HomeMy WebLinkAboutAgenda - 06-08-2004-5rORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 8, 2004
Action Agenda
Item No. 5 - {'
SUBJECT: Contract Renewals with School Systems for Adolescent Parenting Services
DEPARTMENT: Social Services PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Contracts (under separate cover)
INFORMATION CONTACT:
Nancy Coston, 245-2800
Gwen Price, ext 2800
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To continue contracts with each school system to provide specialized services to
pregnant and parenting teens.
BACKGROUND: One of the main goals outlined in the federal welfare reform legislation is to
support teen parents and to avoid additional unplanned pregnancies. Therefore, federal funds
in the Work First Block Grant can be used far this purpose.
The goals of this program are to improve parenting skills, assure that participants complete their
education and delay second pregnancies, The ultimate goals are to help teens prepare to be
self-sufficient and to prevent them from becoming dependent on public assistance. Teen
parents are at high risk for becoming dependent on public assistance, particularly if they drop
out of school, These contracts will be coordinated with the programs at the Department of
Social Services, which have been very effective in helping participants to finish high school and
to delay additional pregnancies. In Fiscal Year 2003-2004, sixteen teen parents were served by
Orange County Schools and twelve were served by the Chapel Hill-Carrboro City Schools.
Because of the services provided under this contract, 11 teen parents will graduate this school
year.
Teen parents have been identified in each school system for services next year and there is
sufficient need to justify a full-time social worker in each system. The contracts are based on a
caseload of 12-18 teen parents far each social worker in each school system, The social
workers will provide individual and group interventions with teens and will try to address issues
that might result in the student dropping out of school. Supportive services (such as housing,
transportation, day care, medical care) may also be arranged by the social workers, The social
workers at the school work with the other school personnel to meet the academic needs of
pregnant or parenting students.
The Social Services Board has reviewed these contracts and recommends approving $44,323
for Orange County Schools and $47,505 for Chapel Hill-Carrboro City Schools for Fiscal Year
2004-2005. The costs for each system are based on the actual salary and related cost of the
person in the school system who will provide these services and varies based on longevity and
other differences. The systems will be reimbursed for actual expenses incurred.
FINANCIAL IMPACT: The $44,323 for Orange County Schools and $47,505 for Chapel Hill-
Carrboro City Schools will be paid with 100% federal funds in the County Work First Black
Grant.
RECOMMENDATION(S): The Manager recommends that the Board accept the Social
Services Board recommendation and approve the contract renewals with the two schools
systems.
Page 1 of 6
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT
This Contract is entered into between the Deparhnent of Social Services and Orazige
County Schools (referred to as Provider) identified on Attaclunent A. This contract shall
consist of form DSS-2497, Attaclunent A (DSS-1292) and Budget (DSS-6844).
The Department will purchase specific services from the Provider as set forth in the
Contract in order to make optimal use of the facilities, staff and programs of the Provider.
This Contract is subject to the provisions of all applicable Federal regulations and State
policies..
Subject to its other provisions, the terms of this contract shall be in effect to and from
the dates specified on Attaclunent A.
SECTION I: RESPONSIBILITIES
A. The Department will:
1. Deternrine client eligibility for service(s) in accordance with Federal and
State regulations; and
2. hxfonn the Provider on Form DSS-1.360 concerning the eligibility of each
individual for the service, the period of time far which services are authorized,
and any changes in the individual's eligibility status; and
3. Reimburse the Provider for service(s) purchased as described in Attachment A
of this Contract for eligible clients; and
4. Keep the Provider informed of any alterations in and/or to the regulations
governing the service program; and
Accept fiscal responsibility for deviations from the terms of this Contract as a
result of acts of the Department or any of its officers, employees, agents or
representatives.
B. The Provider will:
1. Provide service(s) as specified in Attaclunent A of this Contract in accordance
with applicable standards for the service(s); and
2, Furnish information to the Department as required to support the full cost of
service(s) provided pursuant to this Contract; and
Page? of 6
.3. Comply with all State licensing standards, all applicable accrediting standards arrd
any other standards or criteria established by the Division of Social Services to
assure quality of services; and
4. Restrict the use or disclosure of information obtained in connection with the
administration of North Carolina's programs for the provision of services
concerning applicants for and recipients of those services to purpose directly
connected with the administration of the service program; and
Comply with the terms of Section 504 of the Rehabilitation Act bf 197.3 and all
requirements imposed by or pursuant to the regulations of the Department of
Health and Human Services issued pursuant to that Section, which prohibit
discrimination against handicapped persons in employrnent and in the operation
of programs and activities receiving Federal funds; and
6. Comply with Title VI and VII of the Civil Rights Act of 1964 and all requirements
imposed by or pursuant to the regulations of the Department of Health and Human
Services issued pursuant to that Title; and
Accept fiscal responsibility for deviations fiom the terms of this Contract as a
Result of acts of the Provider or any of its officers, employees, agents or
representatives,
SECTION II: RESPONSIBILITY FOR LIABILITIES
Each party hereto agrees to be responsible for its own liabilities and that of its officers,
employees, agents, or representative arising out of this Conhact.
SECTION III: TREATMENT OF ASSETS
Treatment of assets acquired under this Contract shall be subject to the following:
A. Ownership of property purchased by the Provider render the terms of this Contract or
which reimbursement by the Department is based upon the actual purchase cost of the
property shall inmrediately vest with the Department of Human Resources upon such
reimbursement.
B. The North Carolina Department of Human Resources shall have no claim to property
purchased by the Provider under the terms of this Contract for which reimbursement by
the Department is based upon approved depreciation schedule or use allowance.
C. The Provider shall maintain and administer in accordance with sound business practice a
program for the maintenance, repair, protection and preservation of property purchased
under the terms of this Contract to assure its continued availability.
D. Property purchase under the terns of this Contract shall be used only for the performance
of this Contract.
Page .3 of 6
SECTION fV: RECORDS AND REPORTS
A. The Provider agrees to maintain client records which date and document, in accordance
with established policy, the service delivered for the individual, a valid authorization for
service, programs records, documents and other evidence which reflect program
operations.
B, The Provider agrees to furnish information to the Department, as requested, to support
provision of service(s) pursuant to this Contract and the full cost of the service; and
submit changes, as needed or required, in this Contract, Attachment A or approved
supporting information for review and approval by the Department..
