RFQ26-25, Exhibit B.docx

SCOPE OF SERVICES AGREEMENT 2025-2026

Full Vendor Name

THIS SCOPE OF SERVICES AGREEMENT (“SOSA”) is made and entered into this ______ day of ___________ 2025, by and between the BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF DOUGLAS, STATE OF COLORADO (the “County”), and Full Vendor Name, authorized to do business in Colorado (the “Contractor”). The County and Contractor are sometimes collectively referred to herein as the “Parties”.

WHEREAS, the County has an active Master Services Agreement, (the “MSA”) with the Contractor to perform services for the County governed and executed through Scope of Services Agreements (SOSA); and

WHEREAS, the County is undertaking certain activities in its role as the local Human Services Agency, in accordance with Colorado State laws and mandates; and

WHEREAS, the County has budgeted and appropriated the necessary funds to satisfy the financial obligations set forth in this SOSA.

NOW, THEREFORE, for and in consideration of the premises and other good and valuable consideration, the parties agree as follows:

1. MASTER SERVICES AGREEMENT: This SOSA is subject and subordinate to the terms and conditions specified in the MSA, executed between the County and Contractor on January ____, 2025.

2. SCOPE OF WORK: All services described in Exhibit 1, attached hereto and incorporated herein, shall be performed by Contractor.

3. MAXIMUM CONTRACT LIABILITY: Any other provisions of this SOSA notwithstanding and pursuant to Section 29-1-110, C.R.S., the amount of funds appropriated for this Contract is XXX ($0.00) for the Term. Payment terms are as described in Exhibit 2. The County is not under obligation to make any future apportionment or allocation to this SOSA. Any potential expenditure for this SOSA outside the current fiscal year is subject to future annual appropriation of funds for any such proposed expenditure.

Federal rule prohibits entities from supplanting, i.e., replacing or substituting, state or local funds with federal funds. Therefore, if the Contractor is already receiving state or local funds for a specific purpose described in Exhibit 1, the Contractor attests by virtue of executing this Scope of Services Agreement that they will not now use payments made under this Contract (which include federal funds) to cover costs related to those services that were previously covered by state or local funds. Federal funds may be used to supplement existing state or federal funds, but not replace them.

The Contractor will make reasonable efforts to review requirements to become a Medicaid provider and invoice all Medicaid services accordingly should they become a Medicaid provider. The Contractor will reimburse the Department for any funds paid by the Department for a service previously or subsequently paid for by Medicaid.

In the event that third-party payment is available for any service described in Exhibit 1 and the Contractor agrees to accept that payment, said compensation is payment in full. The Contractor will not subsequently invoice the County for any shortfall in third-party payments. Examples of third-party payors include Medicaid or Children’s Health Plan from any state, private health insurance, victim’s compensation, trust fund or disability trust, or settlement. Amounts paid by third-parties do not count against the Maximum Contract Expenditure.

In select circumstances if the Contractor accepts private insurance for a service described in Exhibit 1 and as mutually agreed upon between the Contractor and the County, should a client co-pay or deductible be due to the Contractor, the County will pay the client’s co-pay and/or deductible. Such payments do count against the Maximum Contract Expenditure. Prior to this being considered, the Contractor agrees to verify allowable covered benefits, co-pays, and/or deductibles. The County will provide written approval should this circumstance be approved.

4. TERM: It is mutually agreed by the parties that the term of this SOSA shall commence as of 12:01 a.m. on June 1, 2025 and terminate at 11:59 p.m. on May 31, 2026. This SOSA and/or any extension of its original term shall be contingent upon annual funding being appropriated, budgeted and otherwise made available for such purposes and subject to the County’s satisfaction with all products and services received during the preceding term.

5. COUNTY EXECUTION OF AGREEMENT: This SOSA is expressly subject to and shall not be or become effective or binding on the County, until execution by all signatories of the County.

(Remainder of Page Intentionally Blank)

IN WITNESS WHEREOF, the County and the Contractor have executed this Contract as of the above date.

NAME

BY: _____________________________________________

NAME, TITLE

DATE: __________________________________________

ATTEST: (if a corporation)

BY: _____________________________________________

(Print name and title)

SIGNATURE: ____________________________________

DATE: __________________________________________

Exhibit 1

The Contractor agrees to provide service(s) and deliverables outlined herein and specifically listed in Exhibit 3. Services provided outside of this Exhibit 1 will be deemed gratuitous to and are subject to non-payment by the Department of Human Services’ (the “Department”) discretion.

