DDC DEVELOPMENTAL DISABILITIES CENTER
PCA HOST HOME HOME PROVIDER AGREEMENT
This is an Agreement entered into between DEVELOPMENTAL DISABILITIES CENTER ("DDC"), whose address is 1400
Dixon Avenue, Lafayette, Colorado 80026 and , Tax Identification Number: , as an independent contractor, whose
address is , Colorado, referred to herein as "Provider".
This Agreement shall be effective from and continue in force until , unless terminated earlier in accordance with the
terms of this Agreement.
a. DDC is a private, not for profit agency, duly incorporated and existing under the corporate laws of the State of
Colorado, providing services to developmentally disabled individuals and is funded in part by the Colorado
Department of Institutions. The DDC contracts with the State of Colorado and serves as a placement agency
with respect to meeting the requirements of Internal Revenue Code Section 131 concerning placement of
qualified foster care individuals in a foster family home.
b. DDC, on the behalf of the developmentally disabled individual(s) named in Attachment A, is in need of PCA
Host Home services from Provider as set forth in DDC’s Community Living Contract Provider Procedures.
c. Provider desires to perform PCA Host Home services as set forth herein, on behalf of DDC, for the individuals
named in Attachment A. These services will be provided in at Colorado. Such developmentally
disabled individual(s) shall be referred to herein as "Consumer(s)".
d. Provider possesses the independent degree of skills necessary to perform the services called for in this
e. The parties are desirous of entering into an Agreement wherein Provider will provide the services to DDC
called for in this Agreement as an independent contractor, free from direct supervision and control of DDC. It
is understood that DDC will not direct Provider in the manner in which Provider performs Provider's
contractual duties pursuant to this Agreement. It is further understood that DDC is interested in the results
obtained and not in the manner of performance, except as specifically set forth herein.
IN CONSIDERATION OF the mutual promises, benefits and detriments set forth in the recitals or in the body of this Agreement,
the parties agree as follows:
1. INDEPENDENT CONTRACTOR
a. This Agreement calls for the performance of services by the Provider as an Independent Contractor, and
Provider will not be considered an employee of DDC for any purpose. No agent, employee, or servant of
Contractor shall be, or shall be deemed to be, an agent, employee, or servant of the DDC. Provider is not
entitled to the benefits provided by DDC to it's employees, including, but not limited to, medical insurance,
workmen’s compensation insurance, life insurance or personal leave time. Neither federal, nor state, nor local
income tax nor payroll tax of any kind shall be withheld or paid by DDC on behalf of Provider or any
employee of Provider. PROVIDER WILL BE SOLELY RESPONSIBLE FOR PAYING ANY FEDERAL
OR STATE TAXES DUE ON MONEYS EARNED PURSUANT TO THIS AGREEMENT. Provider shall
not be treated as an employee with respect to the services performed hereunder for federal or state tax
b. IN FURTHERANCE OF THE ABOVE SUBPARAGRAPH, THE FOLLOWING DISCLOSURE IS SET
FORTH, AS PROVIDED FOR BY SECTION 8-70-115 COLORADO REVISED STATUTES: THE
PROVIDER IS NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS
UNEMPLOYMENT COMPENSATION IS DIRECTLY PROVIDED BY THE PROVIDER OR SOME
OTHER ENTITY (OTHER THAN DDC) FOR THE BENEFIT OF PROVIDER. PROVIDER IS
OBLIGATED TO PAY FEDERAL AND STATE INCOME TAX ON ANY MONIES PAID PURSUANT
TO THIS AGREEMENT.
c. Further, there is no requirement pursuant to this agreement that Provider: (1) perform work exclusively for
DDC, Provider being free to carry on such other employment, and to enter into such other independent
relationships, as Provider may desire, and (2) receive training from DDC necessary to perform Provider's
obligations under this agreement, Provider being free to independently obtain any continuing education or
training necessary, in Provider's judgment, for Provider to provide the services called for in this agreement,
except as specified in Community Living Contract Provider Procedures. Provider shall, however, comply with
all State of Colorado rules and regulations and all of DDC's rules, regulations and requirements outlining
training requirements for Provider. Payments hereunder shall be made payable to the trade or business name
under which Provider operates, which may, at the direction of Provider, be simply the name of Provider
d. It is understood by and between the parties that Provider's business of supplying services to DDC pursuant to
this agreement shall remain separate and distinct from the operations of DDC for any purpose, and Provider
shall not be construed to be a partner or agent of DDC for any purpose.
2. Duties of DDC and Provider.
a. Provider shall provide a PCA Host Home residence for Consumer(s) specified in Exhibit A.
b. The specific duties to be performed pursuant to this agreement are set forth in the DDC Community Living
Contract Provider Procedures. The Individual Plan and support documents are an integral part of the service
provision under this contract. Failure to follow the contract for services established in the Individual Plan
constitutes a breach of this Agreement.
c. The provided services shall meet all requirements as set forth in DDC's Policies and Procedures, the Code of
Colorado Regulations (2CCR 503-1), the Rules and Regulations for Developmental Disabilities, and HUD
Section 8 Housing Quality Standards and will include participation in periodic home inspections and records
reviews as requested. Audits of consumer(s) personal funds will be conducted four times per year in
accordance with DDC policy and Medicaid regulations.
d. Provider cannot change Provider's residential address without giving DDC at least 30 days prior notice and all
housing requirements, as stated in and below, must be met.