C. The Provider agrees to maintain books, records, documents and other evidence and
accounting procedures which reflect all direct and indirect costs expended under this
Contract. A current, complete inventory of all equipment purchased under the terms of
this Contract must be kept.
D. The Provider agrees to retain all books, records and other documents relevant to this
Contract for three years after final payment or until all audits continued beyond this period
are completed. Federal auditors and any persons authorized by the Division of Social
Services or the Department shall have the right to examine any of these materials. In
records produced under this Contract will be turned over to the Department..
SECTION V: SUBCONTRACTING
The Provider shall not subcontract any of the work contemplated under this Contract without
obtaining prior written approval from the Department, Any approved subcontract shall be
subject to all conditions of this Contract, The Provider shall be responsible for the
performazrce of any subcontractor.
SECTION VI: MAINTENANCE OF EFFORT
The Provider certifies that the funds to be used under this Contract do not replace or supplant,
in arty way, Federal, State or local funds for already existing services.
SECTION VII: MONITORING AND EVALUATION
A. The Provider agrees to participate in program, fiscal and administrative monitoring or
audits, making records an staff time available to Federal, State and county staff.
B. The Provider agrees to take necessary steps for corrective action, as negotiated within a
corrective action plan, for any items found to be out of compliance with Federal and State
laws, regulations, standards and/or terms of this Contract.
Page 4 of 6
SECTION VIII: AMENDING THE CONTRACT
This contract in whole or in any part maybe amended at any time:
A. By the Department in the event that such amendment is necessary to comply with
applicable laws, regulations, policies and standards; and by mutual consent ofboth parties.
B, Each party to this contract will notify the other immediately in writing if an amendment
becomes necessary due to alterations in the activities described in Attaclmlent A or for
any other reason.
SECTION IX: TERMINATION
A. This contract, in whole or in any part, maybe canceled at any time:
By any party, with cause, upon at least .30 days notice, in writing, and delivered by
registered mail with return receipt requested or in person, or
2. By the Department in the event reimbursement to the Department is not available
and/or continued at ur aggregate level sufficient to allow for the purchase of the
indicated quantity of service. The obligations of each party shall be terminated to the
extent specified in the notice of termination, immediately upon receipt of the notice of
termination from the Department, or
3. By the Department in the event that the Division of Social Services/Deparfinent
determines that the Provider is in violation of any or all of the terms of this Contract..
The obligations of each party shall be terminated to the extent specified in the notice
of termination immediately upon receipt of the notice from the Department, or
4. By mutual consent of all parties.
B. hr the event of termination in part, all parties shall continue the perfomlance of this
Contract to the extent not terminated.
C. If this Contract is terminated, in whole or in part, the Provider may be required to deliver
and transfer Title or assigmnent of interest to the Division of Social Services or dispose of
any property specifically produced or acquired for the performance of such part of this
Contract as has been terminated, and the Provider shall, upon the direction of the Division
of Social Services, protect and preserve property in the possession of the Provider in
which the Division of Social Services has an interest..
D.. After receipt of a notice of termination, and except as otherwise directed by the
Department, the Provider shall cease work under the Contract on the date, an to the
extent specified, in the notice of termination, The Department shall pay the Provider the
agreed upon amount for the delivery of services under the terms of this Contract up to the
effective date of termination. Reimbursement shall not be made for equipment or supplies
purchased after the notice of termination is received except as approved by the
Department.
Page 5 of 6
E. Waiver of any default shall not be deemed to be a waiver of any subsequent default.
Waiver of breach of any provision of the Contract shall not be deemed to be a waiver of
any other subsequent breach and shall not be constnied to be a modification of the terms
of this Contract unless stated to be such in writing, signed by an authorized representative
of the Department and attached to the Contract.
SECTION X: CONCLUSION
It is expressly understood an agreed that the services provided to eligible clients pursuant to
this Contract shall consist exclusively of those services specified in the attached progam
description incorporated into this Contract as Attaclunent A..
It is further understood and agreed that the provision of services pursuant to this Contract
shall be sul?ject to the limitations and conditions contained in the laws regulations, guidelines
and plans cited in this Contact, and that this Contract is subject to renegotiations or revision to
meet any new or revised rules, regulations, or policies that may be issued by the Department
of Health and Human Services, or the North Carolina Social Services Commission, or the
Department of Human Resources and that are communicated to the Provider.
PROVIDER
Orange County Schools
DEPARTMENT
Orange County Department of Social Services
By:
Title: Superintendent
Date:
By:
Title: Director
Date:
This Agreement has been preaudited in the manner required by the local Govenunent Budget
and Fiscal Control Act.
ATTEST:
Orange County Finance Officer
Sib lature:
Date:
Chair, Orange County Board of County Commissioners
Signature:
Date:
Page (of G
SECTION XI: CERTIFICATON
The Orange County Board of Social Services supports this performance based contract with
the Orange County Schools System to provide expanded case management services to
pregnant and parenting teens.
Dorothy Gamble, Chair
Orange County Board of Social Services
ATTACHMENT A
9
State of North Carolina
Division of Social Services
Contract Application
Page 1 of ~_
L Contract Summary
A. This ab Bement is between the Orange County Department of Social Services (hereinafter
referred to as the "Department") and the Orange County Schools (heretofore and hereinafter
referred to as the "Provider").