1. General Provisions

a. The Contractor will comply with all applicable federal and state laws including Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973; Title II of the Americans with Disabilities Act of 1990; the Age Discrimination Act of 1975; and the regulations of the U.S. Department of Health and Human Services issued pursuant to the above statutes at Title 45 Code of Federal Regulations (CFR) Parts 80, 84, and 91, and Title 28 CFR Part 35.

b. The Contractor will comply with all mandatory child abuse and neglect reporting laws and policies outlined in §§ 19-3-307 and 19-3-304, C.R.S.

c. Client missed appointments shall be reported to the Department as soon as possible but no more than forty-eight (48) hours after the missed appointment.

d. Any safety concerns or events considered clinically significant, i.e., family deaths, discovery of new relevant mental health issues, or other events that could be considered pertinent to client welfare shall also be reported to the Department as soon as possible but no more than forty-eight (48) hours after the Contractor becomes aware of such issue or information; and may require immediate action determined by legal mandated reporting responsibilities.

e. The Contractor’s staff will attend periodic meetings or calls to discuss overall service delivery, utilization, and specific case issues as requested. The Contractor as listed under the term Notices in paragraph 16 of the Master Service Agreement (MSA), and/or senior member(s) of Contractor’s organization, will attend meetings as requested by the Department to review contract performance or related issues should they arise.

f. If subpoenaed, the Contractor will accept service of the subpoena via e-mail and will sign and return a Waiver of Service regarding the subpoena. The Contractor will provide the Department a curriculum vitae for any person subpoenaed within two (2) business days of receipt of the subpoena.

g. The Contractor’s internal policies do not supersede or replace any terms contained within this Contract.

2. Staff Background Checks

a. Various required checks are outlined in this section. The Department reserves the right to review all background checks at any time. The costs of the background checks are not reimbursable under this Contract. The Contractor accepts the disqualifying offenses as listed in 12 CCR 2509-8 and Colorado Department of Human Services Volume VII, 7.701.33, D. 7. The Contractor will notify the Department within two (2) business days of any staff charged with a disqualifying crime.

b. The Contractor will complete Colorado Bureau of Investigations (CBI) and Federal Bureau of Investigations (FBI) background checks as follows:

i. The Contactor shall ensure all employees, subcontractors, interns, mentors and volunteers who may have client contact or provide services under this Contract have submitted to and passed a fingerprint-based CBI and FBI criminal background check prior to commencing provision of services under this Contract.

ii. Any items listed in the results of the background checks must be communicated by the Contractor to the Authorized Representative (or their designee) and cleared prior to allowing the subject of the background check to have contact with clients.

iii. Confirmation of results or clearance letters of these criminal background checks must be kept by the Contractor in a secure location as directed by CBI and FBI guidance. Results must be made available for review by the Department upon request and maintained for three (3) calendar years after the date of the Contractor’s final payment from the County under this Contract.

iv. Contractors eligible for automatic CBI and FBI updates, i.e., with five (5) or more employees, will timely review updates and inform the Department of any changes. Contractors that are not eligible for or are not receiving automatic CBI and FBI updates for any reason will ensure that every five (5) years an updated fingerprint-based CBI and FBI criminal background check will be run on each employee, subcontractor, intern, mentor and volunteer, and kept in their secure file for review by the Department.

v. If these conditions cannot be met, the Contractor will immediately notify the County’s Authorized Representative.

c. The Contractor will complete Colorado Department of Early Childhood (CDEC) background checks as follows:

i. The Contractor shall also conduct a Child Abuse and Neglect background check through the Colorado Department of Early Childhood (CDEC), Background Investigations Unit (BIU) on all employees, subcontractors, interns, mentors and volunteers prior to them providing services to Department clients under this Contract.

ii. The Contractor shall notify the Authorized Representative (or their designee) of any employee, subcontractor, or volunteer who has findings of child abuse or neglect; the Authorized Representative will provide a decision on whether the Department will allow that individual to provide services under this Contract.

iii. The Contractor must retain copies of all background check results in the employee, subcontractor, intern, mentor or volunteer secured files; copies must be available for review upon the Department’s request and be maintained for three (3) calendar years after the date of the Contractor’s final payment from the County under this Contract.

iv. The Contractor will ensure that every five (5) years an updated Child Abuse and Neglect background check will be run on each employee, subcontractor, intern, mentor and volunteer.

d. When applicable, Contractor shall retain copies of employee credentialing qualifications from Colorado Department of Regulatory Affairs (DORA) in personnel files and make such records available to the County Representative upon request. The Contractor shall immediately notify the County of any suspension or revocation by DORA of an employee or subcontractor.

e. The Contractor will complete a Sexual Offender Registry check and receive, at minimum, preliminary results before assigning and/or hiring employees, subcontractors, interns, mentors or volunteers to perform under this Contract.

