HomeMy WebLinkAboutbocc.con.317.2016 (} Kt1% Pitkin County
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Contract Cover Sheet
Please complete the Contract Cover Sheet when the contract is completed and signed by Contractor and Pitkin County
Project Manager.
Return all Contract Cover Sheets and Contracts/Change Orders/Amendments to Procurement
(procurement_help@pitkincounty.com). Any contracts$50,000 and over will be routed for signatures to County Manager
and Attorney's Office(if required)by Procurement&Contracts Manager.
Contract Information
Contract Number 317.2016
Project Name Child Care Fiscal Agreement
Contractor Woody Creek Kids
Budget Line Item Click here to enter text.
Additional Budget Line Item(s) Click here to enter text.
and special notes to Finance
Contract Start Date 9/12/2016
Contract End Date Click here to enter a date.
Automatic Renewal Yes ❑ No❑
If Construction: Retainage Click here to enter text.
If this is a new contractor,please request they complete and submit to Finance a W-9 Form.
Contact Information:
Department Health and Human Services
Project Manager Ledingham Project Manager 5766
Phone
Provide a brief description of the contract:
2016-2017 CCAP Fiscal Agreement
Contract Value Summary:
Contract Amount $
This Change order/Amendment amount(if applicable) $
New Contract Total $
Procurement Method:
None ® Informal❑ Formal ❑ Sole Source 0 Emergency 0 Contract Renewal 0
Contract Type:
Services/Maintenance ® Construction 0 Goods,Equipment, Supplies 0
Change Order/Amendment 0 Other, please explain 0 Click here to enter text.
NOTE: CLERKS OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST.
317 . 9-0 ( 6 Licensed Child Care Provider Fiscal Agreement
Child Care Assistance Program
Pitkin County Health and Human Services License/Certificate No: 1689444
PO Box 660
Eagle, CO 81631
Woody Creek Kids
PO Box 615
Woody Creek, CO 81656
This Agreement is entered into and between Pitkin County, herein referred to as"Department'and
Woody Creek Kids, herein referred to as°provide'who will provide child care at the following address:
340 Woody Creek,Woody Creek, CO 81656. This Agreement shall be in effect from 09/12/2016
02/28/2017.
Provider Agrees to:
1. Maintain a valid child care license as required by Colorado Statute and conform to all
applicable State and Federal Regulations and local law.
2. Report to the Department if the provider's license has been revoked, suspended, denied, or
placed on probation within three(3)calendar days of receiving notification.A recovery wit be
established for all payments made as of the effective date of closure.
3. Report to the Department any changes in phone number and/or address no less than ten (10)
calendar days prior to the change.
4. Allow parents or adult caretakers immediate access to the child(ren)in care.
5, Accept referrals for child care without discrimination with regard to race, color, national origin,
age, sex, religion, or physical or mental handicap.
6. Develop an individualized care plan for children with additional child care needs.
7. Provide children with adequate food, shelter, and rest.
8. Maintain as strictly confidential all information concerning children and their families.
9. Protect children from abuse/neglect and report any suspected child abuse and neglect to the
Department.
10. Hold the County Department of Human Services,Colorado Department of Human Services
(CDHS), and the State of Colorado, harmless for any loss or actions caused by the
performance of this Agreement.
11. Offer free, age-appropriate alternatives to voluntary activities.
12. Provide child care only at the facility address listed above and/or in Exhibit A, and ensure
care is provided only by the person or business listed above. Provide care for children under
this agreement only if authorized by the Department in advance.
13. Sign the child care Fiscal Agreement and all other county or state required forms.
14. Notify the Department of a child's unexplained, frequent, and/or consistent absences within
• ten (10)calendar days of an established pattern.