B. This agreement shall be in effect from 7/01/04 to 6/.30/05
C. Services to be Provided:
(1)
Service (~)
Service Code (~)
Number of
Persons Served (4)
Number of Units
of Service (5)
Definition of
Unit of Service
Case Management 522 16 16 1 teen parent
Information/
Referral
520
Education/Training 527
Arty additional services should be listed in ITL, -Service Program Descriptimr
D. Area to he Served: Orange County School District
10
State ofNorth Carolina
Division of Social Services
Contract Application
Page 2 of 7
E. Contract Identification:
1. Provider
a. Name of Contract Administrator Dr. Shirley Carraway
Tel. # : (919) 732-8126
b. Name of Program Contact Person: Donna Williams
Tel. #: (9191732-6271
c. Program Name, Location acid Mailing Address: Orange County Schools
x(1(1 F. T<ing_$t
Hillsborough. NC 27378
d, Additional Service Delivery Sites:
e. Status : (X) Public OPrivate, non-profit
( )Private, for Profit ( )Individual
f: Provider Contract ID #:
2. Count~partment of Social Services
a. Nazne of Contract Administrator: Nancy Coston
Tel. # : (919) 732-8181
b. Nance of Services Program Contact Person: Gwen Price
Tel. #: (919) 7.32-8181
c. Address of Count~partment of Social Services:
P.O. B x 1~
300 W..Tryon St.
Hillsborough, NC 27278
11
State of North Carolina
Division of Social Services
Contract Application
Page .3 of 7
II. Fiscal Provisions
A. Amount of Reimbursement:
Reimbursement under the terms of this agreement will be limited to a maximum of
$ 44,322.53 TOTAL = $ SSBG + $ IV-B + $ RAP +
$ State + $ County + $ Other (identify) :TANF Block
Grant
(Optional : County funds consist of $ for
(funding source)
for )
B. Method of Reimbursement:
1. For Purchase Contract (DSS-2497) Total and Unit Cost:
and $
(X) a. Reimbursement will be made in accordance with the current budget approved by
the Department and on file with both parties. The amount ofYeimbursement will be
based on allowable expenditures made in behalf of eligible clients, determined in a
accordance with acceptable cost allocation methods. The Provider will report all
expenditures made under the ternzs of the contract.
O b. Reimbursement will be made at a unit cost rate of $ per unit of
reimbursement delivered to eligible clients for atr estimated number of
units. The Provider will document total expenditures made under the terms of the
contract to the Department within thirty days after the termination of this contract,
or as instnicted by the Department.. Reimbursement which exceeds actual allowable
cost will be adjusted to actual allowable cost.
2, For Vendor Agreements (DSS-2252) Fixed Rate
Reimbursement will be based on:
() a. a standard fixed rate or
O b. an individual Fixed rate.
c, Reimbursement will be made at a fixed rate of $ per unit of
(define) for as estimated number of units,
Reimbursement will be based on the actual number of units delivered whether over
or under the estimated number. If multiple components are being purchased,
additional rates and units can be identified as follows:
12
State of North Carolina
Division of Social Services
Contract Application
Page 4 of 7
C, Reimbursement Reporting:
1. Expenditures
The Provider will report expenditures monthly in accordance with policy set forth by
the Controller's Offices, Division of Social Services, issued via the Fiscal Manual.
Expenditures are to be reported on the DSS Administrative Cost Report (Form DSS-
1571,Part III). Reports are to be submitted to the Depaztrnent by the fifth working
day of the month following the month in which services were delivered, The
Department will reimburse the Provider monthly, usually by check, upon receipt of a
completed and correctly filed report,
2. Reporting for the Statewide Services Information System (SIS)
In addition to the Administrative Cost Report (DSS-1571, Part III), the Provider will
submit to the Department the Monthly Report of Service Delivery (DSS Forn 1571,
Part N). This should be submitted along with the Administrative Cost Report by the
fifth working day of the month following the month in which services were delivered,
The units reported in Colwmi 12 of the 1571 Part N are the units of service defined in
Column 5 of LC. of this Attachment, Service definition and reporting instructions are
found in Family Services Manual, Volume VI, Chapter N.
D, Audit Requirements
The Provider shall be responsible for compliance with the audit requirements of
Department of Health and Human Services federal regulation 45 CFR Part 74,
Administration of Grants, or State Administrative Procedures Manual for Federal Block
Grant Funds, whichever is applicable, These regulations stipulate that an annual audit be
performed for the fiscal yeaz in which contract funds were received.
() 1, Private, non-profit if amount of reimbursement received is under $ 1,000; private,
for profit or individual
O 2, (Applicable to Private, Non-Profit Providers if reimb. $1,000 or over)
An annual audit is to be performed in accordance with OMB Circular A-110 by an
"independent auditor," Independent auditor" means either: (a) a state government
auditor from the Department of Human Resources or the Department of
Adminisri-ation, Office to the State Auditor; or (b) a certified public accountant.
Upon completion of the audit, a copy of the audit report must be forwarded to the
county department of'social services,
13
State of North Carolina
Division of Social Services
Contract Application
Page 5 of
O 3, (Applicable to Public Hospitals, Colleges, and Universities)
The annual audit must be performed in accordance with OMB Circular A-110..
It is not necessary for the institution to program audits performed separately
from an all-inclusive single audit which entails all revenues and expenditures
of the public agency. However, it is the responsibility of the contractor to
insure that the contract program is included in the institution's single annual
audit,
A copy of the audit report must be provided to the County department of
Social Services upon completion of the annual audit.
(X) 4, (Applicable to State or Local Govemm~ent Agencies)
An annual audit is to be performed in accordance with OMB Circular A-128
by
azr independent auditor. Upon completion of the audit, a copy of the audit
report must be forwarded to the county Department of Social Services,
E. Client Fees for Service
(X) 1. No fees will be charged to individuals determined to be eligible for services by
the department of social services.
O 2. The service(s) under contract with the Provider aze services for which a client
fee maybe assessed.. Policy regarding the assessment azxd collection of fees is
contained in Family Services Manual, Volume VI, Chapter III. If a client is to
to be chugged a fee, the department will inform the Provider of the amount of
fee to be charged and of any subsequent changes by way of the Purchase of
Service Referral azid Authorization (DSS Fonn 1.360). The Provider will
establish a plan with the client for collecting the fee on at least a monthly basis;
and when fees are not paid within ten days of the due date, will bill the client
in writing axed send a copy of the bill to the Depaztment. NO OTHER FEES
FOR SERVICES MAY BE CHARGED TO THE CLIENT. Client fees are to
be reported on the Monthly Report of Service Delivery (DSS Fonn 1571, Part
IV),
F, Management of the Funding/Matching Share Requirement
O 1. A cash transfer of the matching shaze will be made to the county
department of social services in accordance with the terms specified in the
Donation Ab Bement (DSS-1319).
t4
State of North Cazolina
Division of Social Services
Contract Application
Page 6 of
O 2, The provider certifies through the contract budget attached to this contract that
the matching share in available. Further, it is agreed that the provider will
report all prograrn costs incurred each month relating to this contract on the
DSS-1571.. However, reimbursement will be limited to the federal/state
financial participation rate.
