HomeMy WebLinkAboutSawtooth Rehab*.'Idaho Falls
School District 91
A World Class Education
690 fohn Adams Parkway ldaho Falls, Idaho 83401
Phone: [208) 525-7500 FAX: (208J 525-7596
Web Address: www.d91.k 12. id.us
IDAHO FALLS SCHOOL DISTRICT 91
System of Care Protocol for Independent Contractors
I. Protocol for Inde ne ndent Contractors Providin
PHYSICAL THERAPIST:
The purpose of the System of Care is to establish a procedural protocol to assist the Idaho
Falls School District 9l in collaborating with lndependent Contractors for the delivery of
related services provided by in accordance with the following:
l. Eligible students' Individual Education Ptans (IEP) developed pursuant to Idaho
Special Education Manual 2018, and
2. The Medicaid Billing Poticy lbr Physical Therapy and Evaluation in a school
setting (IDAPA 16.03.09).
Proof of workers' compensation coverage
Current Certificate of Liability Insurance
A current Criminal Background Check
Evidence ofqualifications to perform Physical Therapy Services
The school will be the lead agency for any student enrolled while that student is in school.
Before the Independent Contractor may work with the student, a Contractual Agreement
must be completed with the Contractor and Director ofStudent Services.
Idaho Falls School District must follow the privacy provisions set forth by FERPA, HIPPA,
and Idaho Speciat Education Manual 2018. The Idaho Falls School District will need
written authorization lrom the parent/guardian prior to sharing information with
Independent Contractors.
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IContractor: Sawtooth Rehab/Eric Roberts
Student: Assigned PT Students
Date: May 24.2022
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This protocol provides guidelines for the Idaho Falls School District 9l and independenl
contractors to implement Physical Therapy (PT) services that are delivered to eligible
students with an Individual Educational Plan (lEP) on file in the school district. In order
to provide PT services. the independent contractor must be approved through the Director
of Student Services' oftice and provide the fbllowing documentation:
I I. Oven'iew for Indep endent Contractors Working with Students
Independent Contractor means a person, group, agency, or organization that
meets the lollowing two conditions:
a. Is not an employee of Idaho Falls School District 9l or a public agency with
legal jurisdiction over the circumstances related 1o their involvement with
the student, and
b. Is paid or reimbursed for services provided to the student through the
established bitling policy
Independent Contractor may do the lollowing in Idaho Falls School District 91:
Submit evaluation repo rts to a school's Evaluation teams for consideration
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a
related to an evaluation being conducted.
b. Be invited to an evaluation team meeting by either the school or parent.
i. The determination of eligibility for special education and the
provision of a Free Appropriate Public Education (FAPE) are the
responsibility of the IEP teams and cannot be prescribed by any
other entity.
ii. All educational decisions regarding educational methodology,
materials. and personnel are the responsibility ofthe school district.
Provide services in the schools to students under the terms ola contract with
the school district. (See Independent Contractors Agreement)
i. Contracts are established when the school district is paying for the
services and describes the services, the role and responsibilities of
the Independent Contractor with the evaluation team and school
administration, and the frequency and duration ofservices; includes
documentation of licensure/certification to pertbrm the prescribed
services; addresses issues related to liability, terms olpayment; and
states the provisions for changes or termination of the contract.
(Example: District contracts for physical therapy services)
ii. Contracted services to a student with a disability shall be included
on the students [EP.
d. Provide services to students on school grounds under the terms of Summary
of Services with the school district. (See Summary of Services Form)
i. Summary ol Services is established to allow the services to take
place on school property to benefit the student's progress in the
general education curriculum. The Summary of Services shall
describe the specilic services provided, the responsibilities of the
school and independent contractor, procedures for background
checks and insurance, and the provisions for space, time, equipment,
and materials provided by the school district. The school district
may terminate the Summary of Services at any time.ii. Services provided under a Summary of Services to a student with a
disability shall be included on the student's Individual Education
Plan (lEP).
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2Contractor: Sa$tooth Rehab/Lric Rohcrts
Student: Assigned P'I Students
Date: May 2,1. 2022
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The district has no obligation to enter into a contract with an independent
contractor or to allow an independent contractor access to school district
property, space, materials, or equipment.
School district records are only accessible to Independent Contractor under
contract with the school district and with written consent from the student's
parent or guardian, or the adult student (18 years old or older). Request for
records may be subject to a fbe to cover costs olcopying and mailing.
Nothing in this System of Care protocol shall be construed to limit or impinge
in any way on services parents may acquire fbr their child that are not provided
at the school. Issues related to the amount oitime students are removed from
schooI for any purpose fall under the terms ofother school district policies.
