HomeMy WebLinkAbout20111338.tiff RESOLUTION
RE: APPROVE CONTRACT FOR VARIOUS AREA AGENCY ON AGING PROGRAMS
AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Contract for various programs
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency
on Aging, and the Colorado Department of Human Services, Division of Aging and Adult
Services, commencing July 1, 2011, and ending June 30, 2012, with further terms and
conditions being as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said contract, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Contract for various programs between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services, Area Agency on Aging, and the Colorado
Department of Human Services, Division of Aging and Adult Services, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 25th day of May, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
.kg,
WELD COUNTY, COLORADO
ATTEST: %�' �/A CUSED
bara Kirkmeyer, Chair
�p Weld County Clerk to the Bo: 6I ( a1 —
EXCUSED
� 4 Sean P. Con rPro-Tem
BY: /" / / ®( / �'°Q�';
Deputy Clerk to the Board � I v ( �/f
Willi F. Garcia
AP D AS M: •1,,
David E. Long, Acting Cha/Pro-Tem
unty Attorney
ougla Rademac er
Date of signature: C/Rlf/
crY\cSro Su m
S-a5 // C L • Hsi.) 2011-1338
1 II HR0082
MEMORANDUM
1 8 6 1 - 2 0 1 1 DATE: May 23, 2011
TO: Barbara Kirkmeyer, Chair, Board of Commissions
WELCLCOUNTY
I I FROM: Judy A. Griego, Director, Depa nt�i4n rvices
SUBJECT: Federal and State FY 2012 Contract between the
Weld County Department of Human Services' Area
Agency on Aging and the Colorado Department of
Human Services, Division of Aging and Adult Services
Enclosed for Board approval is the Federal and State FY 2012 Contract between the Weld
County Department of Human Services' Area Agency on Aging and the Colorado
Department of Human Services, Division of Aging and Adult Services. This Contract was
presented at the Board's May 19, 2011, Work Session.
The Contract supports the following programs for older adults: the congregate meal
program, legal program, the long term care ombudsman, Hispanic senior outreach, peer
counseling, homemaker and personal care, Meals on Wheels, health promotion, dental,
vision and hearing, chore, caregiver, grandparents raising grandchildren, case management,
adult day care administration etc.
The contact amount is $1,147,138.00. The term of this Contract is July 1, 2011 through
June 30, 2012.
If you have any questions, give me a call at extension 6510.
2011-1338
STATE OF COLORADO
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er
CO
Colorado Department of Human Services *y�e�*
people who help people
OFFICE OF LONG TERM CARE John W.Hickenlooper
Joscelyn Gay,Deputy Executive Director Governor
DIVISION OF AGING AND ADULT SERVICES Reggie Bicha
1575 Sherman Street,10th Floor Executive Director
Denver,Colorado 80203-1714
Phone:303-866-2800
TDD 303-866-2550
FAX 303-866-2696
www.colorado.gov/cdhs
Dan Daly,Director
c ,
July 7, 2011 CT
O
Region 2-B
Judy A. Griego, Director
Weld County Department of Human Services
315 B North 11th Ave., PO Box A .c
Greeley, CO 80632
Dear Ms. Griego:
Enclosed is your executed contract between Colorado Department of Human Services (CDHS) and the Weld County
Department of Human Services, Weld County Area Agency on Aging. This contract is effective July 1, 2011 and
will end on June 30, 2012.
If you have any questions regarding your contract, please contact me via email todd.coffey@state.co.us or by
phone at 303.866.2750.
Sincerely,
J/
Todd Coffey, Manager
State Unit on Aging
Enclosures
cc: Eva Jewell,AAA Director, Region 2-B
Peggy Spaulding, Contract Program Specialist
Todd Swanson, SUA Program Specialist
SUA File
Our Mission is to Design and Deliver Quality Human Services that Improve the Safety and Independence of the People of Colorado
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DEPARTMENT OF HUMAN SERVICES
Contract Routing No. 12 IHA 30636
CONTRACT
This contract is made and entered into by and between the named parties. In accordance with the purpo:.
stated herein, it is hereby agreed as follows:
STATE: CONTRACTOR:
State of Colorado for the use&benefit of the Weld County,Colorado
Department of Human Services Weld County Department of Human Services
Division of Aging and Adult Services Weld County Area Agency on Aging
1575 Sherman St., 10th Floor 315 C. N. 1 1th Ave., P.O. Box 1805
Denver, CO 80203 Greeley, CO 80632
CONTRACT MADE DATE: CONTRACTOR'S ENTITY TYPE:
04/28/2011 Government
CONTRACTOR'S STATE OF INCORPORATION:
PO/SC ENCUMBRANCE NUMBER: N/A
PO IHA AAA12REG02B BILLING STATEMENTS RECEIVED:
TERM: Monthly
This contract shall be effeCtive upon approval STATUTORY AUTHORITY:
by the State Controller,or designee,or on See Exhibit A
07/01/2011,whichever is later. The contract C.R.S. 26-1-111
shall end on 06/30/2012.
CONTRACT PRICE NOT TO EXCEED:
$ 1,147,138.00
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
PROCUREMENT METHOD. FY 12: $ 1,147,138.00
Law Specified Vendor
BID/REP/LIST PRICE AGREEMENT NUMBER
Not Applicable
LAW SPECIFIED VENDOR STATUTE. PRICE STRUCTURE:
Federal Older Americans Act Cost Reimbursement
C.R.S. 26-11-100.1,et seq. FUND SOURCE-NAME OF FEDERAL PROGRAM/GRANT AND FUNDS ID#
OAA #11AACOT3SP and #11AACOT7SP/SFSS
STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE:
Dan Daly, Director Judy A. Griego, Director
Division of Aging and Adult Services \Veld County Department of Human Services
1575 Sherman St., 10th Floor Weld County Area Agency on Aging
Denver,CO 80203 315 C. N. 11th Ave.,P.O.Box 1805
Greeley,CO 80632
SCOPE OF WORK
In accordance with the provisions of this contract and its exhibits and attachments, the Contractor shall:
Perform the duties and responsibilities of an Area Agency on Aging for the prescribed planning and services area.
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EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A- Statement of Work
Exhibit B- Miscellaneous Provision
Exhibit C- HIPAA Business Associates Addendum
Exhibit D- Sample AAA Funding Request
Exhibit E- Sample Option Letter
Exhibit F- Funding Request Number 1 SFY 12
COORDINATION:
The State warrants that required approval, clearance and coordination has been accomplished from and
with appropriate agencies.
APPROVAL:
In no event shall this contract be deemed valid until it shall have been approved by the State Controller or
his/her designee.
PROCUREMENT:
This contractor has been selected in accordance with the requirements of the Colorado
Procurement Code.
PRICE PROVISIONS:
Payments pursuant to this contract shall be made as earned, in whole or in part, from available funds,
encumbered for the purchase of the described services and/or deliverables. The liability of the State at
any time for such payments shall be limited to the encumbered amount remaining of such funds.
Authority exists in the laws and funds have been budgeted, appropriated and otherwise made available,
and a sufficient unencumbered balance thereof remains available for payment.
Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon
funds for that purpose being appropriated, budgeted and otherwise made available.
The Contractor understands and agrees that the State shall not be liable for payment for work or
services or for costs or expenses incurred by the Contractor prior to the proper execution and State
Controller approval of this contract.
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GENERAL PROVISIONS
The following clauses apply to this contract: documents in the following order of priority: I) the
Special Provisions of this contract shall always be
A. Governmental Immunity/Limitation of Liability: controlling over other provisions in the contract or
Notwithstanding anything herein to the contrary, amendments; 2) the contract "cover" pages; 3) the
no term or condition of this contract shall be exhibits to this contract 4) the General Provisions
construed or interpreted as a waiver, express or of this contract.
implied, of any of the immunities, rights, benefits,
protection, or other provisions of the "Colorado E. Notice and Representatives: For the purposes of this
Governmental Immunity Act", C.R.S. §24-10-101, contract, the representative for each party is as
et seq., as now or hereinafter amended. The parties designated herein. Any notice required or permitted
understand and agree that the liability of the State may be delivered in person or sent by registered or
for claims for injuries to persons or property certified mail,return receipt requested,to the party at
arising out of negligence of the State of Colorado, the address provided, and if sent by mail it is
its departments, institutions, agencies, boards, effective when posted in a U.S. Mail Depository
officials and employees is controlled and limited with sufficient postage attached thereto. Notice of
by the provisions of C.R.S. §24-10-101, et seq., as change of address or change or representative shall
now or hereafter amended and the risk be treated as any other notice.
management statutes, C.R.S. §24-30-1501, et seq.,
as now or hereafter amended. Any liability of the F. Contractor Representations:
State created under any other provision of this 1. Licenses and Certifications: The Contractor
contract, whether or not incorporated herein by certifies that, at the time of entering into this
reference, shall be controlled by, limited to, and contract, it and its agents have currently in
otherwise modified so as to conform with, the effect all necessary licenses, certifications,
above cited laws. approvals, insurance, etc. required to properly
provide the services and/or supplies covered
B. Federal Funds Contingency: Payment pursuant to by this contract in the state of Colorado. Proof
this contract, if in federal funds, whether in whole of such licenses, certifications, approvals,
or in part, is subject to and contingent upon the insurance, etc. shall be provided upon the
continuing availability of federal funds for the State's request. Any revocation, withdrawal or
purposes hereof. In the event that said funds, or nonrenewal of necessary license, certification,
any part thereof, become unavailable, as approval, insurance, etc. required for the
determined by the State, the State may Contractor to properly perform this contract,
immediately terminate this contract or amend it shall be grounds for termination of this
accordingly. contract by the State.