(X) 3. The county department of social services is providing the match.
G. Provider Fees (For Purchase Contracts Only)
(NA) 1. The Provider agrees to pay the Department/Division up to $
Administrative Fee as payment in full for the administration of the contract.
The amount of the fee is five percent of the matching share contributed by the
Provider.
(NA) 2. The Provider agrees to pay the Department up to $ Certification Fee
as payment in full for the determination and certification of client eligibility.
The amount of the fee is five percent of the matching share contributed by the
Provider..
Monitoring and Certification Fees, when applicable, will be deducted from the
amount to be reimbursed.
State of North Carolina
Division of Social Services
Contract Application
Page 7 of 7
is
III. Service Progranr Description
The contract between Orange County Department of Social Services and Orange County
Schools was a result of a response to a request for proposals. The Welfare Reform Task
Force identified the need for services expurded services to teen parents.
The Intensive Teen Support Project was designed to expand case management services to
pregnant and parenting teens. Research studies support that intervention and preventive
services to teen significantly impact their ability to successfully care for their children and to
be self-sufficient.
The goals of the project are:
• Keep teen parents in school
• Help teens avoid a second pregnancy
• Improve health care for the teen parent and the child
o Assist teens further their education
• Prepare teens for emploannent and self-sufficiency by strengthening the employability
skills of teen parents
• Enhance parenting skills
Orange County Schools will hire afull-time social worker to provide case management
services to eligible teens, serve on the Adolescent Parenting Community Advisory
Committee, coordinate teen supporC group meetings, recruit and train volunteers, complete
required documentation, and submit monthly reports, The social worker will facilitate a
school based support group for teen parents focusing on health, academic, and career planning
issues. In an effort to ensure collaboration within the schools, monthly team meetings to
coordinate health care, education, child care issues and family dynamics will continue.
Reimbursement
Orange County Schools will be reimbursed based for expendihires as outlined in this contract
in the Purchase Contract Budget. Verification of expenditures must be submitted to the
Department of Social Services on a monthly basis and no later than the 5°i of the month
following the month of expenditure, Reimbursement will be processed within 15 days of
receipt,
Performance Measures
e Maintain a caseload of 12-16 teen parents
• Develop a case plan with each teen parent outlining specific goals
s Paz-ticipate in bi-monthly CAC meetings
• Submit a monthly status report by the 2"~ workday of the month
• Recruit, train and match volunteers with teens
• Maintain data on number of teen parents within school system
Outcomes
s 85 percent of teen mothers active in the prob am will avoid a second pregnancy
• 85 percent of teen mothers will continue their education
16
STATE OF NORTH CAROLINA
DNISION OF SOCIAL SERVICES
PURCHASE CONTRACT BUDGET
SUMMARY Effective
Provider Qcwge C'nnnty Crhnnlc ID# period 7/1 /nd flrrough [,/~(1/(15
Part I -Estimated Expenditures
Object of Expenditure Total Non- Matchable Total Matchable
Program Costs Costs Costs
A. Salaries 30,682,89
B. Fringe Benefits 7 549.64
C. Staff Development-Services 1,000.00
D, Travel 1,900..00
E, Equipment Purchase-Tangible
Property
F. Transportation-Recipient
G. Medical Supplies and Expense
H, Cost ofSpace-Non-Residential
I. Room &Board-Residential Treatment
J. Service Payments
I{. Other 2200.00
L„ hrdirect Costs 990,00
M. Totals 44,322.53
Part II -Computation of Unit Cost or Individual Fixed Rate
A. 1, Total Matchable Costs $
2, Less: Earned Income for Unit Cost Method $
3. Net Matchable Costs $
B. 1. Total Service Unit Capacity, or
2. Total Anticipated Utilization Capacity
Method of Computation or Source of Data
D. Estimated Unit Cost or Individual Fixed Rate: $ per
t~
Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method
(a) (b)
A. Estimated Eligible and Matchable Costs Number Ratio
1. Estimated Eligible Clients 16
2, Estimated ineligible Clients
.3, Total Clients
B. Eligible Costs
16
(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible
Costs Earned Matchable Estimated % for Financial
[Part 1, Line M, hrcome Costs of Eligible Participation
col. (.3) [B. (1) Less (2)}] [A. 1. (b)] [B. (3) x (4)]
$ $ $ $ $
A. Program Costs
1. Federal/State Funds
2. Local Matching Share
3. Other Budgeted Funds
4. TOTAL REVENUE
7, Fees (If Applicable)
I. Administrative Fee
2. Certification Fee
3, TOTAL FEES
Amount Source of Funds
$ 44.3?2.53 Work First Program
e
$ 44 322.53
Part V-Reimbursement Projections (For Title XX Providers Only)
Annual Projection July- September
Projection October-.Tune
Projection
A. $ B. $ C. $
Sib ed: Date:
Provider/Authorized Official
Date:
County Director or Designee
Purchase Contract Budget
Supporting Budget Schedules
is
A. Salary Schedule
~l) ~?) ~~3) l4) ~5) ~6) ~7)
Number Pay % of No. of Amrual Total
of Persons Position or Title Crade Time Months Salary Cost
Employed
1 Social Worker 100% 11 .30,682.89 30682.89
Total - Salaries 30,682.89
B. Fringe Benefits
(1) (2) (3)
Total
Type Method of Computation Cost
Social Security 30,682.89 X 7.65 % 2,347.24
Retirement 3Q682.89 X 5,77% 1,770.40
Hospital Insurance .312 X 11 .1,4.32.00
Total -Fringe Benefits 7,549.64
19
C. Staff Development -Service Funds Schedule
(1)
Item (?)
Total
Cost
Conference and training workshops 1000
Total Staff Development -Service Funds 1000
D. Travel Schedule
(1) (2) (3) (4) (5) Dail Subsistence (8)
No. of
Persons
Position or Title No. of
Miles/Days Rate per
Mile No. of
Days (6)
Rate (7)
Days Total
Cost
~ Social Worker 5,206 @.365 mile 1900
Total -Travel 1900.00
E. Equipment -Tangible Property Schedule
(1)
No. of
Units (2)
Item (3)
Cost per Unit (4)
Total Cost
Total Equipment -Tangible Property
?o
F. Recipient Transportation Schedule
Item Method of Computation Total
Cost
la. Salaries
# of
Persons Position or Title Pay
Grade % of
Time # of Months
Employed Aimual
Salary
lb. Fringe Benefits
Type Method of Computation
Total Recipient Transportation
21
G. Medical Supplies and Expenses Schedule
CI)
Item ~?)
