HomeMy WebLinkAbout20120618 00 DEPggr 2o
or, °� COLORADO DEPARTMENT OF HEALTH CARE POLICY
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�~ ��,� 1570 Grant Street, Denver,CO 80203-1818 •(303)866-2993• (303)866-4411 Fax
rCkeal 6F�� John W.Hickenlooper,Governor • Susan E.Birch MBA,BSN,RN,Executive Director
'POLJuly 16, 2012
Eva Jewell, Director
Weld County Area Agency on Aging
P.O. Box 1805
Greeley, CO 80632-1805
Ms. Jewell:
Enclosed please find your agency's executed original Option Letter #4 on the contract renewal
for SFY 12-13.
If you have questions, please contact me at laura.kiel(a),state.co.us or Sean at
william.bryan@state.co.us.
Thank you, ""g
L �/
ra S. Kiel, JD, BSN, RN
Contracts &Performance Management
Long Term Benefits Division
6:7a-020/3 ?DI a-— Mei8
'The mission of the Department of Health Care Policy&Financing is to improve access to cost-effective,quality health care services for Coloradans"
colorado.gov/hcpf
OPTION LETTER
Date: Original Contract Routing No. Option Letter No. Contract Routing No.
June 19, 2011 3011-1322 04 13-46042
CMS#20517
1. OPTIONS: Level of service change in conjunction with renewal for additional term.
2. REQUIRED PROVISIONS:
In accordance with Section 5, Term and Early Termination, Subsection C, Option to Extend of the Original
Contract between the State of Colorado, Department of Health Care Policy and Financing, and Weld County
Department of Human Services by and through the Weld County Board of Commissioners,
covering the term August 26, 2010 through June 30, 2012, the State hereby exercises its option for an additional
term beginning July 1, 2012, and ending on June 30, 2013, and for an increase in the amount of services under
the Contract at the rate determined by the Department.
The maximum amount payable for the current State Fiscal Year 2012-13 is increased by$1,177,039.52 to a new
total including all previous amendments, option letters, etc. for all State Fiscal Years of $3,395,834.67 as
consideration for services ordered under the Contract. Section 7, Payments to Contractor, Subsection A,
Maximum Amount is hereby modified as follows:
State Fiscal Year 2010-11 $1,030,958.63
State Fiscal Year 2011-12 $1,082,604.46
State Fiscal Year 2010-11 Reconciliation $41,807.19
State Fiscal Year 2011-12 Reconciliation $63,424.87
State Fiscal Year 2012-13 $1,177,039.52
Total for all State Fiscal Years $3,395,834.67
3. EFFECTIVE DATE:
The effective date of this Option Letter is upon approval of the State Controller or June 30,2012, whichever is
later.
STATE OF COLORADO
i hn W.Hrcke u e i e OVERNOR
,
ent of H j lay and Financing
440:—
By: Susan E. Birch,MBA,BSN, RN
Executive Director
Date: S °I, ® 0
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24.30-202 requires the State Controller to approve all State Contracts.This Contracts is not valid until signed and dated below
by the State Controller or delegate.Contractor is not authorized to begin performance until such time.If Contractor begins
performing prior thereto,the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or
services provided hereunder.
STAT ONTR
Day' e tt,CPA
By:
Depart e e Policy d Financing
Date: 7
Page 1 of 1
POO OEPggpe
COLORADO DEPARTMENT OF HEALTH CARE POLICY
"C-Al` t =
�,a 24 1570 Grant Street,Denver,CO 80203-1818 •(303)866-2993• (303)866-4411 Fax
Cgk -a" 45� John W.Hickenlooper,Governor • Susan E.Birch MBA,BSN,RN,Executive Director
FPOCtCt$'
July 6, 2012
Eva Jewell, Director
Weld County Area Agency on Aging
P.O. Box 1805
Greeley, CO 80632-1805
Ms. Jewell:
Enclosed please find your agency's executed original Option Letter #3 on the reconciliation for
SFY 11-12.
If you have questions, please contact me at laura.kiel@,state.co.us or Sean at
william.bryan tstate.co.us.
you, ,
Laura S. 'el JD BSN RN
Contracts &Performance Management
Long Term Benefits Division
"The mission of the Department of Health Care Policy&Financing is to improve access to cost-effective,quality health care services for Coloradans"
colorado.gov/hcpf
OPTION LETTER
Date: Original Contract Routing No. Option Letter No. 03 Contract Routing No.
June 13, 2012 3011-1322 - 12-45892
CMS#20517
1. OPTIONS:
Level of service change within current term.
2. REQUIRED PROVISIONS:
In accordance with Section 7,Payments To Contractor, Subsection G, Option to Increase or Decrease Statewide
Quantity of Service of the Original Contract between the Department of Health Care Policy and Financing,and
Weld County Department of Human Services by and through the Weld County Board of Commissioners,
covering the term August 26, 2010 through June 30, 2012, HCPF hereby exercises its option for an an increase
in the amount of services for SEP Case Management for reconcilation of SFY 2011-12 under the Contract at the
rate determined by the Department.