,15. Collect the full parental fee each month. Parental fees are due to the provider from the parent
or adult caretaker on the first of the month. Providers shall report non-payment of parental
fees no later than the end of the month following the month the parental fees are due unless
am' rcounty policy requires it earlier. The unpaid parental fees must be reported in writing by FAX
G, ,
x N email, mail, or on a manual claim form.
' 116. Maintain proof of age-appropriate Immunizations for the children in the provider's care based
on licensing requirements.
CCAP Licensed Provider Fiscal Agreement(Rev.04/2016) 1 of 5
17. Shall not charge the counties more than the lowest established private pay rates and keep
the Department informed of changes in the private pay rates at least ten(10)days prior to the
change.Attach a copy of the current policies including rates, transportation, activity,
registration fees, payment policies, and all policies distributed to parents or adult caretakers.
Allowable rates and other associated charges shall be in accordance with State Rules for
Colorado Child Care Assistance Program. The provider is subject to recovery If the reported
private pay rates are lower than the agreed upon county reimbursement rates established in
this Fiscal Agreement and/or if providers are paid for care that contradicts provider or county
policies.
18. Shall not charge parents or adult caretakers rates in excess of those agreed upon in the
Fiscal Agreement(this includes the agreed upon registration, activity,transportation fees,
absences, and holidays as set by Department policy). The rate In the Fiscal Agreement Is the
maximum allowable rate of reimbursement for the care provided and includes any portion for
which the parent or adult caretaker is responsible, Providers may not receive payments for
days in which they were not open or available for use.
19. Attend a county face-to-face training before the provider will receive a Point-Of-Service
(POS)device, before the fiscal agreement may begin and before the provider may bill the
county for care. The provider may be required to attend additional county face-to-face training
at the discretion of the county. The POS device Is how the provider will bill for the care
provided. POS usage is a requirement.
20. Understand this fiscal agreement is effective on or after the date the county receives the
signed fiscal agreement from the provider, all additional required forms and documentation,
and the provider attended a live face-to-face POS training. Providers will not be reimbursed
for any care provided before this fiscal agreement start date and after this fiscal agreement
end date.
21. Maintain a land-based phone service to ensure the POS terminal is able to transmit
attendance information to the Department for payment on a daily basis. The provider shall not
hold any parent or adult caretaker responsible for the cost of care If the transactions are not
transmitted timely. Store-and-Forward (SAF)transactions must be transmitted timely for
payment.
22. Ensure the parent or adult caretaker swipes his/her card at the provider's location to check
the child(ren)into and out of care daily for attendance tracking and payment. Missed check-in
and check-out swipes may be updated within nine(9) days of the date of service, The
Department does not guarantee payment to the Provider if the transaction status on the POS
device is"pending,""denied,"or"not authorized,"or if the attendance is not accurately
recorded through the POS device. The parent or adult caretaker shall be responsible for
payment and the Department shall not be held liable if the child care is not authorized or the
parent or adult caretaker does not accurately record attendance through the device. Only
approved attendance transactions resulting in a daily matched pair of check-ins and check-
outs will be reimbursed by the Department.
23. Contact the XEROX Provider Helpline directly at 1-877-779-1932 within two business days if
the Point of Service(POS) terminal stops working for any reason for troubleshooting or
repair.
24. Ensure updates to the POS device are implemented as required by CDHS or the fiscal
agreement will be terminated.
25. Follow the instructions included in the POS User Manual. Train all new staff on the proper
use and requirements of the POS device.
26. Contact the Xerox Provider Helpline at 1-877-779-1932 to request a self-addressed postage
paid return label to assist in returning the POS device if the provider stops caring for children
under the Colorado Child Care Assistance Program. if the POS device is not returned within
fifteen(15)calendar days and in good condition(allowing for normal wear and tear)to Xerox,
the Department will establish a recovery for the POS device,which Is$365.
27. Maintain sign in/out sheets for children in their care. These records are to be maintained for
three years plus the current year and are to be made available to the Department upon
request. The sign-In/out sheets must include no less than: the date of care;the full name of
the child(ren);accurate sign-in time; authorized adult caretaker legible signature for sign-in
time; accurate sign-out time; authorized adult caretaker legible signature for sign-out time.