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,Contractor: SaMooth Rehab/Eric Robetu
Student: Assign€d PT Students
Date : May 24- 2022
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Idaho Falls School District 9l
INDEPENDENT CONTRACTOR CONTRACTAL AGREEMENT:
This Contractual Agreement is entered into between Idaho Falls School District 9l (hereinafter
referred to as "District") and SaMooth Rehab Physical Therapy (hereinafter referred to as
"Contractor").
Whereas, the District provides special educational and related services to assist students attending
school in the District in their educational development, as identified on the students' individualized
education program (lEP) plan; and
Whereas, the Contractor is duly Iicensed or qualified and able to provide related services to the
District's students:
tt is hereby agreed by both panies that
DURATION OF AGREEMENT:
The period ofthis Contractual Agreement will commence on August 23,2022 and remain in effect
until th€ last day ofschool May 23,2023. This Contractual Agreement is contingent upon the
availability offunds ofthe District. This Contractual Agreement shall not exceed twelve (12) calendar
months. At the discretion ofthe District, the Contractual Agreement may be renewed annually.
RELATIONSHIP OF PARTIES:
In performing services under this Contractual Agreement, Contractor is and shall at all times be an
independent contractor ofthe District. Nothing herein is to be construed as establishing an employer-
employee relationship.
SERVICES TO BE RENDERED:
Provider shall render the professional services enumerated on Summary of Services, attached hereto
and made a part ofthis Contractual Agreement as set forth fully herein.
RECORD KEEPING:
Conractor shall be responsible for maintaining complete and accurate records documenting the
professional services provided pursuant to this Contractual Agreement and shall provide copies ofthe
records to the District within five (5) working days ofthe date requested. Additionally, upon
reasonable notice, the District shall have the right to review such records at any time during business
hours. Appropriate Medicaid billing sheets will be completed each month for the student(s) served.
CONFI DENTIALITY:
Provider agrees that all information regarding services provided pursuant to this Contractual
Agreement, including, but not limited to, the students' identity and the nature ofservices rendered,
shall be confidential pursuant to the Family Educational Records and Privacy Act (FERPA).
Contractor is prohibited fiom disclosing any information obtained as a result ofrendering services
pursuant to this contractual Agreement to any individual not authorized and directed by the District,
without parent/guardian consent or consent of the student if l8 years of age or older.
REPORTING OF ABUSE, ABANDONMENT, OR NEGLECT:
Contractor acknowledges its obligation to comply with Idaho Code Section l6-1601, et seq. and report,
\ryithin 24 hours, any suspected abuse, abandonment, or neglect ofa child to the Ia\ry enforcement
agency or Idaho Department of Health and Welfare. Contractor also agrees to inform the District,
within 24 hours, ofsuch suspicion.
Contractor: Sawtooth Rehab/Eric Roberts
Student: Assigned P l Students 1Date: May 24.2022
Phvsical Theranv (PT) Services
SERVICE DELIVERY: TIME AND PLACE:
Contractor shall perform services set fonh in Summary of Services, unless the panies mutually agree
to a modification ofthe time and place ofservice delivery.
COORDINATION OF SERVICES:
To facilitate delivery ofservices, the District will provide: l) reasonable and prompt notification of
meetings and other appointments in which the Contractor is expected to panicipate; 2) signed parental
consent forms, as necessary; 3) identirying information regarding the client and the parenVguardian;
and,4) reasonable assistance in facilitating communication between the Contractor and clients,
parents/guardian, and other providers and agencies.
PRIOR APPROVAL OF SERVICES:
All services rendered by Contractor under the terms ofthis Contractual Agreement shall require prior
approval by the District in accordance with federal and state laws and regulations, local policies and
procedures, and professional codes of conduct.
CONSENT/AUTHORIZATION TO ACCESS EDUCATIONAL RECORD INFORMATION
OR PROTECTED HEALTH INFORMATION:
District and Contactor shall at all times require the written consent or authorization ofthe
parenrguardiar/or adult student, if age of l8 years of age or older, for the disclosure of access to
educational information pursuant to FERPA or protected health information pursuant to the Health
Information Portability and Accountability Act (HIPAA) regarding the student, and shall maintain the
confidentiality ofthat information consistent with the state and federal law and regulations.
PROFESSIONAL SERVICES:
The services rendered pursuant to this Contractual Agreement will be provided by individuals who are
duly licensed to perform the services or supervised by a licensed/certified provider in accordance with
applicable professional standards. Contractor agrees that all work pursuant to this Contractual
Agreement will be performed in accordance with the highest professional standards. Written
assurances will be provided to the District attesting that all employees who come into contact with
students shall have been subject to a criminal background check at least as stringent as that required by
Idaho Code 33 t30 and policies ofthe District, and have been determined to not have a criminal
background inconsistent with working with children. The District shall haye the right to observe
services being provided to the clients.