2. Qualification: Contractor certifies that it is
C. Billing Procedures: The State shall establish billing qualified to perform such services or provide
procedures and requirements for payment due the such deliverables as delineated in this contract.
Contractor in providing performance pursuant to this 3. Debarment and Suspension: The Contractor
contract. The Contractor shall comply with the certifies to the best of its knowledge and belief
established billing procedures and requirements for that the Contractor, its principals and authorized
submission of billing statements. The State shall subcontractors are not presently debarred,
comply with CRS 24-30-202(24) when paying suspended, proposed for debarment, declared
vendors upon receipt of a correct notice of the ineligible, or voluntarily excluded from
amount due for goods or services provided participation in this transaction by any federal
hereunder. department or agency.
4. Work Performed Outside the United States or
D. Exhibits- Interpretation: Unless otherwise stated, all Colorado,pursuant to C.R.S. §24-102-206: The
referenced exhibits are incorporated herein and made Contractor certifies all work performed under
a part of this contract. And,unless otherwise stated, this Contract, including any subcontracts, is
in the event of conflicts or inconsistencies between anticipated to be and will be performed within
this contract and its exhibits or attachments, such the United States or Colorado, unless otherwise
conflicts shall be resolved by reference to the specified in the Statement of Work. If work
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under this Contract is anticipated to be or will a. $1,000,000 each occurrence;
be performed outside the United States or b. $1,000,000 general aggregate;
Colorado, the countries and/or states where c. $1,000,000 products and completed
work will be performed, and the reasons it is operations aggregate;and
necessary or advantageous to go outside the d. $50,000 any one fire.
United States or Colorado to perform the work
are also specified in the Statement of Work. If any aggregate limit is reduced below
$1,000,000 because of claims made or paid,
G. Legal Authority: The Contractor warrants that it the contractor shall immediately obtain
possesses the legal authority to enter into this additional insurance to restore the full
contract and that it has taken all actions required aggregate limit and furnish to the State a
by its procedures, by-laws, and/or applicable law certificate or other document satisfactory to
to exercise that authority, and to lawfully authorize the State showing compliance with this
its undersigned signatory to execute this contract provision.
and bind the Contractor to its terms. The person(s)
executing this contract on behalf of the Contractor e. Automobile Liability Insurance covering
warrant(s) that such person(s) have full any auto (including owned, hired and
authorization to execute this contract. non-owned autos) with a minimum limit
as follows: $1,000,000 each accident
H. Indemnification: Contractor shall indemnify, combined single limit.
save, and hold harmless the State, its employees f Professional liability insurance with
and agents, against any and all claims, damages, minimum limits of liability of not less
liability and court awards including costs, than $1,000,000.
expenses, and attorney fees and related costs, 3. The State of Colorado shall be named as
incurred as a result of any act or omission by additional insured on the Commercial General
Contractor, or its employees, agents, Liability and Automobile Liability Insurance
subcontractors, or assignees pursuant to the terms policies(leases and construction contracts will
of this contract. require the additional insured coverage for
completed operations on endorsements CG
/Applicable Only to Intergovernmental 2010 11/85, CG 2037, or equivalent).
Contracts) No term or condition of this contract Coverage required of the contract will be
shall be construed or interpreted as a waiver, primary over any insurance or self-insurance
express or implied, of any of the immunities, program carried by the State of Colorado.
rights, benefits, protection, or other provisions, of 4. The above insurance policies shall include
the Colorado Governmental Immunity Act, CRS provisions preventing cancellation or non-
§24-10-101 et seq., or the Federal. Tort Claims renewal without at least 30 days prior notice
Act, 28 U.S.C. 2671 et seq., as applicable, as now to Contractor and Contractor shall forward
or hereafter amended. such notice to the State in accordance with
"Provision E. Notices and Representatives"
I. Insurance - Contractor: The contractor shall within seven days of Contractor's receipt of
obtain, and maintain at all times during the term of such notice.
this contract, insurance in the following kinds and 5. The contractor will require all insurance
amounts: policies in any way related to the contract and
1. Workers' Compensation Insurance as required secured and maintained by the contractor to
by state statute, and Employer's Liability include clauses stating that each carrier will
Insurance covering all of contractor's waive all rights of recovery, under
employees acting within the course and scope subrogation or otherwise, against the State of
of their employment. Colorado, its agencies, institutions,
2. Commercial General Liability Insurance organizations, officers, agents, employees and
written on ISO occurrence form CG 00 01 volunteers.
10/93 or equivalent, covering premises 6. All policies evidencing the insurance
operations, fire damage, independent coverages required hereunder shall be issued
contractors, products and completed by insurance companies satisfactory to the
operations, blanket contractual liability, State.
personal injury, and advertising liability with 7. The contractor shall provide certificates
minimum limits as follows: showing insurance coverage required by this
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contract to the State within 7 business days of to have such materials used for any purpose other
the effective date of the contract, but in no than the performance of the contractor's
event later than the commencement of the obligations under this contract without a prior
services or delivery of the goods under the written consent of the State. All documentation,
contract. No later than 15 days prior to the accompanying the intellectual property or
expiration date of any such coverage, the otherwise, shall comply with the State
contractor shall deliver the State certificates of requirements which include but is not limited to all
insurance evidencing renewals thereof. At documentation being in a paper, human readable
any time during the term of this contract, the format which is useable by one who is reasonably
State may request in writing, and the proficient in the given subject area.
contractor shall thereupon within 10 days
supply to the State, evidence satisfactory to L. Proprietary Information: Proprietary information for
the State of compliance with the provisions of the purpose of this contract is information relating to
this section. a party's research, development, trade secrets,
8. Notwithstanding subsection A of this section, business affairs, internal operations and management
if the contractor is a"public entity" within the procedures and those of its customers, clients or
meaning of the Colorado Governmental affiliates, but does not include information lawfully
Immunity Act CRS 24-10-101, et seq., as obtained by third parties, which is in the public
amended ("Act'), the contractor shall at all domain,or which is developed independently.
times during the term of this contract maintain
only such liability insurance, by commercial Neither party shall use or disclose directly or
policy or self-insurance, as is necessary to indirectly without prior written authorization any
meet its liabilities under the Act. Upon request proprietary information concerning the other party
by the State, the contractor shall show proof obtained as a result of this contract. Any proprietary
of such insurance satisfactory to the State. information removed from the State's site by the
Contractor in the course of providing services under
J. Disaster Planning and Pandemic Outbreaks: The this contract will be accorded at least the same
State may require the Contractor to submit a precautions as are employed by the Contractor for
Disaster Response Plan(Plan)to ensure the similar information in the course of its own business.
delivery hereunder of essential government
services during a disaster,declared emergency, M. Records Maintenance, Performance Monitoring &
and/or pandemic outbreak.The Plan would take Audits: The Contractor shall maintain a complete
precedence over and nullify any contractual file of all records, documents, communications,
provision relating to force majeure or"Acts of and other materials that pertain to the operation of
God."Accordingly, should the work performed by the program/project or the delivery of services
the Contractor under this contract include the under this contract. Such files shall be sufficient to
provision of any essential government services,the properly reflect all direct and indirect costs or
State may request a Plan from the Contractor,and, labor, materials, equipment, supplies and services,
upon such request,the Contractor shall forthwith and other costs of whatever nature for which a
submit a Plan,and the Contractor shall be bound to contract payment was made. These records shall
perform hereunder in accordance therewith. be maintained according to generally accepted
accounting principles and shall be easily separable
K. Rights in Data,Documents and Computer from other Contractor records.
Software or Other Intellectual Property:
All intellectual property including without The Contractor shall protect the confidentiality of
limitation, databases, software, documents, all records and other materials containing
research, programs and codes, as well as all, personally identifying information that are
reports, studies, data, photographs, negatives or maintained in accordance with this contract.
other documents, drawings or materials prepared Except as provided by law, no information in
by the contractor in the performance of its possession of the Contractor about any individual
obligations under this contract shall be the constituent shall be disclosed in a form including
exclusive property of the State. Unless otherwise identifying information without the prior written
stated, all such materials shall be delivered to the consent of the person in interest, a minor's parent,
State by the contractor upon completion, guardian, or the State. The Contractor shall have
termination, or cancellation of this contract. written policies governing access to, duplication
Contractor shall not use, willingly allow or cause and dissemination of, all such information and
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advise its agents, if any, that they are subject to or service is provided to the State. These sales or
these confidentiality requirements. The Contractor use taxes will not be reimbursed by the State.