Total
Cost
Total -Medical Supplies and Expense
H. Cost ofSpace -Non-Residential Schedule
~l)
Item ~?)
Total
Cost
Total Cost ofSpace -Non-Residential
I. Room and Board Costs -Residential Treatment
Item
Method of Computation Total
Cost
Total Room and Board Costs - Residential Treatment
n
J. Service Payment Schedule
(I)
No. of
Units (?)
Item (~)
Cost per Unit (4)
Total
Total -Service Payment
K. Other Expense Schedule
(I)
Item (?)
Total
Cost
Inshuctional Materials
Compensation Bonus
Social Worker Supplies (Cell phone usage) 1000.00
500,00
700,00
Total -Other Expense ??00.00
L. Indirect Cost Schedule
(I)
Rate (?)
Rate Applied To: (3)
Amount Rate Applied To: (4)
Total
Space 990.00
Total -Indirect Cost 990.00
Page 1 of 6
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT
23
This Contract is entered into between the Department of Social Services and The
Chapel Hill-Canboro Schools (referred to as Provider) identified on Attachment A, This
contract shall consist of form DSS-2497, Attachment A (DSS-1292) and Budget (DSS-6844).
The Department will purchase specif c services from the Provider as set forth in the
Contract in order to make optimal use of the facilities, staff acid programs of the Provider.
This Contract is sullject to the provisions of all applicable Federal regulations and State
policies.
Subject to its other provisions, the terms of this contract shall be in effect to and from
the dates specified on Attachment A,
SECTION I: RESPONSIBILITIES
A. The Department will:
1. Determine client eligibility for service(s) in accordance with Federal and
State regulations; and
2. hrfonn the Provider on Form DSS-1360 concerning the eligibility of each
individual for the service, the period of time for which services are authorized,
and any changes in the individual's eligibility status; and
3, Reimburse the Provider for service(s) purchased as described in Attachment A
of this Contract for eligible clients; and
4. Keep the Provider informed of any alterations in and/or to the regulations
governing the service program; and
Accept fiscal responsibility for deviations from the terms of this Contract as a
result of acts of the Department or any of its officers, employees, agents or
representatives.
B, The Provider will:
1. Provide service(s) as specified in Attachment A of this Contract in accordance
with applicable standards for the service(s); and
2. Furnish information to the Department as required to support the full cost of
service(s) provided pursuant to this Contract; and
34
Page 2 of 6
Comply with all State licensing standards, all applicable accrediting standards and
any other standards or criteria established by the Division of Social Services to
assure quality of services; and
4. Restrict the use or disclosure of information obtained in cormection with the
administration of North Carolina's programs for the provision of services
concerning applicants for and recipients of those services to purpose directly
connected with the administration of the service prograrn; and
5. Comply with the terms of Section 504 of the Rehabilitation Act of 1973 and all
requir°ements imposed by or pursuant to the regulations of the Department of
Health and Human Services issued pursuant to that Section, which prohibit
discrimination against handicapped persons in employment and in the operation
of programs and activities receiving Federal funds; and
6. Comply with Title VI and VII of the Civil Rights Act of 1964 and all requirements
imposed by or pursuant to the regulations of the Department of Health and Human
Services issued pursuant to that Title; and
7. Accept fiscal responsibility for deviations from the terms of this Contract as a
result of acts of the Provider or any of its officers, employees, agents or
representarives.
SECTION II: RESPONSIBILITY FOR LIABILIIIES
Each party hereto agrees to be responsible for its own liabilities and that of its officers,
employees, agents, or representative arising out of this Contract..
SECTION III: TREATMENT OF ASSETS
Treatment of assets acquired under this Contract shall be subject to the following:
A. Ownership of property purchased by the Provider under the terms of this Contract or
which reimbursement by the Deparhnent is based upon the actual purchase cost of the
property shall immediately vest with the Deparhnent of Human Resources upon such
reimbursement.
B. The North Carolina Department of Human Resources shall have no claim to property
purchased by the Provider under the terms of this Contract for which reimbursement by
the Department is based upon approved depreciation schedule or use allowance.
C. The Provider shall maintain and administer in accordance with sound business practice a
program for the maintenance, repair, protection and preservation of property purchased
under the terms of this Contract to assure its continued availability.
D. Property purchase under the terms of this Contract shall be used only for the performance
of this Contract.
25
Page .3 of 6
SECTION N: RECORDS AND REPORTS
A. The Provider agrees to maintain client records which date and document, in accordance
with established policy, the service delivered for the individual, a valid authorization for
service, programs records, documents and other evidence which reflect program
operations.
B. The Provider agrees to furnish information to the Department, as requested, to support
provision of'service(s) pursuant to this Contract and the fiill cost of the service; and
submit changes, as needed or required, in this Conh~act, Attaclunent A or approved
supporting information for review and approval by the Department..
C. The Provider agrees to maintain books, records, documents and other evidence and
accounting procedures which reflect all direct and indirect costs expended under this
Contract. A current, complete inventory of all equipment purchased under the ternis of
this Conhact must be kept.
D. The Provider agrees to retain all books, records and other documents relevant to this
Contract for three years after final payment or until all audits continued beyond this period
are completed. Federal auditors azid any persons authorized by the Division of Social
Services or the Deparhnent shall have the right to examine any of these materials. In
records produced under this Contract will be turned over to the Department.
SECTION V: SUBCONTRACTING
The Provider shall not subcontract any ofthe work contemplated under this Contract without
obtaining prior written approval from the Department. Any approved subcontract shall be
subject to all conditions of this Contract. The Provider shall be responsible for the
performance of any subcontractor.
SECTION VI: MAINTENANCE OF EFFORT
The Provider certifies that the funds to be used under this Contract do not replace or supplant,
in any way, Federal, State or local funds for already existing services...
SECTION VII: MONITORING AND EVALUATION
A. The Provider agrees to participate in prograrn, fiscal and administrative monitoring or
audits, malting records an staff tune available to Federal, State and county staff.
