HomeMy WebLinkAboutbocc.con.096.2014 RESERVED
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Licensed Providar Fiscal Agreement
� Pitkin County Health and Human SCrviees � PROVIDER#: 83235
PO Box 860
Eagle, CO 81631
R�C'txVt?
witdwood scnooi FEB 5 2014
PO BOX 9290
Aspan, CO E�E'IZ HEALTtI ;=.HUf„�,M SERVICES
This Agreement is entered into and belwean Pitkln County, herein refercetl to as"DepaAment°and
� � Wildwoo<i Schoa, hereln referced to as"provider'who wiil provide child cere�at th0 follawing addreas:
0241 Wildwond Lane.As,pen. CO 81811. 7his Agreement shall be in affact from 1 /20�4 to 2/ 017,
provfder Agrees to:
1. MBintain a valld child care IlcensC as required by Coloredo Statute and tanform to all applicable
State, Federal Regulations and local law.
2. Raport to the county if the Drovitler's ilcense has been revoketl,suspentled,or denled within
threa(3)calendar days of re�iWng notlfication;a recovery will be estebllshed of all paymonts
made as of the eHective date af clpsure.
3. Allow parente immetllata acc9ss to lho chitd(re�)in care.
4. Aooept refer�als for chiltl care wilhcut discrlminaaon with regard to race, eolor, natlonal origin,
age,sex,raligion,or physicaf or mental h0n(SiCap. � � .
5. Provide chiltlren with adequate food,shel[er and rest.
8. Maintain as 6ViCtly confidential all IMormatlon concam;ng chAdren and their tamllles.
� 7. Proteet ehildren from ebuse/naglect and report any suspacted chtltl abusa and neglact to the
Department.
8. Ho�d the Cnloracio Department of Human ServiCes and the State of Colorado harmtBSb for any
loss aYactions causetl by the performance af thlS AgreemeM,
9. Pravider shall aHer free,age•apprupriate allematives to voluntary act+vities. .
10.'Prnvttle chiid care al tha faciiity addrese listed above antl e�sure that eere is provided only by the
person ar 6ustness listed above.Provide cere for children under this agreernent only if authorized
by tha Department in ativance. � �
t 1. Slgn the child care Fiscal Agreernent anG flll other county or state required forms.Devalop an
- indlvidualized caro plan for chlltlren with additional c�iltl care needs. � �
12. NotRy lne Departmenl of unexplainetl,hequent entl/or con9istenl absences within ten (10)
ca�ertdar days of an astablished panam.
13. Provlders are requirad to collect the tufl parental fae each mOnth, Parental fees are due to the
providar fram the parent or atlult tareteker at the beginning of U+e mo�th. Raport non-payment of
pareMal fees no later than the last day of the month for which they have not been recaived.
14. Maintain proaf of age-appropriate immunizatlons for the chiltlren In the pao�ider's care,H required
by county pvlicy. Immunl�sclon records shall be olri2ined irom parents or adult Caretakers elthar
at the time of admission or within thlrty(30)calendar deys of the date of a0mission and Shall be
updated annually. For chlldren whose parents or adult caretakers object to immunizaiions on
religiaus prounds or ior chlldren whase medical condition conUaindicates immuniration, providers
shall malntaln a statement in the cht10's file e�gned by lhe parenl or adult caretaker stating the
reason for not Immunlzing. . �
15. Shall not cha�ge tne counti85 mo�e than the established prlvat9 pay r2t9s and keap tha
pepartmant irdortned of change6 In the private pay rates wiihin ten(7D)tlays o(ihe change.
Altach a copy ot the Current charqe pollCies on rates,transportstian, ectivity, reg�StraGon feeS and
payment paiGes.Allowable rates e�d other associated chargas shall be in accordance with State
RWes fo�Colorado Chila Care Asslatance Program.Tfie provide�is suBject to recovary ff the
�eported private pay retes are lowar than the agread upon counry reimbureemenl ra4es
eslabllshed in this Fiscal AgrBement.