shall provide its agents, if any, with a copy or
written explanation of these confidentiality O. Conflict of Interest: During the term of this
requirements before access to confidential data is contract, the Contractor shall not engage in any
permitted. business or personal activities or practices or
maintain any relationships which conflict in any
The Contractor authorizes the State, the federal way with the Contractor fully performing his/her
government or their designee, to perform audits obligations under this contract.
and/or inspections of its records, at any reasonable
time, to assure compliance with the state or federal Additionally, the Contractor acknowledges that, in
government's terms and/or to evaluate the governmental contracting, even the appearance of
Contractor's performance. Any amounts the State a conflict of interest is harmful to the interests of
paid improperly shall be immediately returned to the State. Thus, the Contractor agrees to refrain
the State or may be recovered in accordance with from any practices, activities or relationships
other remedies. which could reasonably be considered to be in
conflict with the Contractor's fully performing
All such records,documents, communications, and his/her obligations to the State under the terms o.
other materials shall be the property of the State this contract, without the prior written approval of
unless otherwise specified herein and shall be the State.
maintained by the Contractor, for a period of three
(3) years from the date of final payment or In the event that the Contractor is uncertain
submission of the final federal expenditure report whether the appearance of a conflict of interest
under this contract, unless the State requests that may reasonably exist, the Contractor shall submit
the records be retained for a longer period,or until to the State a full disclosure statement setting forth
an audit has been completed with the following the relevant details for the State's consideration
qualification. If an audit by or on behalf of the and direction. Failure to promptly submit a
federal and/or state government has begun but is disclosure statement or to follow the State's
not completed at the end of the three (3) year direction in regard to the apparent conflict shall be
period, or if audit findings have not been resolved grounds for termination of the contract.
after a three (3) year period, the materials shall be
retained until the resolution of the audit findings. Further, the Contractor shall maintain a written
code of standards governing the performance of its
The Contractor shall permit the State, any other agent(s) engaged in the award and administration
governmental agency authorized by law, or an of contracts. Neither the Contractor nor its
authorized designee thereof, in its sole discretion, agent(s) shall participate in the selection, or in the
to monitor all activities conducted by the award or administration of a contract or
Contractor pursuant to the terms of this contract. subcontract supported by Federal funds if a
Monitoring may consist of internal evaluation conflict of interest, real or apparent, would be
procedures, reexamination of program data, special involved. Such a conflict would arise when:
analyses, on-site verification, formal audit I. The employee,officer or agent;
examinations, or any other procedures as deemed 2. Any member of the employee's immediate
reasonable and relevant, All such monitoring shall family;
he performed in a manner that will not unduly 3. The employee's partner; or
interfere with contract work. 4. An organization which employees, or is about
to employ,any of the above,
N. Taxes: The State, as purchaser, is exempt from all has a financial or other interest in the firm selected
federal excise taxes under Chapter 32 of the for award. Neither the Contractor nor its agent(s)
Internal Revenue Code [No. 84-730123K] and will solicit nor accept gratuities, favors, or
from all state and local government use taxes anything of monetary value from Contractor's
[C.R.S. §39-26-I I4(a) and 203, as amended].The potential contractors,or parties to subagreements.
contractor is hereby notified that when materials
are purchased for the benefit of the State, such P. Conformance with Law: The Contractor and its
exemptions apply except that in certain political agent(s) shall at all times during the term of this
subdivisions the vendor may be required to pay contract strictly adhere to all applicable federal
sales or use taxes even though the ultimate product laws, state laws, Executive Orders and
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implementing regulations as they currently exist • The Single Audit Act Amendments of 1996, 31
and may hereafter be amended. Without limitation, USC 7501, Public Law 104-156,OMB Circular
these federal laws and regulations include: A-133,and 45 CRF 74.26.
• Age Discrimination Act of 1975, 42 U.S.C. • The Federal Funding Accountability and
Section 6101 et seq. and its implementing Transparency Act of 2006 (Public Law 109-
regulation,45 C.F.R.Part 91; 282), as amended by §6062 of Public Law
• Age Discrimination in Employment Act of 110-252, including without limitation all data
1967,29 U.S.C.62] et seq.; reporting requirements required thereunder.
• Americans with Disabilities Act of 1990 This Act is also referred to as FFA1'A.
(ADA),42 U.S.C. 12101 et seq.; • The American Recovery and Reinvestment
• The Drug Free Workplace Act of 1988, 41 Act of 2009 (Public Law 111-5), including
U.S.C.701 et seq.; without limitation all data reporting
• Equal Pay Act of 1963,29 U.S.C.206; requirements required thereunder. This Act is
• Health Insurance Portability and also referred to as ARRA.
Accountability Act of 1996, 42 U.S.C.
§ 1320d et seq. and implementing regulations, Q. Restrictions on Public Benefits: Pursuant to House
45 C.F.R.Parts 160 and 164; Bill 06S-1023,as codified at C.R.S. §24-76.5-101 et
• Immigration Reform and Control Act of 1986, 8 seq., except as otherwise provided therein or where
U.S.C. 1324b; exempt by federal law,the State is required to verify
• Pro-Children Act of 1994, 20 U.S.C. 6081 et the lawful presence in the United States of each
ssg. natural person 18 years of age or older who applies
• Section 504 of the Rehabilitation Act of 1973, for state or local public benefits or for federal public
benefits for the applicant. Accordingly, should the
29 U.S.C. 794, as amended, and implementing
regulation 45 C.F.R.Part 84; work performed by the Contractor under this
• Titles VI&VII of the Civil Rights Act of 1964, contract include the provision of any of said benefits
42 U.S.C.2000(d)&(e); to any natural person 18 years of age or older who
applies therefore for the applicant, the Contractor
• The Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, 42 shall follow the requirements of said law in the
USC 604a, PL 104-193. See also State provision of said benefits as if it were the State. The
Executive Order D 015 00; State will provide the Contractor with specific
instruction on the identification documentation
• Title IX of the Education Amendments of 1972, required and the process to be followed by the
20 U.S.C. 1681 et seq.; Contractor to properly comply with the law if the
• The Uniform Administrative Requirements for work done under this contract is subject to these
Grants and Cooperative Agreements to State requirements.
and Local Governments (Common Rule), at 45
CFR,Part 92; R. Statewide Contract Management System:
• The Uniform Administrative Requirements for 1. When Applicable. If the maximum amount
Awards and Subawards to Institutions of Higher payable to Contractor under this Contract is
Education, Hospitals, Other Non-Profit $100,000 or greater,either on the Effective
Organizations, and Commercial Organizations Date or at anytime thereafter,this provision
(Common Rule),at 2 CFR 215; applies.
• Office of Management and Budget Circulars A- 2. Governing State Statutes. Contractor agrees
87, A-21 or A-122, and A-102 or A-110, to be governed,and to abide,by the provisions
whichever is applicable. of CRS §24-102-205, §24-102-206, §24-103-
• The Hatch Act (5 USC 1501-1508) and Civil 601, §24-103.5-101 and§24-105-102
Service Reform Act, Public Law 95-454 concerning the monitoring of vendor
Section 4728. performance on state contracts and inclusion
• Departments of Labor, Health and Human of contract performance information in a
Services, and Education and Related Agencies statewide contract management system.
Appropriations Act, 1990, PL 101-166, Section 3. Performance Evaluation and Review.
511. Contractor's performance shall be subject to
• 45 CFR Subtitle A, Department of Health and Evaluation and Review in accordance with the
Human Services regulations. terms and conditions of this Contract, State
law(including without limitation CRS §24-
103.5-101),and State Fiscal Rules, Policies
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and Guidance. Evaluation and Review of guidelines for what final rating will be given, are
Contractor's performance shall be part of the as follows:
normal contract administration process and 1. Above Standard: This rating may be given
Contractor's performance will be where Contractor consistently performs in a
systematically recorded in the statewide manner that exceeds the requirements of this
Contract Management System. Areas of Contract, and where such performance is
Evaluation and Review shall include without measurable against objective factors
limitation quality,cost and timeliness. specifically identified for use in achieving the
Collection of information relevant to the purposes of this provision. If applicable to
performance of Contractor's obligations under work performed under this Contract, the
this Contract shall be determined by the objective factors and performance required to
specific requirements of such obligations and merit an "Above Standard" rating are
shall include factors tailored to match the specified in a so dedicated Exhibit to this
requirements of Contractor's obligations Contract, which may be included herein from
hereunder. Such performance information the start of the contract or subsequently be
shall be entered into the statewide Contract added by formal contract amendment at any
Management System at intervals during the time before the end of the contract term. If
term hereof determined appropriate by the there is no such dedicated Exhibit included or
State.and a final Evaluation, Review and subsequently added herein, this rating is
Rating shall be rendered by the State within unavailable.