B. The Provider agrees to tape necessary steps for corrective action, as negotiated within a
corrective action plan, for any items found to be out of compliance with Federal and State
laws, regulations, standards and/or terms ofthis Contract,.
26
Page 4 of 6
SECTION VIII: AMENDING THE CONTRACT
This contract in whole or in any part maybe amended at any time:
A, By the Department in the event that such amendment is necessary to comply with
applicable laws, regulations, policies and standards; and by mutual consent ofboth parties.
B. Each party to this contract will notify the other immediately in writing if azr amendment
becomes necessary due to alterations in the activities described in Attaclunent A or for
any other reason.
SECTION UY: TERMINATION
A. This contract, in whole or in any part, maybe canceled at aziy time:
1. By any party, with cause, upon at least .30 days notice, in writing, and delivered by
registered mail with return receipt requested or in person, or
By the Department in the event reimbursement to the Department is not available
and/or continued at an aggregate level sufficient to allow for the purchase of the
indicated quantity of service. The obligations of each party shall be terminated to the
extent specified in the notice of termination, immediately upon receipt of the notice of
termination from the Department, or
3. By the Department in the event that the Division of Social Services/Depaztment
determines that the Provider is in violation of any or all of the terms of this Contract,
The obligations of each party shall be terminated to the extent specified in the notice
of termination immediately upon receipt of the notice from the Department, or
4. By mutual consent of all parties.
B. In the event of termination in par-C, all parties shall continue the performance of this
Contract to the extent not terminated.
C. If this Contract is terminated, in whole or in part, the Provider may be required to deliver
azrd transfer Title or assignment of interest to the Division of Social Services or dispose of
any property specifically produced or acquired for the performance of such pazt of this
Contract as has been terminated, and the Provider shall, upon the direction of the Division
of Social Services, protect and preserve property in the possession of the Provider in
which the Division of Social Services has an interest.
D. After receipt of a notice of termination, and except as otherwise directed by the
Department, the Provider shall cease work under the Contract on the date, an to the
extent specified, in the notice of termination, The Department shall pay the Provider the
agreed upon amount for the delivery of services under the terms of this Contract up to the
effective date of termination. Reimbursement shall not be made for equipment or supplies
purchased after the notice of temlination is received except as approved by the
Department.
?~
Page 5 of 6
E. Waiver of any default shall not be deemed to be a waiver of any subsequent default.
Waiver of breach of any provision of the Contract shall not be deemed to be a waiver of
any other subsequent breach and shall not be construed to be a modification of the terms
of this Contract unless stated to be such in writing, signed by an authorized representative
of the Department and attached to the Contract..
SECTION X: CONCLUSION
It is expressly understood an ab -eed that the services provided to eligible clients pursuant to
this Contract shall consist exclusively of those services specified in the attached program
description incorporated into this Contract as Attaclunent A.
It is further under°stood and agreed that the provision of services pursuant to this Contract
shall be subject to the limitations and conditions contained in the laws. regulations,
guidelines and plans cited in this Contact, and that this Contract is subject to renegotiation or
revision to meet any new or revised rules, regulations, or policies that maybe issued by the
Department of Health and Human Services, or the North Carolina Social Services
Commission, or the Department of Human Resources and that are communicated to the
Provider.
PROVIDER
DEPARTMENT
Chanel Hill - Carrboro City Schools Orazrge County Department of Social Services
Signature: Signature:
Title: Superintendent Title:
Date:
Date:
Director
This Agreement has been preaudited in the manner required by the local Government Budget
and Fiscal Control Act.
ATTEST:
Orange County Finance OfTcer
Signature:
Date:
Chair, Orange County Board of County Commissioners
Signature:
Date:
?g
Page C of 6
SECTION XI: CERTIFICATON
The Orange County Board of Social Services supports the need for this performance-based contract
with the Chapel Hil]/Carrboro City Schools to provide expanded case management services to
pregnant and parenting teens,
Dorothy Gamble, Chair
Orange County Board of Social Services
ATTACHMENT A
State of North Carolina
Division of Social Services
Contract Application
29
Page 1 of _L
I. Contract Sunurrar''y
A, This agreement is between the Orange County Department of Social Services
(hereinafter referred to as the "Department") and the Chapel Hill-Carrboro City Schools
(heretofore and hereinafter referred to as the "Provider").
B. This agreement shall be in effect from
7/1/2004 to 6/.30/2005
C. Services to be Provided:
(1)
Service (2)
Service Code (3)
Number of
Persons Served (4)
Number of Units
of Service (5) -
Definition of
Unit of Service
Case
Management
522
16
16
1 teen parent
Outreach 520 16 16 1 teen parent
Educatior>/Training 527 16 16 lteenparent
Any additional services should be listed in III. -Service Program Description
D. Area to be Served: All Chapel Hill - Carrboro City Schools
State of North Carolina
Division of Social Services
Contract Application
Page 2 of
30
E. Contract Identifcation:
1. Provider
a. Name of Contract Administrator Neil Pederson
Tel. # :967-8211
b. Name of Program Contact Person: Jeff Reilly
Tel. #: 967-8211
c, Program Name, Location and Mailing Address:
750 S. Merritt Mill Rd.
Chanel Hill. NC 27516
d. Additional Service Delivery Sites:
e. Status : (X) Public ()Private, non-profit
( )Private, for Profit ( )Individual
f Provider Contract ID #:
2, County Deparhnent of Social Services
a. Name of Contract Administrator: Nancy Coston
Tel. # : 245-2800
b, Name of Services Program Contact Person:
Gwen Price
Tel. #: 245-2800
c. Address of Count~partment of Social Services:
300 W. Tryon Street
Hillsborough, NC 27278
31
State of North Carolina
Division of Social Services
Contract Application Page 3 of 7
II. Fiscal Provisions
A. Amount of Reimbursement:
Reimbursement under the terms of this agreement will be limited to a maximum of
$ 47,505.00 TOTAL = $ SSBG + $ IV-B + $ RAP +
$ State +$ County + $ Other (identify): TANF Bloclc Grant
(Optional : County funds consist of $ for
(funding source)
for
B. Method of Reimbursement:
1. For Purchase Contract (DSS-2497) Total and Unit Cost:
and$
(X) a. Reimbursement will be made in accordance with the current budget approved by
the Department and on file with both parties. The amount of reimbursement will be
based on allowable expenditures made in behalf of eligible clients, determined in a
accordance with acceptable cost allocation methods. The Provider will report all
expenditures made under the terms of the contract.