CCAP Licensed Provider Fiscal Agreement(Rev.04/2015) 2 of 5
Sign-in/out times must be accurate and within five minutes of the time recorded on the POS
device.
28. Manually bill the Department for authorized services, based on county payroll policies, not
reimbursed automatically based on approved POS transactions. The provider shall provide
sign in/out sheets and all other requested Information based on county policy to support
requests for manual payment. Counties may impose additional requirements regarding
manual claims. Manual bills are only accepted under certain rare circumstances or
exceptions. The provider forfeits payment for services if the original manual billing form is
received by the county more than sixty(60) calendar days following the end of the month of
care.The provider forfeits payment for services billed manually if the care could have been
paid through the automated payment process.
28. Never keep in their possession(whether at the facility or in any other place) a client's CCAP
Card used to swipe for attendance. Violations of this nature will be reported to CDHS
licensing staff.
30. Understand that if the provider commits fraud or an intentional program violation the provider
will be subject to disqualification from the Colorado Child Care Assistance Program (CCCAP)
as a provider for 12 months for the first offense;24 months for the second offense and
permanently for the third offense. Violations of this nature will be reported to CDHS licensing
staff.
31. Allow county and/or child care licensing the authority to inspect the provider's facility for the
presence of CCAP cards or any other(fraudulent)or suspicious billing information. Upon
discovery of these materials the provider understands either of these entities have the right to
seize these materials including the CCAP cards and/or the(Point of Service)(POS)Device.
32. Return any overpayment.All overpayments will be recovered including, but not limited to,
inaccurate or fraudulent billing. If at the time any overpayment is established while your fiscal
agreement is active,the amount of the overpayment will be deducted beginning with the next
child care payment and every payment thereafter until the overpayment is paid in full, unless
negotiated otherwise by the county through a signed repayment agreement. The county shall
collect the overpayment in accordance with standard collection procedures, which may
include State Income Tax intercept if your fiscal agreement is inactive. Fraudulent billing will
be prosecuted.
Full Time Rates
Rate Type OM-6M 6M-12M 12M-18M 18M-24M - 24M-30M 30M-36M 38M-SA SA
Regular $0.00 $0.00 $0.00 $0.00 $65.00 $65.00 $65.00 $65.00
Part Time Rates
Rate Type OM-6M 6M-12M 12M-18M 18M-24M 24M-30M 30M-36M 36M-SA SA
Regular $0.00 $0.00 $0.00 $0.00 $35.75 $35.75 $35.75 $35.75
Provider Rights:
1. When a provider contends that the county has not made adequate payment based on program rules
for care provided, the provider has the right to an informal conference with county staff pursuant to 9
CCR 2503-1 at Section 3.910, (E).
• Providers may request a conference in writing within 15 days of the date of the action.
• This request should be addressed to the county director of the county Department of
Social/Human services responsible for the action.
• Provider may request that State CCCAP staff participate in the conference. That participation
may be by telephone conference.
• The conference shall be held within two weeks of the date the request for a conference is
received by the county.
• The purpose of the conference is limited to discussion about the payments in dispute and the
relevant rules regarding payment.
• The final decision of the county shall be mailed to the provider within 15 days of the
conference date.
CCAP Licensed Provider Fiscal Agreement(Rev.04/2015) 3 of 5
2. A provider may request an informal conference if s/he disputes the termination of a Fiscal Agreement
pursuant to 9 CCR 2503-1 at Section 3.912,4.
• Providers may request a conference in writing within 15 days of the date of the action.
• This request should be addressed to the county director of the county Department of
Social/Human services responsible for the action.
• The conference shall be held within two weeks of the date the request for a conference is
received by the county.