30 days of the end of the Contract term. 2. Standard: This rating will be given where: 1.)
Contractor shall be notified following each Contractor's performance hereunder meets the
performance Evaluation and Review,and shall requirements of this Contract in areas of
address or correct any identified problem in a quality, cost, and timeliness; 2.) Contractor's
timely manner and maintain work progress. work is accepted by the State; and 3.) full
4. Gross Failure to Meet Performance Measures. payment hereunder is made to Contractor for
Should the final performance Evaluation and such performance.
Review determine that Contractor 3. Below Standard: This rating may be given
demonstrated a gross failure to meet the where Contractor materially fails to perform
performance measures established hereunder, the requirements of this Contract and such
the Executive Director of the Colorado failure results in the State's invocation of
Department of Personnel and Administration contract remedies and/or contract termination
(Executive Director), upon request by the in accordance with General Provision X.
Department of Human Services, for good below.
cause shown, may debar Contractor and
prohibit Contractor from bidding on future T. Discrimination: The Contractor during the
contracts. Contractor may contest the final performance of this contract shall:
Evaluation and Review and Rating by: (a) 1. not discriminate against any person on the basis
filing rebuttal statement(s), which may result of race, color, national origin, age, sex, religion
in either removal or correction of the and handicap, including Acquired Immune
evaluation (CRS §24-105-102(6)), or (b) Deficiency Syndrome (AIDS) or AIDS related
under CRS §24-105-102(6), exercising the conditions.
debarment protest and appeal rights provided 2. not exclude from participation in, or deny
in CRS §§24-109-106, 107,201 or 202,which benefits to any qualified individual with a
may result in the reversal of the debarment disability,by reason of such disability.
and reinstatement of Contractor by the Any person who thinks he/she has been
Executive Director upon showing of good discriminated against as related to the performance
cause. of this contract has the right to assert a claim,
Colorado Civil Rights Division, C.R.S. §24-34-
S. Performance Ratings and Guidelines: 302,et seq.
The Contractor will be given a Final Contractor
Performance Evaluation at the end of the contract U. Criminal Background Check: Pursuant to C.R.S.
term in accordance with C.R.S. §24-102-205(6) §27-1-110 and Department of Human Services
and General Provision R. above. The list of Policy VI-2.4, any independent contractor, and its
available Performance Ratings, along with agent(s), who is designated by the Executive
Director or the Executive Director's designee to be
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a contracting employee under C.R.S. §27-1-1 10, I. withhold payment until performance is cured,
who has direct contact with vulnerable persons in a 2. require the vendor to take necessary action to
state-operated facility, or who provides state- ensure that the future performance conforms
funded services that involve direct contact with to contract requirements,
vulnerable persons in the vulnerable person's home 3. request removal of a Contractor's agent from
or residence,shall: contract work,
1. submit to a criminal background check,and 4. equitably reduce the payment due the vendor
2. report any arrests,charges,or summonses for to reflect the reduced value of the services
any disqualifying offense as specified by performed,
C.R.S. §27-1-110 to the State. 5. recover payment for work that due to the
Any Contractor or its agent(s), who does not Contractor cannot be performed or would be
comply with C.R.S. §27-1-110 and DHS Policy of no value to the State,
VI-2.4,may,at the sole discretion of the State, be 6. modify or recover payments (from payments
suspended or terminated. under this contract or other contracts between
the State and the vendor as a debt due to the
V. Litigation: The Contractor shall within five (5) State) to correct an error due to omission,
calendar days after being served with a summons, error, fraud and/or defalcation,
complaint, or other pleading which has been filed 7. terminate the contract.
in any federal or state court or administrative
agency notify the State that it is a party defendant These remedies in no way limit the remedies
in a case which involves services provided under available to the State in the termination provisions of
this contract. The Contractor shall deliver copies this contract,or remedies otherwise available at law.
of such document(s) to the State's Executive
Director. The term "litigation" includes an Y. Termination:
assignment for the benefit of creditors, and filings 1. Termination for Default: The State may
in bankruptcy,reorganization and/or foreclosure. terminate the contract for cause. If the State
terminates the contract for cause, it will first
W. Disputes: Except as herein specifically provided give ten (10) days prior written notice to the
otherwise, disputes concerning the performance of Contractor, stating the reasons for
this contract which cannot be resolved by the cancellation, procedures to correct problems,
designated contract representatives shall be if any, and the date the contract will be
referred in writing to a senior departmental terminated in the event problems have not
management staff designated by the department been corrected. In the event this contract is
and a senior manager designated by the terminated for cause, the State will only
Contractor. Failing resolution at that level, reimburse the Contractor for accepted work or
disputes shall be presented in writing to the deliverables received up to the date of
Executive Director and the Contractor's chief termination. In the event this contract is
executive officer for resolution. This process is terminated for cause, final payment to the
not intended to supersede any other process for the Contractor may be withheld at the discretion
resolution of controversies provided by law. of the State until completion of final audit.
Notwithstanding the above, the Contractor
X. Remedies: Acceptance is dependent upon may be liable to the State for the State's
completion of all applicable inspection procedures. damages. If it is determined that the
The State reserves the right to inspect the goods Contractor was not in default then such
and/or services provided under this contract at all termination shall be treated as a termination
reasonable times and places. The Executive for convenience as described herein.
Director of the State or her/his designee may 2. Termination for Convenience: The State shall
exercise the following remedial actions should s/he have the right to terminate this contract by
find the Contractor substantially failed to satisfy giving the Contractor at least twenty (20)days
the scope of work found in this contract. prior written notice. If notice is so given, this
Substantial failure to satisfy the scope of work contract shall terminate on the expiration of
shall be defined to mean substantially insufficient, the specified time period, and the liability of
incorrect or improper activities or inaction by the the parties hereunder for further performance
Contractor. Without limitation, the State has the of the terms of this contract shall thereupon
right to: cease, but the parties shall not be released
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from the duty to perform their obligations up In no event shall reimbursement under this
to the date of termination. clause exceed the contract amount reduced by
3. Immediate Termination: This contract is amounts previously paid by the State to the
subject to immediate termination by the State Contractor.
in the event that the State determines that the
health, safety, or welfare of persons receiving Z. Venue: The panics agree that venue for any action
services may be in jeopardy. Additionally,the related to performance of this contract shall be in the
State may immediately terminate this contract City and County of Denver,Colorado.
upon verifying that the Contractor has
engaged in or is about to participate in AA.Understanding of the Parties:
fraudulent or other illegal acts. I. Complete Understanding: This contract is
4. Termination for Financial Exigency: The State intended as the complete integration of all
shall have the right to terminate this contract understandings between the parties. No prior
for financial exigency by giving the or contemporaneous addition, deletion, or
Contractor at least thirty (30) days prior other amendment hereto shall have any force
written notice. For the purposes of this or effect whatsoever, unless embodied herein
provision, a financial exigency shall be a in writing. No subsequent novation, renewal,
determination made by the Colorado addition, deletion, or other amendment hereto
legislature or its Joint Budget Committee that shall have any force or effect unless embodied
the financial circumstances of the State are in a written contract executed and approved
such that it is in the best interest of the State to pursuant to the State Fiscal Rules. Descriptive
terminate this contract. If notice of such headings as used herein are for convenience
termination is so given, this contract shall and shall not control or affect the meaning or
terminate on the expiration of the time period construction of any provision of this contract.
specified in the notice. and the liability of the 2. Severability: To the extent that this contract
parties hereunder for further performance of may be executed and performance of the
the terms of this contract shall thereupon obligations of the parties may be
cease, but the parties shall not be released accomplished within the intent of the contract,
from the duty to perform their obligations up the terms of this contract are severable, and
to the date of termination. should any term or provision hereof be
declared invalid or become inoperative for any
In the event that the State terminates this reason, such invalidity or failure shall not
contract under the Termination for affect the validity of any other term or
Convenience or Termination for Financial provision hereof.
Exigency provisions,the Contractor is entitled 3. Benefit and Right of Action: Except as herein
to submit a termination claim within ten (10) specifically provided otherwise, it is expressly
days of the effective date of termination. The understood and agreed that this contract shall
termination claim shall address and the State inure to the benefit of and be binding upon the
shall consider paying the following costs: parties hereto and their respective successors
a. the contract price for performance of and assigns. All rights of action relating to
work, which is accepted by the State, up enforcement of the terms and conditions shall
to the effective date of the termination. be strictly reserved to the State and the named
b. reasonable and necessary costs incurred Contractor. Nothing contained in this
in preparing to perform the terminated agreement shall give or allow any claim or
portion of the contract right of action whatsoever by any other third
c. reasonable profit on the completed but person. It is the express intention of the State
undelivered work up to the date of and the Contractor that any such person or
termination entity, other than the State or the Contractor,
d. the costs of settling claims arising out of receiving services or benefits under this
the termination of subcontracts or orders, agreement shall be deemed an incidental
not to exceed 30 days pay for each beneficiary only.
subcontractor 4. Waiver: The waiver of any breach of a term
e. reasonable accounting, legal, clerical, and hereof shall not be construed as a waiver of
other costs arising out of the termination any other term, or the same term upon
settlement. subsequent breach.