O b. Reimbursement will be made at a unit cost rate of $ per unit of
reimbursement delivered to eligible clients for an estimated number of
units. The Provider will document total expenditures made under the terms of the
contract to the Department within thirty days after the termination of this contract,
or as instructed by the Department. Reimbursement which exceeds actual allowable
cost will be adjusted to actual allowable cost.
2. For Vendor Agreements (DSS-2252) Fixed Rate
Reimbursement will be based on:
O a, a standard fixed rate or
O b. an individual fixed rate.
c. Reimbursement will be made at a fixed rate of $ per unit of
(define) for as estimated number of units,
Reimbursement will be based on the actual number of units delivered whether over
or under the estimated number.. If multiple components are being purchased,
additional rates and units can be identified as follows:
32
State of North Carolina
Division of Social Services
Contract Application
Page 4 of 7
C. Reimbursement Reporting:
1. Expenditures
The Provider will report expenditures monthly in accordance with policy set forth by
the Controller's Offices, Division of Social Services, issued via the Fiscal Manual.
Expenditures are to be reported on the DSS Administrative Cost Report (Form DSS-
1571, Part III). Reports are to be submitted to the Department by the fifth working
day of the month following the month in which services were delivered.. The
Department will reimburse the Provider monthly, usually by check, upon receipt of a
completed and correctly filed report.
2. Reporting for the Statewide Services Information System (SIS)
In addition to the Administrative Cost Report (DSS-1571, Pazt III), the Provider will
submit to the Department the Monthly Report of Service Delivery (DSS Fonn 1571,
Part IV). This should be submitted along with the Administrative Cost Report by the
fifth working day of the month following the month in which services were delivered.
The units reported in Column 12 of the 1571 Part N are the units of service defined in
Column 5 of LC. of this Attachment. Service definition and reporting instructions are
found in Family Services Manual, Volume VI, Chapter IV.
D. Audit Requirements
The Provider shall be responsible for compliance with the audit requirements of
Department of Health and Human Services federal regulation 45 CFR Part 74,
Administration of Grants, or State Administrative Procedures Manual for Federal Block
Grant Funds, whichever is applicable. These regulations stipulate that an amoral audit be
performed for the fiscal year in which contract funds were received.
O 1, NA
Private, non-profit if amount of reimbursement received is under $ 1,000; private,
for profit or individual
O 2. (Applicable to Private, Non-Profit Providers if reimbursement $1,000 or over)
An annual audit is to be performed in accordance with OMB Circular A-110 by an
"independent auditor." hndependent auditor" means either: (a) a state government
auditor from the Depaztment ofHuman Resources or the Department of
Administration, Office to the State Auditor; or (b) a certified public accountant.
Upon completion of the audit, a copy of the audit report must be forwarded to the
county depaztment of social services,.
3.3
State ofNorth Carolina
Division of Social Services
Contract Application
Page 5 of 7
O 3. (Applicable to Public Hospitals, Colleges, and Universities)
The anrrual audit must be performed in accordance with OMB Circular A-110.
It is not necessary for the institution to prob am audits perfomred separately
from an all-inclusive single audit which entails all revenues and expenditures
of the public agency. However, it is the responsibility of the contractor to
insure that the contract prod 'am is included in the institution's single annual
audit.
A copy of the audit report must be provided to the County depamnent of
Social Services upon completion of the annual audit.
(X) 4. (Applicable to State or Local Goverunent Agencies)
An annual audit is to be performed in accordance with OMB Circular A-128
by
an independent auditor., Upon completion of the audit, a copy of the audit
report must be forwarded to the county Department of Social Services.
E. Client Fees for Service
(X) 1. No fees will be charged to individuals determined to be eligible for services by
the department of social services.
O Z. The service(s) under contract with the Provider are services for which a client
fee maybe assessed. Policy regarding the assessment and collection of fees is
contained in Family Services Manual, Volume VI, Chapter III. If a client is to
to be chugged a fee, the department will inforn the Provider of the amount of
fee to be charged and of any subsequent changes by way of the Purchase of
Service Referral and Authorization (DSS Form 1.360), The Provider will
establish a plan with the client for collecting the fee on at least a monthly basis;
and when fees are not paid within ten days of the due date, will bill the client
in writing and send a copy of the bill to the Department. NO OTHER FEES
FOR SERVICES MAY BE CHARGED TO THE CLIENT. Client fees are to
be reported on the Monthly Report of Service Delivery (DSS Form 1571, Part
IV ),
F. Management of the Funding/Matching Share Requirement
O 1. A cash transfer of the matching share will be made to the county department
of social services in accordance with the terms specified in the Donation
Agreement (DSS-1.319).
34
State of North Carolina
Division of Social Services
Contract Application
Page 6 of 7
O ?. The provider certifies through the contract budget attached to flris contract that
the matching share in available. Further, it is agreed that the provider will
report all program costs incurred each month relating to this contract on the
DSS-1571. However, reimbursement will be limited to the federal/state
financial participation rate.
(X) 3. The county department of social services is providing the match,
G. Provider Fees (For Purchase Contracts Only)
(NA) 1, The Provider agz-ees to pay the Depaxtment/Division up to $
Administrative Fee as payment in full for the administration of the contract.
The amount of the fee is five percent of the matching share contributed by the
Provider,
(NA) 2. The Provider agrees to pay the Department up to $ Certification Fee
as payment in full for the deterniination and certification of client eligibility.
The amount of the fee is five percent of the matching share contributed by the
Provider.
Monitoring and Certification Fees, when applicable, will be deducted from the
amount to be reimbursed,
State of North Carolina
Division of Social Services
Contract Application
Page 7 of 7
35
III. Service Pro~m~am Description
The contract between Orange County Department of Social Services and Chapel Hill-
Carrboro Schools was a result of a response to a request for proposals. The Welfare Reform
Task Force identified the need for expanded services to teen parents.