• The purpose of the conference is limited to discussion about the termination of the fiscal
agreement pursuant to 9 CCR 2503-1 at Section 3.906, (0).
• The final decision of the county shall be mailed to the provider within 15 days of the
conference date.
Department Agrees to:
1. Provide face-to-face training to the provider on how to use the Point of Service(POS)device prior to
entering into a Fiscal Agreement with the provider.
2. Enter the Fiscal Agreement into the Childcare Automated Tracking System (CHATS)within five (5)
business days of receipt of the completed Fiscal Agreement and all supporting documentation.
3. Determine client's eligibility for child care services within fifteen(15)days of receiving the complete
application packet including verification.
4. Send Child Care Authorization Notices to the provider within seven (7)business days of the
Department's Initial approval or prior to making any changes in eligibility for each child such as
parental fees,authorized amount of care, added or deleted children, and/or any other changes to
child care arrangements.
5. Reimburse the provider for authorized, attended,and properly recorded and transmitted child care in
accordance with Colorado Child Care Assistance Program rules, Payment to the licensed provider is
the total cost of the lesser of authorized and attended care based on rates set by this Agreement
minus the parental fee(if applicable).
Either party may terminate this Agreement by giving the other party eleven (11)calendar days' notice.
This Agreement may be terminated without advance notice if a child's health or safety is endangered; if
the provider is under a negative licensing action; if the Department has concerns involving the provider,
an employee,or a resident in the provider's home;or if the Department or CDHS verifies the provider
possesses any CCAP card(s).
By signing this Agreement, the provider acknowledges receipt of information regarding the rules and
policies of the Colorado Child Care Assistance Program.The effective date of this contract is no earlier
than the date that the provider attends required in person training, and the county receives and signs the
Fiscal Agreement.The provider shall receive a copy of the signed Fiscal Agreement.
CHILD CARE DIRECTOR CHILD CARE OWNER OR DESIGNEE
ls. 1 4,4OWa
Print Name I Dat• Print Name Date
Signature Signature
V,0 63)( le lc
Mailing Address Mailing Address
(lJotb vjo,X , Cit) Oct -
City,State Zp Phone 91r City State Zip Phone
CCAP Licensed Provider Fiscal Agreement(Rev.04/2015) 4 of 5
DEPA TMENT OF SOCIAUHUMAN SERVICES
Authorized Representive(Print Name) Date
.. ..a
Signature
PO Box 660
Mailing Address
Eagle,CO 81631 970-328-8888
City,State,Zip Phone
*Please NOTE: Fiscal Agreement is NOT complete until the provider has completed POS
training
CCAP Licensed Provider Fiscal Agreement(Rev.04/2015) 5 of 5
EXHIBIT A
PROVIDER LOCATION INFORMATION l ' 7-5q-21143
��2�
Provider ID Number. I Ill fc �'L4 Tax ID.No: 46t
The following are the Provider locations are authorized by the State of Colorado to care for children under the license number listed above. Copy
this page if more locations need to be listed.
Location Number Primary Location 2 3 4
Location Street &i.e it2
Address
City LJo ,►t' (
State and Zip /y A c l(o c r
Primary phone# L �.1O Vt' 9 0 1`,i
Secondary phone# �/
Fax number
E-mail address , rC i }Sy{ @�rlt.a{Ifs
Emergency phone#
Primary l .kv(Sh\k4t �t
Point of Contacttgaig
Secondary
Point of Contact
Check here if additional sheets are attached listing more locations. This is sheet (#)of (total)
Please return this form to the county if you provide care at any location in addition to the one indicated on page one(1)of the fiscal agreement Care provided
at additional locations must be in accordance with licensing requirements, Colorado Child Care Assistance Program rules, and county policies.Any additions
or modifications to provider locations must be submitted to the county no less than ten(10)days prior to the change.
CCAP Licensed Provider Fiscal Agreement Exhibit A(Rev.03/2013)