3. Staff Assignments and Performance

a. The Department has the right to approve or disapprove the Contractor’s employees, subcontractors, interns, mentors or volunteers performing services under this Contract prior to the commencement of the work and shall have the right to review the employment files prior to granting approval. The Contractor will ensure said staff are familiar with the term Conflict of Interest in paragraph 7 of the Master Service Agreement (MSA) prior to commencing work under this Contract.

b. If the Department becomes dissatisfied with the Contractor’s performance (inclusive of employees, subcontractors, interns, mentors or volunteers), the Department will notify the Contractor. Disciplinary measures, if any, will be the sole responsibility of the Contractor. However, if the concerns are not resolved to the Department’s satisfaction, the Contractor’s staff will not be allowed to provide services under this Contract.

c. The Contractor and its employees, subcontractors, interns, mentors or volunteers shall remain in good standing with the appropriate licensing authority(ies) if applicable to performance of service provided. Temporary suspension, permanent loss, or any change of a license status that renders the person ineligible to provide service at any time during this Contract is considered a Breach of Contract, and payment will not be rendered for any services performed when required licensure was not in effect and good standing and may result in Contract termination.

4. Referrals

a. The Department will request service using the “Referral for Services” (See Exhibit 4.) for the person, services(s), unit(s), and rate(s) identified in Exhibit 3.

b. The services will be provided at the location(s) noted on the “Referral for Service”.

c. The “Referral for Services” will include identifying information such as the name and address of the family, social history, medical and educational information, as appropriate.

d. The “Referral for Services” must be received by the provider prior to the commencement of services.

e. The Contractor may only provide service(s) listed in a current “Referral for Services” for services described in Exhibit 3. Services provided without a current Referral, any additional service(s), or an activity not outlined in the service description is subject to non-payment. Questions about the Referral, services and dates should be directed back to the Case Workers.

f. In rare circumstances, the Department may wish to utilize services outlined herein for clients participating in another program or where services will be paid for using an alternate funding stream. Should this occur, Exhibit 3 will not be applicable. Rather, the Department will outline all required referral elements in writing, and the Contractor agrees to provide services as outlined in paragraph 5, Services and Deliverables (below) and Exhibit 2. The rates for services contained in Exhibit 3 will still apply as to any services provided under this paragraph.

5. Services and Deliverables

a. Services and deliverables are listed in Exhibit 3.

b. The Contractor will ensure staff are appropriately credentialed. This includes:

1) required training, certifications and licenses; 2) insurance; and 3) background checks as required by law and specified in this Contract, to render these services.

c. Missing or incomplete deliverables with insufficient detail will result in slower invoice review and payment processing due to additional follow-up. Required deliverable(s) never provided or late deliverable(s) are subject to non-payment.

During the course of this Contract, the Department will:

1. Use appropriate funding streams and will solely determine the appropriate eligibility for services and applicable funding streams;

2. Provide clients information regarding rights and fair hearings;

3. Monitor the provision of services which includes various expenditure and outcomes analyses, practice enhancements, and meetings with the Contractor; and

4. Schedule meetings, inclusive of background check reviews, with the Contractor as needed.

Exhibit 2

METHOD OF PAYMENT

1. The Contractor will provide service(s) and deliverable(s) for the rate(s) listed in Exhibit 3 and accept any and all forms of payment.

2. Providers will only be paid for services authorized on an approved “Referral for Service.” Verbally discussed rates between the Department staff and the Contractor are not binding. Required deliverable(s) never provided will result in non-payment, reduction of future payment, or demand for reimbursement.

3. Rates outlined in Exhibit 3 constitute payment in full and the Contractor will not be paid for any additional fees, amounts, or costs. The Contractor will not charge the Department rates greater than those charged to other persons in the same geographic area. The Contractor will not be paid more than one time for the same service, or more than the Maximum Contract Liability as outlined in paragraph 3 of this Contract.

4. If the Contractor or client misses an appointment or service, it will not be paid. Monthly rates will be pro-rated depending on when services begin or end in the month.