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5. Survival: The State and the Contractor's effect during the term of the contract including any
obligations under this contract shall survive extensions.
following termination or expiration to the extent
necessary to give effect to the intent and
understanding of the parties.
6. Subcontracting: Except as herein specifically
provided otherwise, the duties and obligations
of the Contractor arising hereunder cannot be
assigned, delegated, subgranted or
subcontracted except with the express prior
written consent of the State. The subgrants
and subcontracts permitted by the State shall
be subject to the requirements of this contract.
The Contractor is responsible for all
subcontracting arrangements, delivery of
services, and performance of any subgrantor
or subcontractor. The Contractor warrants and
agrees that any subgrant or subcontract,
resulting from its performance under the terms
and conditions of this contract, shall include a
provision that the said subgrantor or
subcontractor shall abide by the terms and
conditions hereof. Also, the Contractor
warrants and agrees that all subgrants or
subcontracts shall include a provision that the
subgrantor or subcontractor shall indemnify
and hold harmless the State. The subgrantors
or subcontractors must be certified to work on
any equipment for which their services are
obtained.
BB.Holdover: In the event that the State desires to
continue the services provided for in this Contract
and a replacement contract has not been fully
executed by the expiration date of the Contract,
this Contract may be extended unilaterally by the
State for a period of up to two (2) months upon
written notice to the Contractor under the same
terms and conditions of the original Contract
including, but not limited to, prices, rates, and
service delivery requirements. However, this
extension terminates when the replacement
contract becomes effective when signed by the
State Controller or an authorized delegate.
CC.Health Insurance Portability &Accountability Act
of 1996 ("HIPAA"). Federal law and regulations
governing the privacy of certain health information
requires a "Business Associate Contract" between
the State and the Contractor. 45 C.F.R. Section
164.504(e). If applicable to this Contract,attached
and incorporated herein by reference and agreed to
by the parties is a HIPAA Business Associate
Addendum for HIPAA compliance. Terms of the
Addendum shall be considered binding upon
execution of this contract and shall remain in
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These Special Provisions apply to all contracts except where noted in italics.
1. CONTROLLERS APPROVAL. CRS§24-30-202(1).This contract shall not be valid until it has been
approved by the Colorado State Controller or designee.
2. FUND AVAILABILITY.CRS §24-30-202(5.5). Financial obligations of the State payable after the current
fiscal year are contingent upon funds for that purpose being appropriated,budgeted, and otherwise made
available.
3. GOVERNMENTAL IMMUNITY.No term or condition of this contract shall be construed or interpreted
as a waiver,express or implied,of any of the immunities,rights, benefits, protections, or other provisions,of the
Colorado Governmental Immunity Act,CRS §24-10-101 et seq.,or the Federal Tort Claims Act,28 U.S.C.
§§1346(b)and 2671 et seq.,as applicable now or hereafter amended.
4. INDEPENDENT CONTRACTOR.Contractor shall perform its duties hereunder as an independent
contractor and not as an employee.Neither Contractor nor any agent or employee of Contractor shall be deemed
to be an agent or employee of the State.Contractor and its employees and agents are not entitled to
unemployment insurance or workers compensation benefits through the State and the State shall not pay for or
otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance
benefits will be available to Contractor and its employees and agents only if such coverage is made available by
Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and
local head taxes incurred pursuant to this contract. Contractor shall not have authorization, express or implied,to
bind the State to any agreement, liability or understanding,except as expressly set forth herein.Contractor shall
(a)provide and keep in force workers'compensation and unemployment compensation insurance in the amounts
required by law,(b)provide proof thereof when requested by the State, and(c)be solely responsible for its acts
and those of its employees and agents.
5. COMPLIANCE WITH LAW. Contractor shall strictly comply with all applicable federal and State laws,
rules,and regulations in effect or hereafter established, including,without limitation, laws applicable to
discrimination and unfair employment practices.
6. CHOICE OF LAW. Colorado law,and rules and regulations issued pursuant thereto,shall be applied in the
interpretation,execution,and enforcement of this contract.Any provision included or incorporated herein by
reference which conflicts with said laws,rules,and regulations shall be null and void. Any provision
incorporated herein by reference which purports to negate this or any other Special Provision in whole or in part
shall not be valid or enforceable or available in any action at law, whether by way of complaint,defense,or
otherwise.Any provision rendered null and void by the operation of this provision shall not invalidate the
remainder of this contract,to the extent capable of execution.
7. BINDING ARBITRATION PROHIBITED.The State of Colorado does not agree to binding arbitration
by any extra-judicial body or person. Any provision to the contrary in this contact or incorporated herein by
reference shall be null and void.
8. SOFTWARE PIRACY PROHIBITION.Governor's Executive Order D 002 00. State or other public
funds payable under this contract shall not be used for the acquisition,operation,or maintenance of computer
software in violation of federal copyright laws or applicable licensing restrictions. Contractor hereby certifies
and warrants that,during the term of this contract and any extensions, Contractor has and shall maintain in place
appropriate systems and controls to prevent such improper use of public funds. If the State determines that
Contractor is in violation of this provision,the State may exercise any remedy available at law or in equity or
under this contract, including,without limitation, immediate termination of this contract and any remedy
consistent with federal copyright laws or applicable licensing restrictions.
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9. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST. CRS§§24-18-201 and 24-50-
507. The signatories aver that to their knowledge,no employee of the State has any personal or beneficial
interest whatsoever in the service or property described in this contract. Contractor has no interest and shall not
acquire any interest, direct or indirect,that would conflict in any manner or degree with the performance of
Contractor's services and Contractor shall not employ any person having such known interests.
10. VENDOR OFFSET. CRS§§24-30-202(1)and 24-30-202.4. [Not Applicable to intergovernmental
agreements] Subject to CRS §24-30-202.4(3.5),the State Controller may withhold payment under the State's
vendor offset intercept system for debts owed to State agencies for: (a) unpaid child support debts or child
support arrearages; (b)unpaid balances of tax, accrued interest, or other charges specified in CRS §39-21-101,et
seq.; (c)unpaid loans due to the Student Loan Division of the Department of Higher Education; (d)amounts
required to be paid to the Unemployment Compensation Fund; and(e)other unpaid debts owing to the State as a
result of final agency determination or judicial action.
11. PUBLIC CONTRACTS FOR SERVICES. CRS§8-17.5-101. [Not Applicable to agreements relating
to the offer, issuance, or sale of securities, investment advisory services or fund management services,
sponsored projects, intergovernmental agreements, or information technology services or products and
services] Contractor certifies,warrants, and agrees that it does not knowingly employ or contract with an
illegal alien who will perform work under this contract and will confirm the employment eligibility of all
employees who are newly hired for employment in the United States to perform work under this contract,
through participation in the E-Verify Program or the Department program established pursuant to CRS §8-
17.5-102(5)(c), Contractor shall not knowingly employ or contract with an illegal alien to perform work
under this contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
contract. Contractor(a)shall not use E-Verify Program or Department program procedures to undertake pre-
employment screening of job applicants while this contract is being performed, (b) shall notify the
subcontractor and the contracting State agency within three days if Contractor has actual knowledge that a
subcontractor is employing or contracting with an illegal alien for work under this contract, (c) shall
terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien
within three days of receiving the notice, and (d) shall comply with reasonable requests made in the course of
an investigation, undertaken pursuant to CRS §8-17.5-102(5), by the Colorado Department of Labor and
Employment. If Contractor participates in the Department program, Contractor shall deliver to the
contracting State agency, Institution of Higher Education or political subdivision a written, notarized
affirmation, affirming that Contractor has examined the legal work status of such employee, and shall
comply with all of the other requirements of the Department program. If Contractor fails to comply with any
requirement of this provision or CRS §8-17.5-101 et seq., the contracting State agency, institution of higher
education or political subdivision may terminate this contract for breach and, if so terminated, Contractor
shall be liable for damages.
12. PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural
person eighteen(18)years of age or older, hereby swears and affirms under penalty of perjury that he or she
(a)is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply
with the provisions of CRS §24-76.5-101 et seq., and (c)has produced one form of identification required by
CRS §24-76.5-103 prior to the effective date of this contract.
Revised 1-1-09
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Division of Contract Management
Contract Routing Number 12 IHA 30636
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
*Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and
acknowledge that the State is relying on their representations to that effect.