3. Changes in Provider's PCA Host Home Status.
The Provider's Contract Host Home occupants consists of adults and children. If Provider's PCA Host
Home occupant status changes (i.e. additional Host Home members, less Host Home members, or guests over 14 days)
DDC must be notified within 10 days and consumer(s)'s ID Team will decide if this placement still meets the contract
consumer(s)'s needs and choices.
4. Terms of Payment.
a. The Provider shall be paid $ per month by DDC for services delivered in accordance with this
Agreement for services provided to consumer(s) listed in Exhibit A. Extended absences from the home by the
consumer(s) may result in monthly rates being reduced.
b. Provider agrees to submit itemized reports as specified in DDC Community Living Contract Provider
Procedures to DDC's Administration office on the first business day of each month, by 12:00 noon, in the
format specified by the DDC.
c. Provider shall receive no payments from DDC other than as expressly set forth herein.
d. Whether Provider makes a profit pursuant to this agreement turns entirely upon Provider's own initiative,
including the amount of Provider's investment in facilities, equipment or other assets necessary to perform
pursuant to this agreement, and the initiative, skill, judgment and actual hours worked by Provider at any given
e. Payment pursuant to this contract is contingent upon the Provider securing and properly maintaining all
necessary provider numbers, licenses, certification, approvals, etc., required to properly provide the services or
goods covered by the contract. Provider agrees that services provided on dates not covered by Medicaid
certification for such services issued by the Colorado Department of Human Services are not reimbursable
under this contract.
f. Provider understands that payment for services may be withheld until requested documentation of services
performed is received.
a. The parties agree that DDC will evaluate Provider's performance pursuant to this agreement as part of the
responsibility of DDC to its Consumer(s) on an ongoing basis. Using Provider's own skill, and employing such
procedures as Provider may desire to employ, Provider shall perform all duties and meet all performance
standards set forth in this agreement. Provider will also participate in the DDC’s Quality Assurance
b. The DDC will have access to the Provider’s facilities at any reasonable time during the term of this contract to
observe the operation of this program carried on by the Provider and perform inspections required by DDS and
a. Termination due to loss of revenue. Payment pursuant to this Agreement is contingent upon the continuing
availability of State and/or Federal funds for the purposes hereof. In the event that said funds, or any part
thereof, become unavailable as determined by the DDC, the DDC may immediately terminate this Agreement
or amend it accordingly.
b. Termination due to consumer move. Payment pursuant to this Agreement is contingent upon the continuing
desire of the consumer (or the consumer’s legal guardian) to reside with the Provider. In the event that a
consumer residing with the Provider chooses a different residential living environment as determined by the
DDC, the DDC may immediately terminate this Agreement or amend it accordingly.
c. Termination upon Provider's Inability to Fulfill Agreement.
(1). This Agreement will terminate upon the death of the Provider.
(2). This Agreement will terminate if the Provider, for any reason, fails or is unable to personally fulfill
his/her responsibilities and obligations under this Agreement.
d. Termination for Convenience by Either Party. This Agreement may be terminated by either party upon written
notice without cause, and neither party need give any reasons for such termination.
e. Termination with Cause. If DDC determines, in its sole discretion that the Provider
(1) has violated any consumer rights, including a consumer's right to be free from abuse or neglect,
(2) has not provided a safe living environment,
(3) has engaged in any behavior which threatened, or threatens the health and safety of the consumer(s); or
(4) becomes involved in drug use or alcohol abuse, is experiencing discord in the marital or family unit, or
becomes involved with law enforcement in any negative way, or engages in any behavior which, in the sole
judgment of the DDC, creates an inappropriate living environment for the consumer(s), DDC may immediately
remove the consumer(s), terminate this Agreement, and cease funding, all without prior notice.
e. Return of Property on Termination. Upon termination, the Provider agrees to return to consumer(s) all
consumer(s)'s personal property and to DDC all of DDC's property; and consumer(s) and/or DDC agree to
return all personal property owned by Provider to Provider.
f. Final Payment Due. In the event of any termination of this Agreement, DDC shall be liable for all payment due
Provider through the date of termination less any amounts outstanding to the DDC.