INSURANCE AND LIABILITY:
Contractor shall be solely liable for any losses or damages resulting from Contractor's performance of
any ofthe services covered by this Contractual Agreement. Contractor shall indemniI and hold
harmless the District fiom any liability, including, but not limited to, cost. expenses, and attomey fees,
resulting from Contractor's performance ofthe services provided under this Contmctual Agreement.
Proof of insurance shall be submitted to the District within ten (10) days ofthe date ofthis Contractual
Agreement.
ASSIGNMENT:
This Contmctual Agreement shall not be subject to assignment, in whole or in part, by Contractor or by
operation of law, so as to authorize any person other than Conaactor, or Contractor's employees, to
assume the duties subject to this Contractual Agreement without the District's prior written consent.
AMENDMENT:
This Contractual Agreement may be amended at any time with the prior written consent ofboth
parties. Any and all amendments to this Contractual Agreement shall be in writing.
5Contnctor: Sawtooth Rehab/Eric Roberts
Student: Assigned P'l Students
Datet May 24.2022
TERMINATION:
This Contractual Agreement may be terminated without cause by either party within thirty (30) days
after providing written notice ofthe intent to terminate to the other party.
Additionally, the District may immediately terminate this Contractual Agreement. upon written notice,
in the eyent funding for the District s program is no longer available or the specific services to this
Contractual Agreement are modified or terminated lor a student.
DEFAULT:
Upon default by either party, the non-defaulting party may cancel this Contractual Agreement
immediately, upon notice and may pursue any and all available legal, equitable, and other remedies.
The defaulting party shall be liable for any and all expenses that are incurred by the non-defaulting
parry as a result thereoi including, but not limited to, procuring substitute performance, legal fees, and
other losses incurred due to the default.
TIME OF PERFORMANCE:
Time is ofthe essence in this Contractual Agreement; therefore, all times for performance ofthe
obligations, as stated herein, shall be strictly complied with by the parties.
NON-WAVIER BREACH:
The failure ofContractor or the District to insist upon strict performance ofany ofthe terms ofthis
Contractual Agreement, or to exercise any option herein conferred in any or all instances, shall not
constitute a waiver or relinquishment of any such term. but the same shall be and remain in full force
and effect, unless such waiver is evidence by the prior written consent ofContractor or the District.
NON-DISCRI MINATION:
The parties hereby agree that no person shall, on the grounds ofrace. color, creed. national origin, sex,
age, or disability, be excluded flom or denied participation in, or otherwise subjected to, discrimination
under any activity performed pursuant to this Contractual Agreement.
GOVERNANCE:
This Contractual Agreement shall be governed by the laws ofthe State of ldaho. Contractor shall, at all
times, comply with and observe all federal, state, and local laws, regulations, and ordinances which are
in effect and applicable during the period ofthis Contracnral Agreement.
ATTORNEY FEES:
Ifeither party defaults in any manner or fails to fulfill any and/or all provisions ofthis Conractual
Agreement, and ifthe non-defaulting party hires an attomey to exercise its rights upon such default or
failure, or ifthe parties are involved in any litigation (including any proceedings in bankuptcy), the
prevailing party shall be entitled to recover reasonable attomey fees and costs from the other party.
This paragraph shall be enforceable by the panies notwithstanding any rescission, forfeiture, or other
termination of this Contractual Agreement.
DISPUTE RESOLUTION:
All participating agencies agree to resolve systemic disputes that arise in the provision ofspecial
education and independent contractor services in a non-adversarial manner and to ensure that using the
following process to resolve interagency disputes does not disrupt services to students and families:
Contractori Sa$Iooth Rehabf,ric Roberts
Student: Assigned P'l' Students
Date: May 21.2022
l. An individual or agency with a concem will first use the agency's internal procedures to address
the concem.
2. Ifresolution is not achieved at the previous level, the issue and all relevant information will now
be forwarded to the Director ofStudent Services ofthe ldaho Falls School District 9l and
contractor's administrator.
3. lfconsensus is not reached at the previous level, the Director ofStudent Services will forward the
issue and all relevant information to the superintendent ofldaho Falls School Disrict 91.
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4. Ifa concem is identified that is related to the quality ofservice or health and safety issues, schools
should refer concems about a contractor, their services, or quality ofservices to the Director of
Student Services and contractor's administrator to address these concerns.
5. Ifthese concems are not resolved in the dialogue with school administrator (Director ofStudent
Services and/or superintendent) and the contractor's administrator, the DHW regional licensing
entity may be contacted to investigate the situation.
COM PENSATION/BILLINC:
The District shall compensate Contractor for the direct services identified below. Additional hours
will be compensated at the same rate, provided that the additional hours have been pre-approved, in
writing, by the District's designee.