The Intensive Teen Support Project was designed to expand case management services to
preb cant and parenting teens. Research studies support that intervention and preventive
services to teen significantly impact their ability to successfully care for their children and to
be self-sufficient..
The goals of the project are:
0 Keep teen parents in school
• Help teens avoid a second pregnancy
• Improve health care for the teen parent and the child
• Assist teens further their education
• Prepare teens for employment and self-sufficiency by strengthening the employability
skills of teen parents
• Enhance pazenting skills
Chapel Hill-Carrboro City Schools will hire a ful]-time social worker to provide case management
services to eligible teens, serve on the Adolescent Parenting Community Advisory Committee,
coordinate teen support group meetings, recruit and train volunteers, complete required
documentation, and submit monthly reports. The social worker will facilitate a school based support
group for teen parents focusing on health, academic, and career planning issues. In an effort to ensure
collaboration within the schools, monthly team meetings to coordinate health care, education, child
care issues and family dynamics will continue.
Reimbursement
Chapel Hill-Carrboro City Schools will be reimbursed based for expenditures as outlined in
this contract in the Purchase Contract Budget. Verification of expenditures must be submitted
to the Department of Social Services on a monthly basis and no later than the 5"' of the month
following the month of expenditure. Reimbursement will be processed within I S days of
receipt.
Performance Measures
• Maintain a caseload of 12-16 teen parents
o Develop a case plan with each teen parent outlining specific goals
s Participate in bimonthly CAC meetings
• Submit a monthly status report by the 2"`` workday of the month
• Recruit, train and match volunteers with teens
s Maintain data on number of teen parents within school system
o Coordinate teen peer group meetings
Outcomes
• 85 percent of teen mothers active in the program will avoid a second pregnancy
• 85 percent of teen mothers will continue their education
36
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT BUDGET
SUMMARY Effective
Provider Chapel Hill-Carrboro City Schools ID# 68E20 Period 7/1/04 through 6/30/05
Part I -Estimated Expenditures ',
Object of Expenditure Total Non- Matchable Total
Program Costs Costs Matchable
(I) (2) Costs (3)
A, Salaries $38,976.00
B. Fringe Benefits 7,951,00
C. Staff Development-Services 140.00
D. Travel 4.38.00
E. Equipment Purchase-Tangible
Property
F. Transportation-Recipient
G. Medical Supplies azid Expense
H, Cost of Space-Non-Residential
I. Room &Board-Residential
Treatment
.L Service Payments
IC, Other
L. Indirect Costs
M. Totals $47,505.00
Part II -Computation of Unit Cost or Individual Fixed Rate
A. L Total Matchable Costs $
2. Less: Earned hicome for Unit Cost Method $
i. Net Matchable Costs $
B. 1. Total Service Unit Capacity, or
2. Total Anticipated Utilization Capacity
Method of Computation or Source of Data
D. Estimated Unit Cost or Individual Fixed Rate: $ per'
Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method
37
Estimated Eligible and Matchable Costs Number Ratio
1. Estimated Eligible Clients 16
2. Estimated ineligible Clients 0
3. Total Clients
B. Eligible Costs
16
(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible
Costs Earned Matchable Estimated % for Financial
[Part I, Line M, Income Costs ofBligible Participation
col. (3) [B. (1) Less (2)}] [A. L (b)] [B. (3) x (4)]
$ $ $ $ $
A. Program Costs Amount Source of Funds
1. Federal/State Funds $ 47,505.00 TANF Block Grant
2. Local Matching Share $
.3, Other Budgeted Funds $
4. TOTAL REVENUE $ 47 505.00
B. Fees (If Applicable)
L Administrative Fee $ 0
Z. Certification Fee $ 0
3. TOTAL, FEES $ ~
Part V-Reimbursement Projections (For Title XX Providers Only)
Annual Projection .Tiny- September
Projection October-.Tune
Projection
A. $ B. $ C. $
Signed: Date:
Provider/Authorized Official
Date:
County Director or Designee
38
Purchase Contract Budget
Supporting Budget Schedules
A. Salary Schedule
~1) (?) ~3) (4) ~5) ~6) ~7)
Number Pay % of No, of Annual Total
of Persons Position or Title Grade Time Months Salary Cost
Employed
1 Adolescent Parenting Prob "am G-1 100 10 $38,976 $38,976
Social Worker
Total - Salaries $ 38,976
B. Fringe Benefits
Total
Type Method of Computation Cost
Social Security $.38,976 X 7.65% 2,982
Retirement $38,976 X .3.42% 1,.3.3.3
Hospital Insurance $30.3 X 12 months 3,6.36
Total -Fringe Benefits $7,951
39
C. Staff Development -Service Funds Schedule
(1)
Item (~)
Total
Cost
Attend workshops 140
Total Staff Development -Service Funds $140
D. Travel Schedule
(1) (2) (.3) (4) (5) Dail Subsistence (8)
No. of
Persons
Position or Title No. of
Miles/Days Rate per
Mile No, of
Days (6)
Rate (7)
Days Total
Cost
t Social Worker 1200 .365 438
Total -Travel 438
E. Equipment -Tangible Property Schedule
(1)
No, of
Units (2)
Item (3)
Cost per Unit (4)
Total Cost
Total Equipment -Tangible Property
40
F. Recipient Transportation Schedule
Item Method of Computation Total
Cost
1a. Salai°ies
# of
Persons Position or Title Pay
Crade % of
Time # of Months
Employed Annual
Salary
lb. Fringe Benefits
Type Method of Computation
Total Recipient Transportation
4t
G. Medical Supplies and Expenses Schedule
~l)
Item ~2)
Total
Cost
Total -Medical Supplies and Expense
H. Cost ofSpace -Non-Residential Schedule
~1)
Item ~~)
Total
Cost
Total Cost ofSpace -Non-Residential
I. Room and Board Costs -Residential Treatment
Item
Method of Computation Total
Cost
Total Room and Board Costs - Residential Treatment
42
J. Service Payment Schedule
(1)
No. of
Units (~)
Item (3)
Cost per Unit (4)
Total
Total -Service Payment
K. Other Expense Schedule
(1)
Item (~)
Total
Cost
Total -Other Expense
L. hidirect Cost Schedule
(1)
Rate (2)
Rate Applied To: (3)
Amount Rate Applied To: (4)
Total
Total - hidirect Cost