Da[e
o�-\S N C10.c 4hsSC1-. S� S�2S
Mailing Address � -
Q,spo.� c o 8'��c �� 9�0 -3�9 �tz�i
City, State, Zip Phone Number
��?AR7N;ENT OF SOCIAL/HUMAN SERVICES
�� � ��� � �
Auihonzed Represe t�•s•ae Date
PO Box 660
Address
Eaqle.CO 81631 970.328-8888
Cily, State, Zip � Phone Niunber
CCAP Licensed Prwider Fiscal AgreemeM(Rev.09Y1011) 4 of 3