18. Shall not char9e parents or adult caretakers rates in excess of those agreed upon in tha Fiscal
Ag�eement(thls InGudes the agraed upon regisVation. ac6vity and tranSporfatio�fees'rf the
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county pays these tees).7�e rate in the Fiscal Agreement is the maximum allowable rate of
reimbursement tor the care providaO and Includea any portion for which the parent or adult
Caretaker is responsible.
77. The provider understaMls that they must attend a county face-to-tace tralning before Me provider
wAl reCeiva a Point•Ot-5erviCe(POS)device.The provider is roqulred to use the POS device to
recortl attendance and bill�or care provided.
18. Malntain a land-based phone service m ensure that the POS tarminal is able to submR
attendance infwmatlon to the DepartmeM for payment on e waekly basls.
� � . 18. Providecis responsible to ensure the parent or adult caretekar swlpes his/her eard.lo check the
chlld(ren)Inro and out of care dalry for ariendance tracking and payment.Missed cheek�n and
check-oul swipes may be updated within nlna(8)days of tha date of sarvlca.The DepeAment
does not guarantee payment ro the Providar ii tha euthorization status on the POS device is
'pantling,""denied;or'not authonzetl"If ine chlld cara is not autharizotl,fha parent or adult
caretaker shall be reSponSib�e for payment antl the Depertment shall not be held liable. �
20. Provider Is responsible to contact Affifiatetl Computar Service, Ine(ACS)at 1-8�7•779-1832'rf tha
Poinl of Service(POS)terminal stoqs working far any reason for troublashooUng or repair.
21. If the provitler sWps car'mg tor chHtlren under the Colorado Child Caro Assistance Program they
shall coMxt ACS to request a self-atldreas postage paid raturn label to assist in retuming the
POS device. H the POS d0vice I5 not retumetl Wlthin thlrly(30}day9 end In good ahape(allowing
for normef wear and teer}to ACS a reeovery wtil pe eatablished for tAe cost ot reWaoament inr
� . the POS device whioh Is$765. � �
22. 7he provid9r is requlred to maintain 9ign tn/out sheets for chlldren In thoir ca�e. Thase racords
shall be malntained for three years plus dt9 cunant year and are to ba made dvailable to the
Departmant upon request.
23. The pravitlar may manually bill the Department for services authorized,based on county payrou
policies,that were not reimbursed automaBcally based on the POS transactions.7be provider
. shali provitle sgn iNOUt sheats to supparl requasts for manual payment.The provider forfeits
. payment for seNiC6s ff the orginal manual bllling fam is submN[ed moro than slxty(60)calendar
deys following the and of the month the servlce period ended.
24. Never keep in their p6ssession(whether at tha facluty or in any othar place)a clienPS CCAP
Card. Possesslon of any CCAP Cartl(s)w10:tertninale tfiis Flscal Agreement and prevent the
provider hom provlding child canB assistance services in lhe fufuro with eny county In Colorado.
25. The provider understands that if tha provlder commits frauC or en Intenlianel program violation
the provider wil4 De subject to disqualificatlon from the Colorado ChiM Cere Assistance Program
(CCCAP)as a prwlGer Tor 12 months for lhe first offense;24 months for the sacond oHense and
permanenUy for the third offensa.
26. 7he Dep2rtment and/or child care licensing shall have the authoriry lo inspect the provider�s
�. factl ity for the preSenee of CCAp CBrds or any other suspic�0us billing informetlon. Upon �
diSCOVery of these malerials the pravider undersiands either M these entities have the right to
seize tbese materlals including the CCAP Gards endlor POS Device.
27. I under6ta�d that any overpayment WIII be recovered including, but not limlted to, ineccurate or
ffdUdU1901 bBflfiB. IT 8t t110 tirrle afly Ove�pByment is esta611shed whlle youf fiscal agreamant�is �
active,the amount of the overpayment wiN be deducted beginning wlth the nexl chlid care
payment and every payment thereafter urnll the overpayment is paid in fulL H your fiscal
agreement is inactive, the COUnry shall COliect the overpayment in accordance with sianderd
� co119Ction prpCetlures which may inGutla State Inwme Tax intercept. Fraudulent bAling will be .
prOSecuted. �
28..7he provlder will be paitl the raies.agreetl upo� in this flscal agreemant listed below.