CONTRACTOR STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Weld County, Colorado Department of Human Services
Reggie Bicha, Executive Director
Weld County Department of Human Services
Weld County Area Agency on Aging
/ a gilizta,-
By: �.11udy A. riego,D ctor By: Pauline Burton, Deputy Executive Director
Date: J o 6 Date: C ///
2n Conti ractor Signature if Needed LEGAL REVIEW
By: Name of Authorized Individual John W. Suthers, Attorney General
Title: cial Title of Aut orized Individual
By: dl By:
* Signature Signature -Assistant Attorney General
David E. Long, Acting C air Pro-Tem
Board of Weld County C issioners
Date: MAY2 5rj i Date:
T—
ALL CONTRACTS REQUIRE APPROVAL by the STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State Contracts.This Contract 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.
STATE CONTROLLER
David J. McDermott,// CPA
By: �/ ! .K2
Valri Gimple
Date: of freS ew
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- G//-/.3S'
Table of Contents Page
EXHIBIT A Statement of Work 1
Section I Executive Summary and Recitals 1
Section II References 3
Section III Requirements and Services 4
A General Requirements 4
B Program Requirements 6
C Management and Administration 8
D Area Plan and Administration 8
E Programs and Services Delivery 8
F Program Income 9
G Funding Request 9
H Data Collection and Reporting 10
Advocacy Plan 11
J Elder Rights and Abuse Prevention Services 11
K Supportive Services 12
L Nutrition Services 14
M National Family Caregiver Support Services 16
ATTACHMENT A TO EXHIBIT A Definitions
EXHIBIT B Miscellaneous Provisions
EXHIBIT C HIPAA Business Associate Addendum
ATTACHMENT A TO EXHIBIT C HIPAA Business Associate Addendum
EXHIBIT D Sample AAA Funding Request
EXHIBIT E Sample Option Letter
EXHIBIT F Funding Request Number 1 SFY12
EXHIBIT A
STATEMENT OF WORK
SECTION I
EXECUTIVE SUMMARY AND RECITALS
As used herein, unless otherwise required based upon the context of use, the words and
phrases set forth in Attachment A to this Exhibit A shall be the definitions ascribed hereto.
It is the intent of the parties to fulfill the mandates of the Older Americans Act and the State
Funding for Senior Services (OAA/SFSS) to develop greater capacity and foster the
development and implementation of comprehensive and coordinated systems to secure and
maintain maximum independence and dignity for older adults. Therefore, it is the desire of the
Colorado Department of Human Services (CDHS), herein referred to as the State, and the Area
Agency on Aging (AAA), herein referred to as the Contractor, enter into this contract to provide
services and programs for consumers in assigned Planning and Service Areas (PSA).
A. The following statements describe essential facts that are relied upon when entering into
this contract. These statements ensure that the minimum requirements have been met.
1. The State receives certain Federal and State funds to provide an array of
services to eligible consumers in Colorado. The State distributes the funds to the
Contractor, which may be a local government, not-for-profit agency, or other local
entity to deliver services for the elderly, and other eligible individuals, in the PSA
served by the Contractor.
2. The State, through the Department of Human Services, is the policy-making
body for the Older Americans Act and State Funding for Senior Services, and for
programs operated by the Contractor under this contract that receive funding
from the State.
3. The State is authorized by statute to provide the Contractor with direction on
the use of such funds and to enter into contracts that specify how the Contractor
will use these funds to provide services in accordance with Older Americans Act
Programs, as described in 12 Colorado Code of Regulations 2510-1 Rule
Manual, Staff Manual Volume 10.
4. The Contractor is accountable to the State for using funds obtained through
this Contract appropriately in the delivery of services for the elderly and other
eligible individuals, and for complying with applicable state and federal laws,
policies, audit requirements, contract requirements and State directives.
5. The State is authorized by statute to monitor the Contractor's use and
management of these funds; to oversee its governance of the human services
programs in the Contractor's assigned PSA; and to review the Contractor's
compliance with law, policies, audit requirements, contract requirements, and
State policy directives.
Page 1 of 16
6. In accordance with the current plan objectives cited in the "State Plan on
Aging" regarding monitoring performance of contracted Area Agencies on Aging,
the State will, at a minimum, perform on-site evaluations to ensure reporting
compliance by reviewing programmatic and financial performance and
communicating deficiencies to the Contractor as needed.
7. The State may refuse to contract with, and may take legal action against, the
Contractor that breaches its contract with the State or fails to use or expend
contract funds in accordance with applicable laws, policies, and State directives.
8. State fiscal rules require that a contractor must have a fully executed contract
prior to delivery of services.
B. Titles III and VII of the Older Americans Act (OAA) provide grants for State and
community-based programs to foster the development and implementation of
comprehensive and coordinated systems to serve consumers in their communities.
Specifically, the OAA authorizes states to contract with Area Agencies on Aging to
provide an array of community services, as approved by the State.
These services may include, but are not limited to:
1. Elder Abuse Prevention services including: Long-Term Care (LTC) Ombudsman
and Legal Assistance Services;
2. Supportive Services such as: Information and Assistance, Case Management,
Assisted Transportation, Outreach, Transportation, Adult Day Care, Chore,
Homemaker, and Personal Care;
3. Nutrition Services such as Congregate Meals, Home-Delivered Meals, Nutrition
Counseling, Nutrition Education, and Nutrition Screening;
4. Health Promotion and Disease Prevention Services such as Health Promotion,
Education, and Screening; and,
5. Caregiver support services such as Respite, Counseling, and Education
Programs.
C. With regard to this contract the State shall:
1. Monitor and evaluate program performance;
2. Perform program on-site evaluations, as required;
3. Disburse program funds in a timely manner, as available;
4. Provide training, technical assistance and consultation, as available;
5. Work cooperatively with the Contractor to ensure that OAA/SFSS and associated
local funds (i.e. matching funds) are used appropriately, and that the State
directives to the Contractor are not duplicative or conflicting; and
6. Set Information Technology (IT) standards for printers, connectivity tools and
operating systems that connect to State servers. Usage outside of those
standards may result in compatibility issues and a lack of support by the State for
such printers, connectivity tools and operating systems.
Page 2 of 16
EXHIBIT A
STATEMENT OF WORK
SECTION II
REFERENCES
In addition to the "Conformance of Law" requirements set forth at Paragraph P. of the contract
General Provisions, the Contractor and its agent(s) shall at all times during the term of this
contract, be bound by and strictly adhere to the following Federal and State laws, rules,
regulations and the State Unit on Aging (SUA) Policies and Procedures as they currently exist
and may hereafter be amended, which documents are incorporated herein by this reference:
A. Federal Older Americans Act;
B. Code of Federal Regulation (CFR), Title 45 Public Welfare
C. Older Coloradans' Act, C.R.S. 26-11-100.1 et seq.;
D. C.R.S. Title 25 Health and 26 Human Services Code;
E. Colorado Long-Term Care Ombudsman Act, C.R.S. 26-11.5 et seq.;
F. Colorado Department of Human Services Staff Manual Volume 10;
G. Administration on Aging Fiscal Guide, Older Americans Act, Titles III and VII;
H. Colorado Legal Assistance Policy and Procedures Manual;
Colorado Long-Term Care Ombudsman Program Policy and Procedures Manual;
J. Colorado Retail Food Establishment Rules and Regulations;
K. Dietary Guidelines for Americans;
L. Dietary Reference Intakes (DRIs);
M. SUA Policy and Procedures Manual; and,
N. SUA Policy Directives (f/k/a ASU Memorandums)
Page 3 of 16
EXHIBIT A
STATEMENT OF WORK
SECTION III
REQUIREMENTS AND SERVICES
A. GENERAL REQUIREMENTS
1. COMPLIANCE WITH LAW
Contracting organizations must comply with Federal, State, and local laws, rules,
regulations, standards, and contractual requirements applicable to providing the
contracted service(s). Contracting organizations will be required to sign
assurances, including, but not limited to, non-discrimination and equal
opportunity.
2. COMPLIANCE WITH SERVICE STANDARDS
Contracting organizations must comply with applicable program policies and
standards included in this contract. Services must be implemented according to
these standards, unless the State has granted a waiver of compliance.
Proposals for any waivers must be identified in the Area Agency on Aging
Funding Request.
3. SERVICE ELIGIBILITY
Eligibility for services is controlled by laws and regulations relating to the
OAA/SFSS. In general, persons 60 years of age or older are eligible for
OAA/SFSS services. Contracting organizations must comply with eligibility
criteria.
A means test may not be utilized to determine eligibility for OAA/SFSS services.
Service may not be denied to a consumer based on their unwillingness or
inability to contribute toward the cost of the service.
4. TARGET POPULATIONS
Contracting organizations must seek to serve eligible consumers, with particular
attention to older individuals identified in Section 306, Area Plans (a)(4)(i) of the
OAA. Older individuals identified in this section include:
a. Older individuals with greatest social need;
b. Older individuals with greatest economic need;
c. Older individuals at risk for institutional placement;
d. Low income minority older individuals;
e. Older individuals with limited English proficiency; and
f. Older individuals residing in rural areas.