The maximum amount payable for the current State Fiscal Year 2012 is increased by$63,424.87 to a new total
including all previous amendments, option letters, etc. for all State Fiscal Years of$2,218,795.15 as
consideration for services ordered under the Contract. Section 7,Payments to Contractor, Subsection A,
Maximum Amount is hereby modified as follows:
State Fiscal Year 2010-11 $1,030,958.63
State Fiscal Year 2011-12 $1,082,604.46
State Fiscal Year 2010-11 Reconciliation $41,807.19
State Fiscal Year 2011-12 Reconciliation $63,424.87
Total for all State Fiscal Years $2,218,795.15
3. EFFECTIVE DATE:
The effective date of this Option Letter is upon approval of the State Controller.
STATE OF COLORADO
John W.Hickenloo.er,GOVERNOR
Dep• ,4!ent of Health I . , .nd Financing
4
�. .
By: Susan E. Birch,MBA, BS'1,RN
Executive Director
Date: it
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
STA CON_Te .ER
Da i . c ermott, CPA
By: _�.
Depart t of r eal h Care Policy nd Financing
Date: �9 .�.�
Page 1 of 1
OPTION LETTER
Date: Original Contract Routing No. Option Letter No. Contract Routing No.
October 4, 2011 3011-1322 02 3212-9202
CMS#20517 CMS#37282
1. OPTIONS:
Level of service change within current term.
2. REQUIRED PROVISIONS:
In accordance with Section 7,Payments To Contractor, Subsection G, Option to Increase or Decrease Statewide
Quantity of Service of the Original Contract between the Department of Health Care Policy and Financing, and
Weld County Department of Human Services by and through the Weld County Board of Commissioners,
covering the term August 26, 2010 through June 30, 2012, HCPF hereby exercises its option for an an increase
in the amount of services for SEP Case Management for reconcilation of SFY 2010-11 under the Contract at the
same rates as specified in Exhibit G, Rate Schedule. Exhibit G-2, Rate Schedule is hereby added and
incorporated into the Contract.
The maximum amount payable for the current State Fiscal Year 2012 is increased by$41,807.19 to a new total
including all previous amendments, option letters, etc. for all State Fiscal Years of$2,155,370.28 as
consideration for services ordered under the Contract. Section 7, Payments to Contractor, Subsection A,
Maximum Amount is hereby modified:
State Fiscal Year 2010-11 $1,030,958.63
State Fiscal Year 2011-12 $1,082,604.46
State Fiscal Year 2010-11 Reconciliation $41,807.19
Total for all State Fiscal Years $2,155,370.28
3. EFFECTIVE DATE:
The effective date of this Option Letter is upon approval of the State Controller.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
De ent of Healt ar is d Financing
By: Susan E. Birch, MBA, BSN, RN
Executive Director
I i "L
Date: ° I l
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
STA CON LER
D v' . c ermott, CPA
By:
Department f H al Car Polic and Financing
Date:
`'n u u.ni C LVW tiv>)
Page -
3:S-�/� g 3_a I a 2012-0618
Contract Routing Number 3212-9202
EXHIBIT G-2
RATE SCHEDULE
SFY 2010-11 Reconciliation
SEP Case Management Rate Table
Services/ Appropriation 275 Unit Quantity Rate Total
Base Rate each 923.33 $ 974.00 $ 899,323.42
Appeals each 923.33 $ 39.75 $ 36,702.37
Long-term Home Health (LTHH) PAR each 923.33 $ 39.75 $ 36,702.37
Multiple County (per county for SEPs with 2 or more per
0 $ 8,000.00 $
counties) county
Mental Illness (MI) Differential each 68.67 $ 75.00 $ 5,150.25
Comsumer Directed Attendant Support Services each 144.75 $ 200.00 $ 28,950.00
(CDASS) Differential
Assessments (initial only) each 754.00 $ 75.00 $ 56,550.00
Community Transition Services (CTS) each 4.00 $ 75.00 $ 300.00
Total Calculated Service Value Appropriation 275 $ 1,063,678.41
Utilizitlon Review!Appropriation 160 Unit Quantity Rate Total
Utilization Review(UR) each 923.33 $ 75.00 $ 69,249.75
Total Calculated Service Value Appropriation 160 $ 69,249.75
Services/Appropriation 275
Contract Allocation Appropriation 275 $ 1,008,909.72
Total Calculated Service Value $ 1,063,678.41
Contract Over Payment (Under Payment)Amount Appropriation 275 $ (54,768.69)
Contract Over Payment Recovery Owed Appropriation 275 $ -
Contract Increase Appropriation 275 (Allocation of available funds) $ 41,807.18
Utilization Review/Appropriation 160
Contract Allocation Appropriation 160 $ 22,048.91
Total Calculated Service Value $ 69,249.75
Contract Over Payment (Under Payment)Amount Appropriation 160 $ (47,200.84)
Contract Overpayment Recovery Owed Appropriation 160 $ -
Contract Increase Appropriation 160 $ -
Total Contract Change ! $ 41,807.19
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