Procedure for Contracting with Saratoga County to provide CPSE Services

  1. Intake information to the Youth Bureau:  Name, Address, Phone #, Email, Licensed services
  2. Complete and submit State Central Registry Clearance forms to the Youth Bureau
  3. Notification received from Dept. of Health that candidate has no findings
  4. Complete and submit required documentation for contract
  5. 3 original signed copies of the contract
  6. Provider agreement – 2 pages
  7.   Appendix A – Description of services and locations
  8. Appendix B – Statement of Medicaid Reassignment
  9. Insurance that includes:

– Name of provider, NYS authorized insurance company, policy number

– Professional liability insurance with coverage at a minimum of $1 million per incident and $2 million in the aggregate

– Workplace liability with coverage at a minimum of $1 million per incident and $2 million in the aggregate OR – General liability/Off-premise liability with coverage at a minimum of $1 million per incident and $2 million in the aggregate (additional insured must be added to the General/Off-premise liability only!)  An endorsement naming County of Saratoga, 40 McMaster St., Ballston Spa, NY 12020 must be provided to prove this additional insured on the General/Off Premise liability only.

– Abuse and molestation coverage.  Endorsement not necessary from Savers, CNA/HPSO, and American Home insurance providers (included in policy)

– Proof of payment on memorandum or a receipt

  1. Current resume
  2. A copy of your license/diploma, current registration, teaching certification and evidence of ASHA membership (if speech pathologist)
  3. Documentation of your National Provider Identifier number
  4. School Supportive Health Services Program (SSHSP)-Medicaid number-(if speech pathologist)
  5. Submit to County Attorney for Chairman’s approval and signature
  6. Executed contract is sent back to the Youth Bureau.  Provider is notified and sent a packet of information explaining billing, vouchers, claims, etc.

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