5. SERVICE COORDINATION
The Contractor shall show demonstrable efforts are being made with other aging
service providers within the geographic service area to ensure that a
comprehensive, coordinated system of services are available to older people.
The Contractor shall document these coordination efforts.
Page 4 of 16
6. INVOLVEMENT OF OLDER PERSONS
Contracting organizations must involve older persons, including program
consumers, in decisions relative to service design, delivery, and ongoing quality
improvement processes.
7. VOLUNTEERS
If the Contracting organization utilizes volunteers to provide services, the
Contracting organization shall document how volunteers will be utilized in the
program(s) including, but not limited to, the use of time sheets and job
descriptions.
8. EVALUATION
The Contractor shall implement a quality improvement process, which includes,
at a minimum, monitoring of service quality and consumer satisfaction.
Method of receiving consumer input on the quality of service needs to be
documented and utilized on a regular basis. Examples include site councils,
project councils, consumer forums, consumer satisfaction surveys, telephone
interviews, and visits.
9. ACCOUNTING SYSTEM REQUIREMENTS
The Contractor must establish and maintain an accounting system that
adequately identifies each revenue source and the application of funds. The
accounting records must contain information pertaining to projects, contracts or
sub-awards, authorizations, obligations, unobligated balances, assets, liabilities,
outlays, expenditures and revenue. Each funding source shall bear only
reasonable and allowable costs.
Transactions and other significant events are to be clearly documented. The
documentation is to be readily available for examination by persons authorized
by the State.
The Contractor shall establish and maintain adequate internal control systems and
standards that apply to the operation of the organization.
10. AUDIT REQUIREMENTS
This contract is funded with Federal financial assistance funds and State funds.
The Contractor of this program is considered an independent contractor of Title
III Federal financial assistance, subject to audit requirements under Office of
Management and Budget (OMB) Circular A-133 and Government Audit
Standards, regardless of the amount of Federal funding the Contractor receives.
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11. MATCH REQUIREMENTS
The Older Americans Act, Title III and Title VII service programs are Federally
funded programs and require a minimum in non-Federal cash funds and/or in-
kind match for each program. The OAA has established the following funding
ratios to govern the degree of Federal participation in costs of services or
projects funded.
Title III Federal/ Local Comments
State Match
Administrative Allocation 25% 1/3rd of the total allocation (cash and/or in-kind)
Parts B, C, and D Allocation 10% 119th of the total allocation (cash and/or in-kind)
Part E Allocation 25% 1/3rd of the total allocation (cash and/or in-kind)
Title VII Allocation 25% 1/3rd of the total allocation (cash and/or in-kind)
12. PROGRAM INCOME
The Contractor shall collect and report program income to the State.
13. REIMBURSEMENT METHOD
The Contractor shall invoice the State on approved forms and according to
established due dates.
Monthly or quarterly service units in Social Assistance Management System
(SAMS), or another system approved by the State, are required to justify the
payment or reimbursement of funds.
14. RECOVERY OF IMPROPER PAYMENTS
The Contractor shall notify the State immediately if they believe they have
received an overpayment or other erroneous or improper payment. The
Contractor is required to refund any erroneous or improper payment within 90
days of written demand by the State.
B. PROGRAM REQUIREMENTS
With regard to programs provided, in accordance with the provisions contained herein,
as well as the OAA/SFSS, the Contractor shall:
1. Establish and maintain a comprehensive and coordinated service delivery system for the
provision of services including supportive, nutrition, information, caregiver, and advocacy
services to consumers in accordance with the Older Americans Act, as amended, Colorado
Revised Statutes and regulations,and approved State Plan on Aging;
2. Revise and update the Area Plan annually in the Funding Request or as required;
3. Incorporate the identification of strengths, needs, and targeting of services for
seniors in the Contractor's Area Plan;
4. Select a local agency, program, or person(s) to be designated as the Local Long-
Term Care Ombudsman (LTCO), and to serve as an official and identifiable link
to the Office of the Colorado LTCO, including designation of a "lead" Local
LTCO;
5. Submit for-profit contracts to the State for approval prior to delivery of services
annually;
Page 6 of 16
6. Not use funds made available under the OAA/SFSS for lobbying activities, as described at Section 24-6-
301. C.R.S., including, but not limited to activities intended to influence decision or activity by non-
judicial Federal,State or local officials or body;
7. Not use Federal funds to supplant non-Federal funds;
8. Make reasonable efforts to obtain support from private sources and other public
organizations to enhance or maintain services;
9. Provide leadership and advocacy for older adults residing within the Planning
and Service Area (PSA), including monitoring and evaluating factors and issues
affecting older adults within the PSA;
10. Establish and maintain a uniform information system compatible with State
systems for collection and exchange of required data and information that
accurately reflect the Contractor's program(s), project(s) and financial operations;
11. Complete reports as specified by the State;
12. Evaluate the costs/benefits, quality, accessibility, utilization, priority, targetin
and overall effectiveness of programs, services, and activities, which the
Contractor provides through the Funding Request;
13. Conduct public hearings when submitting, amending, or seeking a waiver to the
Area Plan, to provide an opportunity for the general public, officials of local units
of general-purpose government, service providers, and other interested parties to
comment on the Area Plan or Funding Request;
14. Disseminate information and policy directives to applicable providers within 60
days or within the timeframe as directed by the State; and,
15. Develop and maintain an AAA Policy and Procedures manual to ensure
compliance with statutes, rules and regulations, and efficient delivery of services.
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C. MANAGEMENT AND ADMINISTRATION
With regard to programs provided, in accordance with the provisions contained herein,
as well as the Older Americans Act and State Funding for Senior Services (OAA/SFSS),
the Contractor shall:
1. Provide training to service providers and staff regarding data collection and
reporting on services contained within the Area Plan and Funding Request.
Records of these efforts shall be retained to verify training has been conducted;
2. Participate or designate a staff member to attend State training and/or meetings in
person or via one of the available media (e.g. telephone conference, video
conference, or web cam);
3. Complete an investigation and recovery of all erroneous or improper payments
within ninety-days (90) of discovery of error in payment;
4. Provide to the State information about the Contractor's organizational structure
and operating practices; including assurance of compliance with rules and
regulations governing programs and projects;
5. Employ a Director or Manager of the Area Agency on Aging who possesses
academic preparation or experience in related fields;
6. Have access to qualified accounting personnel on staff or available on a contract
basis;
7. Obtain the services of a registered dietitian, or individual of comparable expertise,
through employment, contract, subcontract, or memorandum of understanding for
the nutrition services program; and,
8. Be accountable for contract requirements, the dissemination and implementation
of required policies and procedures (e.g. OMB circulars, State Policy Directives,
AoA Program Instruction or Information Memorandums), and timely and accurate
submission of reports to the State.
D. AREA PLAN AND ADMINISTRATION
The Contractor shall develop, submit, and maintain a comprehensive and coordinated
(four-year) Area Plan for the Planning and Service Area (PSA) in accordance with State
instructions.
E. PROGRAMS AND SERVICES DELIVERY
Programs and services shall be delivered in accordance with the Older Americans Act,
the Older Coloradans Act, other applicable Federal and State rules and regulations, and
Colorado Department of Human Services rules, policies, and procedures (i.e. Staff
Manual Volume 10, the SUA Policy and Procedures Manual, and SUA Policy Directives).
The Contractor shall:
1. Provide training and technical assistance to service providers (sub-contractors);
2. Provide services to protect the health, safety, welfare, and rights of the older
adults within the PSA;
3. Perform assessment of population needs within the PSA when writing the Area
Plan, or as needed;
4. Complete reports in formats as required by the State;
Page 8 of 16
5. Ensure that criminal background checks are conducted for employees,
volunteers, and contractors according to rule or policy directive;
6. If applicable, develop and implement a plan to assist potential direct service
providers to develop capacity to efficiently and effectively provide services under
the Area Plan. An update of progress in developing potential direct service
providers may be included in the Funding Request; and,
7. Identify and coordinate with community organizations and service providers in
developing, expanding or maintaining a community-based system of services,
which meet the needs of the consumers residing within the PSA.
F. PROGRAM INCOME
Program Income is any income generated through delivery of OAA/SFSS services by a
Contractor (i.e., voluntary contributions). Program Income shall:
1. Be solicited through non-coercive, voluntary contributions provided by
consumers;
2. Be used in accordance with the Additional Costs Alternative, be added to funds
committed to the project or program, and used to increase access to services or to
further eligible project or program objectives;
3. Include interest earned on program income accounts, as well as earnings, and
expenditures of program income, and reported monthly in accordance with the
format and time period required by the State;
4. Program Income shall be spent prior to reimbursement from the State.
G. FUNDING REQUEST
The Funding Request presents information related to the amount of resources the
Contractor has budgeted for each fiscal year, for what purpose the funds will be used
and who will be served. The Contractor shall:
1. Ensure that Federal funds are not used to supplant non-Federal funds;
2. Ensure that appropriate efforts to obtain support from private sources and other
public organizations continue;
3. Have an independent audit conducted annually and performed in accordance
with Federal regulations, including OMB Circulars 122, 128, or 133, State
statutes and rules;
4. Maintain financial records and other records pertinent to this agreement,
pursuant to generally accepted accounting principles and using appropriate and
sufficient documentation of expenses; and,
5. Upon request, make fiscal records, books, documents, papers, plans and
writings available to the State.