7. Workers Compensation and Liability Insurance.
a. Workers Compensation. AS AN INDEPENDENT CONTRACTOR, PROVIDER IS NOT ENTITLED TO
WORKER'S COMPENSATION BENEFITS UNDER THIS AGREEMENT. IF PROVIDER CLAIMS TO
BE EXEMPT FROM WORKERS COMPENSATION INSURANCE COVERAGE BY VIRTUE OF
MEETING PROVISIONS OF CRS 8-48-414 (2.5) PROVIDER MUST SIGN A DECLARATION TO THAT
b. General Liability Insurance. During the term of this Agreement Provider will keep in force a policy or policies
of comprehensive general liability insurance, issued by a company authorized to do business in Colorado in an
amount no less than $500,000.00 combined single limit for total injuries or damages arising from any one
incident (for bodily injuries or damages). Provider shall provide DDC with a Certificate of Insurance as
evidence that such insurance is in effect within 15 days of the inception of this Agreement.
c. Auto Liability Insurance. During the term of this Agreement Provider will keep in force an automobile
Liability\ insurance policy in an amount no less than $300,000 per incident/$100,000 per person. Provider
shall provide DDC with proof of insurance within 15 days of the inception of this Agreement.
8. No Authority to Enter Into Contracts. Provider has no authority to enter into contracts or agreements on behalf of DDC
or consumer(s). This includes but is not limited to therapies, nutritional supplements, and repairs.
9. Indemnification. To the extent authorized by law, Provider shall indemnify, save, and hold harmless the DDC, the State
of Colorado, the Department of Institutions, the Division for Developmental Disabilities, their employees, officers,
agents and assignees from and against any and all claims, damages, liability, and court awards including costs, expenses
and attorney fees incurred as a result of any act or omission by the contractor, or its employees, agents, subcontractors,
or assignees pursuant to the terms of this Agreement.
10. Personal Services. DDC having relied on the independent and personal judgment and skills Provider brings to this
contractual relationship, the work and services provided for herein shall be performed by Provider personally. In those
instances where it is not possible for Provider to personally provide the services for any short period of time, no person
other than regular primary associates, employees or agents of Provider shall be engaged in performance of Provider's
duties pursuant to this Agreement. Any associate, employee, or agent of the Provider that does perform services to
Provider in need of Provider's contractual duties under this contract shall meet the same training and other requirements
that the Provider does, including Medication Administration if applicable. Concerning any associates, employees or
agents of Provider that may become engaged in the performance of Provider's duties and services pursuant to this
agreement, Provider as an independent contractor, shall be solely responsible for the amount of hours worked and
overtime paid, medical insurance benefits, compliance with federal and state income tax withholding requirements, and
the compensation of any such associates, employees or agents of Provider.
11. Confidentiality. Provider acknowledges that in the performance of Provider's duties under this Agreement Provider will
or may come to know information that is treated by DDC as confidential information. Provider agrees not to reveal any
such confidential information to any person or entity, at any time, without the express written consent of DDC and or
Consumer or Consumer's guardian if applicable. Provider shall observe and comply with all applicable Colorado rules
and regulations and DDC's policies and procedures regarding confidentiality.
12. Notices. Any notices required to be given pursuant to this Agreement, or which may be given pursuant to this
Agreement, shall be in writing, and sent by first class mail or delivered to the party to which notice is being given, to the
addresses set forth at the end of this Agreement.
13. Saving Clause. The invalidity or unenforceability of any particular provision of this Agreement shall not effect the other
provisions hereof, and the Agreement shall be construed in all respects as though such invalid or unenforceable
provisions were omitted.
14. Law to Apply. This Agreement shall be interpreted in accordance with the laws of the State of Colorado.
15. Entire Agreement. This instrument constitutes the entire agreement between the parties, and may be changed only by an
agreement in writing signed by the parties.
16. Non-Assignability. Neither this Agreement nor any rights or obligations hereunder, are assignable by either party,
without the prior written consent of the other party, which consent may be withheld with or without cause, and no reason
need be given for refusal to consent.
17. Binding Effect. This Agreement shall inure to the benefit of, and be binding upon, the parties, and their respective legal
representatives, successors and assigns; provided, however, that nothing in this paragraph shall be construed to permit
the assignment of this Agreement except as otherwise specifically authorized herein.
18. Effect of Waiver. The waiver by any party to this Agreement of a breach of any term or provision of this Agreement
shall not operate or be construed as a waiver of any subsequent breach by any party.
19. Additional Assurances. The parties agree to execute any additional documents and to take any additional action
necessary to carry out this Agreement.
DEVELOPMENTAL DISABILITIES CENTER
John M. Taylor, Executive Director
PCA HOST HOME PROVIDER AGREEMENT
The Developmental Disabilities Center, on the behalf of the developmentally disabled individuals named herein, agrees to pay
the following amounts for Contract Host Home services from Provider as set forth in DDC’s Community Living Contract
NAME MEDICAID ID CONSUMER CONTRACT
Provider will bring Consumer’s financial records to the DDC Business Office and complete a successful
audit of those records every month. The words “exempt” indicates the consumer’s records are exempt from
audit. Provider’s contract payment will be held until audit requirements are met.
TOTAL MONTHLY CONTRACT PAYMENT:
FOR CONTRACT PERIOD .