2-CSA - Existing Provider Renewal Information.pdf

DEPARTMENT OF SOCIAL SERVICES

FAUQUIER COUNTY

May 15, 2026

CSA Contractor:

It is time to start working on the FY 2027 service year contracts for our Children’s Services Act.

Fauquier County utilizes a five (5) year contract, renewed annually each year over the course of the five-year period. Each renewal year, you will be requested to provide a few documents that allow us to update your rates, licenses, and certificates of insurance in our systems. Fauquier Procurement will be responsible for tracking all required documents and issuing the final renewal document. Fauquier Community Policy and Management Team (CPMT) is responsible for the approval of any rate increase proposals. Please check one of the boxes listed below to indicate what type of rate increase proposal your agency will be submitting for review and include a letter justifying the increase in rates. Fauquier CSA staff will be available to assist if there are any questions. Questions should be sent through Bonfire. All renewal documents should be uploaded within Bonfire by June 15, 2026, to be processed for FY 2027. The Service period of the annual renewal will continue to be July 1st to June 30th of each CSA fiscal year.

All CSA contractors must register with Bonfire https://fauquiercounty.bonfirehub.com, once registered the documents can be obtained on Fauquier County’s projects listed within Bonfire https://fauquiercounty.bonfirehub.com/projects

If you are a new CSA contractor, please submit your documents for review and processing through the link within the Bonfire application.

RENEWAL CHECKLIST:

Updated cover sheet with current contacts to include- address, phone, fax, and contact person for clinical services AND billing issues

Updated Rate sheet or fee schedule for FY 2027 There are no proposed rate increases for FY 2027 The proposed rate increases for FY 2027 are below a 3% increase The proposed rate increases for FY 2027 are above a 3% increase

Updated School Calendar for education services (including ESY if appropriate)

Updated program/ staff licenses if applicable

No Crimes Against Children Form

Updated COI (Certificate of Insurance)

If you have questions, please submit them through Bonfire application. We look forward to another successful year of serving our children and families in Fauquier County.

Sincerely, Michael Mahoney Administrative Program Manager, Fauquier County Department of Social Services

Michael Mahoney Administrative Program Manager 320 Hospital Drive, Suite 11 Warrenton, VA 20186

(540) 422-8409 Phone

(540) 422-8449 Fax https://fauquiercounty.bonfirehub.com/ https://fauquiercounty.bonfirehub.com/projects

Fauquier County Agreement for Purchase of Services Rev. 04/2026

CSA PROVIDER INFORMATION

Fiscal Year 2027

Please Print

PROVIDER: Agreement #:_____________

Corporate (Legal) Name: _______________________________________________________________

DBA (if applicable): __________________________________________________________________

Address:

Phone: ___________________________ Website:__________________________________

Contract Contact: _________________________ Contract E-mail: ___________________________

Contract Phone: ___________________________ Contract Fax: _____________________________

Admissions Contact:________________________ Admissions E-mail: ________________________

Admissions Phone:_________________________ Admissions Fax: __________________________

Payment Contact: __________________________ Payment Email: ___________________________

Payment Phone: ___________________________ Payment Fax: _____________________________

PROVIER SERVICES UNDER PURCHASE AGREEMENT (check all that apply):

□ Special Education and Related Services □ Treatment Foster Care Services

□ Congregate Care and Residential Services □ Community Based Services

□ Community Based Services for DJJ Court Services Unit

PROVIDER SERVICES THAT ARE MEDICAID ELIGIBLE:

□ Treatment Foster Care: □ Residential Facility

□ Community Based Services: □ Other: __________________________________

□ Group Home – Level B only

CHILDREN’S SERVICES

DEPARTMENT OF SOCIAL SERVICES

FAUQUIER COUNTY, VIRGINIA

Michael Mahoney, CSA Coordinator

320 Hospital Drive, Suite 11

Warrenton, VA 20186

(540) 422-8409 Phone

(540) 422-8449 Fax

Fauquier County Agreement for Purchase of Services Rev. 04/2026

FAUQUIER COUNTY CSA INFORMATION

Fiscal Year 2027

CSA Administrative Specialist (AS): Lisa Trapani

AS E-mail: lisa.trapani@dss.virginia.gov

AS Phone: (540) 422-8425

AS Mailing Address: 320 Hospital Dr., Suite 11, Warrenton VA 20186

Director of Procurement: Kristen Hylton

CM E-mail: kristen.hylton@fauquiercounty.gov

CM Phone: 540-422-8357 CM Fax: 540-422-8355

CM Mailing Address: 320 Hospital Drive, Suite 23, Warrenton, VA 20186

CSA Coordinator: Carly Baughn

Coordinator E-mail: carly.b.baughn@dss.virginia.gov

Coordinator Phone: 540-422-8440 Coordinator Fax: 540-422-8458

Coordinator Mailing Address: 320 Hospital Drive, Suite 11, Warrenton, VA 20186

FCPS Supervisor of Special Education (SSE): Angie Gum

SSE E-Mail: agum@fcps1.org

SSE Phone: 540-422-7147 SSE Fax: 540-422-7198

SSE Mailing Address: 430 East Shirley Ave, Bldg. B, Warrenton, VA 20186

Utilization Review Specialist (URS): Mimi DeNicholas

URS E-mail: mimi.denicholas@dss.virginia.gov

URS Phone: (540) 422-8409 URS Fax: 540-422-8458

URS Mailing Address: 320 Hospital Drive, Suite 11, Warrenton, VA 2 mailto:lisa.trapani@dss.virginia.gov mailto:kristen.hylton@fauquiercounty.gov mailto:carly.b.baughn@dss.virginia.gov mailto:agum@fcps1.org mailto:mimi.denicholas@dss.virginia.gov

PROCUREMENT DEPARTMENT

Fauquier County Government & Public Schools 320 Hospital Drive, Suite 23 Warrenton, VA 20186-3037 procurement@fauquiercounty.gov Phone (540) 422-8352 Fax (540) 422-8355

CERTIFICATION OF NO CRIMES AGAINST CHILDREN

Contractor acknowledges that the implementation of this Contract requires Contractor, Contractor’s employees, or other persons that will provide services under this Contract to have direct contact with students and children.

Therefore, Contractor hereby certifies that neither Contractor, Contractor’s employees, nor any person that will provide services under this Contract who will have direct contact with students and children on Fauquier County Public School and/or Fauquier County property during regular school hours or during school-sponsored activities has been convicted of any violent felony set forth in the definition of barrier crime in subsection A of § 19.2-392.02;

any offense involving the sexual molestation, physical or sexual abuse, or rape of a child, or the solicitation of any such offense; or any crime of moral turpitude.

Contractor understands that, pursuant to Code of Virginia § 22.1-296.1, making a materially false statement regarding offenses which are required to be included in the certification referenced above is a Class 1 misdemeanor and, upon conviction, the fact of such conviction shall be grounds for the revocation of the contract to provide such services and, when relevant, the revocation of any license required to provide such services. Fauquier County Public Schools and/or Fauquier County shall not be liable for materially false statements regarding the certifications required under this Contract.

Company Name Contract # and Title

Company Address Company Phone Number

Print Name of Authorized Representative Authorized Representative Title

Authorized Representative Signature Date

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mailto:procurement@fauquiercounty.gov https://law.lis.virginia.gov/vacode/19.2-392.02/