5. The Contractor will not charge any fees or co-pays for services to clients or use any part of payment made under this Contract as a co-pay or partial payment to any third-party unless otherwise noted in the “Referral for Services” or other Department documentation. When applicable, documentation of a denial of benefits from a third-party provider may be requested by the Department.

6. Invoices submitted must reflect actual services rendered and cannot be estimates or requests for pre-payment. Monthly rates will be pro-rated to accurately reflect when clients begin services and end dates for services in partial months. Partial payment for services rendered without full completion of the service and/or deliverable(s), inclusive of court testimony, may be provided at the Department’s discretion.

7. Invoices must be submitted by the 15th of each month after the month in which service(s) were rendered, except June 2026 is due July 7, 2026. Complete invoices will only use the service names listed in Exhibit 3 and include the required deliverable(s) listed in Exhibit 3. Failure to submit invoices timely or without required deliverables may result in non-payment.

8. The Department does not receive federal or state reimbursement for delinquent claims. Contractors are encouraged to reconcile their accounts every sixty (60) days to ensure all services have been invoiced and paid. Delinquent invoices are subject to non-payment.

9. Invoices and back-up documentation may only be sent via:

a) secure email to CWAccounting@douglas.co.us,

b) posted to the Department’s OneDrive contractor folder, or

c) mailed to:

Douglas County Human Services Attn: Business Office 4400 Castleton Court Castle Rock, CO 80109

The Contractor will email CWAccounting@douglas.co.us when new invoices have been added to OneDrive or existing documents edited in OneDrive.

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EXHIBIT 3

SERVICES, DELIVERABLES AND RATES

Invoices must be submitted by the 15th of each month after the month in which service(s) were rendered. Complete invoices will only use the service names listed in Exhibit 3 and include the required deliverable(s) listed in Exhibit 3. Failure to submit invoices timely or without required deliverables may result in non-payment.

Intake/Assessment - Completed to determine appropriateness of service within 10 days of the service start date. Contractor will notify Department of assessment outcome when done for services to continue.

Treatment Plan - Completed within two (2) weeks of intake/assessment for child(ren) and family treatment objectives and outcomes including target dates from Referral. Plan is subject to Department approval.

Monthly Report - Written reports detailing specific treatment progress toward goals. An example is provided in Attachment A3, but any report must include: 1) Client name, 2) Court case number, if known and applicable, 3) Department Case Worker’s name, 4) Clinician’s/provider’s name, 5) Date(s) of service, 6) Date(s) of missed sessions, 7) All family members receiving services, 8) Level of family participation, if appropriate, 9) Initial service goal(s), 10) Weekly or monthly progress, 11) Concerns or barriers to achieving goals, 12) Ongoing assessment of child safety, 13) Appropriateness and need of ongoing services or therapeutic recommendation, and 14) Therapist’s/clinician’s/provider’s signature.

Discharge Summary - Due within 10 business days following close of service. Report will include documentation of outcome of services, achievement of treatment objectives, and recommendation for family.

Various - Documentation as requested to ensure continued quality improvement, e.g., quarterly outcome reports and utilization reviews.

To be billed in 15-minute increments.

This applies when the Department subpoenas the Contractor (as opposed to client’s counsel, the State, or District Attorney for example). The rate outlined in this Attachment applies if the service is provided to the client regardless of whether the Contactor was paid for the service by Medicaid, CHP+, or other third-party insurance.

Preparation Time: $37.50 per hour, up to the amount of preparation time agreed upon with the County Attorney’s Office upon receipt of the subpoena.

Drive Time: $18.75 per hour.

All time is billable in 15-minute increments.

Preparation Time: $100.00 per hour, up to the amount of preparation time agreed upon with the County Attorney’s Office upon receipt of the subpoena

Drive Time: $50.00 per hour.

All time is billable in 15-minute increments.

EXHIBIT 4

REFERRAL FOR SERVICES

EXHIBIT 5

MONTHLY REPORT EXAMPLE

Provider/ Company Name Provider Address Provider email and phone

Client: Name Therapist: Name Reporting Month: Month Case Worker: Name Sessions Dates: List dates of service Missed Sessions: List dates of missed appointments Level of family participation: indicate if Low Medium High

Initial Goals of Service: Indicate why services were referred and goals of service.

Progress: Yes No Partial

Notes: Give progress update here.

Concerns and Ongoing Service: indicate reason services are either still needed or are closing out. what is left to work on in therapy. Treatment goals etc.

Therapist Recommendations: Therapeutic recommendations to include any recommended changes to referral or frequency of service etc.

Therapist: sign and date

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