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Full Tlme Ratea
Rate T e OM-6M 6M•12M 12M•18M 18M-24M 24M30M 30M-36M 36M•SA 9A
� Re uler $0.00 $0.00 $0.00 $0.00 $0.00 � $81.11 $81.11 $0.00 �
. Per!Time Retey � -
Rate T OM-6M 6M-12M 12M-18M 18M•24M ?.4M•30M 30M•96M 36M-SA SA
R ular $0.00 $0.00 $0.0 50.00 y0,00 $38.50 $35.75 $0.00
Provitler Rlghts: � � ' � �
1. When a provid8r rqntCntlS that the county has not made adequate paym6nt ba50d On prOgram rules�
for care provided,the provider has the right to an iMormal wnference with county staff pursuant to 9
CCR 2503-1 at Seetion 3.910, (Dj.
• Provitlers may raquest a wnference in writing within 15 days.of the data of tha action.
• This request should be addressed to the counry director of the counry DepaRment ai
SociaUHumen services reaponalble for the action,
• Provider may request that State CCCAP staff parkioipate In the coMerence. 7hat partieipation
may be by telephone corderence.
• 7he conference shall be held within two weaks of tha data tha requast for a conference is
receivad by the county.
• 7he purpose of lhe conference is limited to discussion about the payments in dispu4e and the
relevant roles regarding paymenk
• The final decision of the county Shall be maled to the provider within 15 days OT the
conference date.
2. A provider may request an informal cortFerence if s/he tlisputes the tennination oi a Fiscal Agreement.
� • � Providers may request a conierence in wriling within 75 days of the date of the actton.
• 7hls request should l�e addrassed to tha counly director ot the county Department of
. SociaUNuman services responsibte for tha aciion. � . �
� • The wnterence shail be�haltl within two weeks of the date tF�e request.for a conferenca is
received by the wunty.
� • The purpose of fhe coMer2nce is limited to discussion about the termination of the fisc8l �
agreement pursuant to 8 CCR 2503-1 at Section 3.908, (D),
• The final decision of the county shali be mafled to the provider wlthin 15 daye of the
conference datg. .
' DepaRmont Agrooe to: . . '
1. Provida faca•to-faca tralning to tha provider on how to use the Point of Service(POS)device prior to
antaringlnto a Fiacal Agreement wlth the provide�. - � - �
2. Enter�the Fiscal Agreement intoihe Childcare Auromated Trecking Syetem(CHATS)within five(5) �
business days of receipt of the completed Fiscal Agreemenl and all suppoAing documentation,
3. Determina clienCs eligibilRy foc child cara services within frfteen(15)days of recaiving the wmpleta
appllCation pecket inClutling verification.
. 4. Send Child Cara Authorization Notices to the provfder wilhin seven(7)working days oT tbe
� . DCpeAmenPs initial approvel or prior to making any chanyes in ei�gibility for e&Gi chdd such as
parental fees,autharized amount of care,atltled or deleted chllCren, an[UOr any other changes to
child cara anangements.
5. Reimburse tha provider for authorized ch�d care in acwrdance with Colorado Child Care Assislance -
program rules. Payment to the licensad provlder is the total wst of authorized care based on rates
set by this Agreement minus the parenlat fee.
This Agreament may be lerminated Dy either party by giving ihe other party fiReen{15)days nollce.Thia
Agreement may be terminated without ativance noHCe if a ch�d's heaqh or safery is endangered, if the
provide�is under a negatNe Iicensing actlon,ar if the Depanment verified tha provider possesees any
CCAP card(s).
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By signing this Agreement, the provider acknowletlges receipt of in}ormation reqarding the rules and -
polioies ot the Colorado Chtltl Care nssiatance Program.The effective date of this contract is the dete �
that the county rece��es and signs the fiscal Agreemant.The Orovlder shall receive a copy of the signed
Fiscal Agreement.
CHII.D CARE DIRECTOR or OWNER
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� AuMorized Re ntative . Dale -
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Meiling/Wdres
PoBax �a9U
CI 8�n��1 161� `�''70- `�5-56'7$
ta� p Phone Number � � .
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DEPARTMENT OF$OCIAI,/HUMAN SERVICES
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thorized Rep+e6en aGve � D8
PO Boz�60
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