Contractor will submit to the Director ofStudent Services, by the end ofeach month, an Invoice
(statement of services rendered) for that month and the completed district's Medicaid reporting forms
for each student served whether Medicaid eligible or not. These completed forms must be accurate
and ready to submit to the district's billing service. Generally, the district will issue checks once each
month, ifstatement and paperwork is completed and in the District Office by the end ofthe previous
month. All forms must be completed fully, signed and be the original. Each monthly statement must
include the following information for each student receiving services: a) student's name; b) description
or services providedi c) total number of hours spent in providing professional services: and d) cost of
services provided. Additional documentation may be required by the District and must be provided
within five (5) working days ofthe date the written request for the documentation is made.
The district agrees to pay the Contractor at a rate of $70.00 pe r hour for Physical Therapy
@igg linOividual physical therapy provided by professional) ard a rate of $2qq0 per hour
for IEfu4g19l!4gq for the duration of the contract. In any case, total compensation for services
shall not exceed $75,000 total for the term of service.
COMPLETE STATEMENT OF TERMS:
This Contractual Agreement constitutes the entire agreement between the parties hereto, and shall
supersede all previous oral or wriften proposals, negotiations, commitments, and all other
communications betw€en the parties. This Contractual Agreement may not be released, discharged, or
modified except by an instrument in writing signed by the duly authorized representatives ofthe
parties.
7Contractor: Sa$tooth Rehabr'Eric Roberts
Student: Assigned PT Students
Date: Mav 2,1 2022
SUMMARY OF SERVICES
Independent Contractor/Idaho Falls School District 9l Protocol
This Summary of Services is to be used only after the District and Contractor has signed the
contract. Ind€pendent Contractor Contractual Agreement.
Independent Contractor Agency: Sawtooth Rehab, PLLC
Administrator: EricRoberts
Business Address: 185 Pevero Dr., Idaho Falls, ldaho 83401
Telephone Number: (208) 360-3900
Supenisor: Independent
Direct Service Provider: Eric Deloy Roberts
Idaho Licensure Number: PT-2268
Telephone Number: (208) 360-3900
Expiration Date: 1 | I I7 12022
E-Mail: juiceww@yahoo.com
Direct Service Provider: Qualified individual mutually agreed upon.
Review of Service: Indicate when each review will be done and who will do the review:
First Review: September 26, 2022
Second Review: November 14, 2022
Third Review: February 13, 2023
Fourth Review: April 24, 2023
Other: Upon the request ofeither party
Service(s) to be provided: Physical Therapy Services
When will service(s) be provided:
Time: Not to exceed 8 hours per day
Location: All District 9l schools
8Contractor: Sawtooth RehabEric Robens
Student: Assigned PT Students
Date: May 24- 2022
Contractor will comply with the district/school operational procedures and will fulfill the
following responsibilities:
o Sign in and out ofschool office each visit - provide proper identification.
. Must wear a picture identification and/or obtain a visitor's identification badge from the
school at the time ofeach visit.
. Must wear appropriate clothing for a school setting.
o Adhere to set schedule - arrive and leave on time.
. Noti0 building administrator ifyou will be absent (one day notice ifpossible).
. Student must be picked up from and retumed to an appropriate school staff person each visit
if applicable.
o Remain in assigned location.
o Be knowledgeable about emergency procedures ofthe school.
o Do not violate the right ofprivacy ofany student by using any information randomly
obtained by observing other students as service reference to make contact with parents to sell
or contract them to services from your agency.
. The special education teacher and/or general education teacher is the instructional leader in
the classroom. At no time should a service provider assume that theirjudgment for
instructional implementation or supervision of an individual/class can supersede the teacher
or school staff member.
o Notif,/ the district/school ofany stalfing changes within the agency that relates to the services
indicated on this agreement.
. Be cooperative when resolving conflicts with schooUdistrict staff.
o Provide testing materials and technology devices (laptop, iPad, headphones) for personal use
and to work with students.
SchooVDistrict responsibilities include:
o Respect the rights ofcontractor.
o Provided information regarding the procedurals and schedule ofthe school.
o Provide information on emergency procedures.
. When appropriate, invite service provider to specific student's MDT and/or IEP team
meetings, with parental approval.
. Accommodate, within reason, Contractor's needs to fulfill the service review plan.
. Provide a positive climate and building environment to facilitate mutual assistance.
o Be cooperative when resolving conflicts between contractor and school staff.
The above items are not to be conscribed as all inclusive. Any concems will be addressed
according to the Dispute Resolution item in the Contractual Agreement.
IN WITNESS WHEREOF, the parties have executed this Contractual Agreement
Si of Co tor's Repre lve e
5/1ul I zor'
Signature of uperintendent/Desi gnee
Contractor: Sawtooth Rehab/Eric Roberts
Student: Assigned P'I Students
Date. May 24.2022
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