Page 9 of 16
H. DATA COLLECTION AND REPORTING
The Contractor shall ensure that:
1. Each service provider establishes and maintains a uniform system for the
collection of data that will accurately reflect the project and financial operations;
2. Programmatic and fiscal data are on file and available to the State including
service expenditures, local cash, local in-kind, and program income;
3. The service provider has completed required reports on the prescribed forms in
accordance with the State directives;
4. Service provider applications fiscal and programmatic records are retained until
formal notice is received from the State advising that records are no longer
necessary for audit purposes;
5. Submissions of monthly reimbursement requests are timely. The State shall be
notified 3-days prior to deadline to request approval for an extended deadline;
6. A tracking system to monitor carry-over by part is established, and is maintained
at levels approved by the State. These records will be available for review at the
time of on-site evaluations. Carry over funds shall not exceed 10% of the current
federal grant award from one annual cycle to the next by grant part; after
transfers between Parts B, C-1, and C-2;
7. Expenditures are tracked and if needed, action plans are developed to correct
deficiencies;
8. The State approved Consumer Information Assessment forms are used and
providers and staff are trained regarding the appropriate and correct use of these
forms;
9. A uniform system compatible with the State's systems is used for the collection
and exchange of required data and information. This data and information should
accurately reflect the project and financial operations;
10. Evidence of program cash, local match, and in-kind contributions are
documented and retained; and,
11. Training and technical assistance is provided to staff and providers regarding
approved data entry methods. This training should include information on how to
maintain accurate information in the data management system.
Page 10 of 16
ADVOCACY PLAN
The Contractor shall identify and describe advocacy efforts in the Area Plan. Advocacy
activities shall include, but are not limited to:
1. Serving as the advocate and focal point for older adults within the community by
monitoring, evaluating, and commenting upon policies and programs that will
affect consumers;
2. Soliciting input and comment from consumers; and,
3. Developing and maintaining an Advisory Council that acts as a stakeholder group
for consumers residing in the PSA and reflects the demographic makeup of the
PSA, and/or other requirements of the State. The purpose of the advisory
council is to advise the Area Agency on Aging on matters related to
development, administration, and operation of the Area Plan.
J.ELDER RIGHTS AND ABUSE PREVENTION SERVICES
1. Long-Term Care Ombudsman Services: The local Long-Term Care (LTC)
Ombudsman Program is established, under the oversight of the Office of the
Colorado Long-Term Care Ombudsman, which operates under contract with the
State, to: investigate and resolve complaints on behalf of residents of long-term
care facilities; educate residents and their families regarding rights and choices;
provide information and consultation for consumers regarding options with regard
to nursing homes or assisted living residences or alternatives to nursing home
placement; advocate for long-term care system reform; and provide other
services as described in the Colorado Long-Term Care Ombudsman (CLTCO)
Policies and Procedures, and Training Manuals.
With regard to programs provided, in accordance with the provisions contained
herein, the Contractor shall:
a. Establish and maintain an appropriately staffed local LTC Ombudsman
Program;
b. Maintain a current Colorado Ombudsman Program Policies and
Procedures Manual for the local Ombudsman;
c. Require local ombudsmen to adhere to the requirements within the
CLTCO Policies and Procedures Manual and provide services to assist in
protecting the health, safety, welfare, and rights of residents;
d. Provide technical support for the development of resident and family
councils within facilities and to protect the well-being and rights of
residents;
e. Provide or obtain training as approved and required for representatives
(LTC Ombudsmen) of the Colorado Long-Term Care Ombudsman
(CLTCO) Program, including unpaid volunteers, as described in Staff
Manual Volume 10;
f. Prohibit any representative, other than the CLTCO or local, certified LTC
ombudsmen, from carrying out any activities on behalf of the Office of the
CLTCO;
g. Ensure that local ombudsmen receive the required certification or re-
certification training.
Page 11 of 16
h. Ensure that the lead ombudsmen or his or her designee participate in
eight hours of annual training provided or sponsored by the Office of the
Colorado Long Term Care Ombudsman;
Ensure that local ombudsmen pass the Contractor's background check
process;
j. Ensure that local ombudsmen are currently certified by the CLTCO, as
qualified to carry out activity on behalf of the Office and be able, upon
request, to produce proof of certification (certification card);
k. Oversee and require use of the State specified database software by the
local LTC ombudsmen and/or approved clerical assistants; and,
Produce reports as required by the Office of the CLTCO and the State,
including, but not limited to: (a) The Ombudsman Reporting Tool (ORT)
reports and (b) facility visit compliance reports.
2. Legal Assistance Services: This program is established to offer advice, counsel,
and legal intervention for eligible consumers regarding issues such as public
benefits, health care, financial exploitation, consumer problems, advanced
directives, and guardianship. Older people often experience issues that threaten
their autonomy, dignity, rights and security, and for some consumers these
issues require legal intervention.
With regard to legal assistance programs provided, in accordance with the
provisions contained herein, the Contractor shall:
a. Agree that funds made available under the Older Americans Act may not
be used to pay dues exceeding $100.00 per recipient per annum to any
organization (other than the bar association), whose purpose or function
is to engage in activities prohibited under the Regulations described in
Staff Manual Volume 10, and,
b. Work to resolve any issues noted by the Colorado Legal Assistance
Developer (CLAD), e.g. during the CLAD's on-site evaluation. The CLAD
operates under contract with the State to provide oversight, technical
assistance and consultation for the local legal assistance providers.
K. SUPPORTIVE SERVICES
INFORMATION AND ASSISTANCE: THIS PROGRAM INCLUDES ONE-ON-ONE OR GROUP
CONTACTS BETWEEN INFORMATION AND ASSISTANCE PROVIDER AND CONSUMER OR THE
CONSUMER'S CAREGIVER.
WITH REGARD TO THIS PROGRAM, IN ACCORDANCE WITH THE PROVISIONS CONTAINED
HEREIN, THE CONTRACTOR SHALL:
a. Evaluate the needs and capacities of consumers;
b. Develop and maintain current information about opportunities, benefits,
services, and resources available to consumers within the community;
c. Provide information to the consumer or his/her caregiver about available
opportunities, benefits, services and resources;
Page 12 of 16
•
d. Refer consumers to needed services, including initiating an arrangement
between the consumer or caregiver and the service provider, if
necessary, and advocating with agencies on the behalf of consumers;
e. Where practical, follow-up to assure that the consumer and/or his/her
caregiver has been able to access the services available;
f. Provide additional assistance to the consumer and/or caregiver in locating
or accessing needed services, if necessary; and,
g. In areas where five percent (5%) or more of consumers speak a language
other than English as their principle language, provide information and
assistance in that language.
2. Outreach: This program includes interventions with consumers and/or their
caregivers for the purpose of identifying potential adults and encouraging the
consumer or caregivers' use of existing services and benefits.
With regard to programs provided, in accordance with the provisions contained
herein, the Contractor shall:
a. Conduct outreach activities throughout the PSA to identify consumers and
their caregivers;
b. Establish communication with the local news media to inform the public of
available services and opportunities to contribute to the planning and
implementation of services for seniors; and,
c. In an area where a predominant number of consumers (five percent or
more) speak a language, other than English, as their principal language,
provide outreach, information and assistance services in that language.
3. Transportation Services: Unless a waiver is approved by the State, the Contractor
shall make transportation and assisted transportation under the OAA/SFSS
available to consumer for the purpose of accessing services necessary to remain
independent and socially integrated in the community.
With regard to programs provided hereunder, the Contractor shall:
a. Document the transportation services provided for each consumer,
through registration or estimate, in the Social Assistance Management
System (SAMS);
b. Not use OAA/SFSS funds to pay for transportation or assisted
transportation if such transportation is offered or covered through other
Federal or State programs for which the consumer may be eligible;
c. Require all transportation providers, except private vehicles, rendering
services to OAA older adults to have all licenses, approvals, or
certifications required by federal, state, and local law or regulation; and
d. Require all transportation providers not requiring licensure by the Public
Utilities Commission (PUC) to have their drivers, vehicles, and auxiliary
equipment meet all applicable regulations and standards for passenger
and vehicle safety, as well as all applicable safety inspection and
maintenance requirements, and shall comply with the State's mandated
minimum insurance coverage.
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•
L.NUTRITION SERVICES
1. Congregate and Home Delivered Meals: The Contractor assures that this
program provides an array of nutrition services, including nutrition education,
nutrition screening, nutrition assessment, nutrition counseling, modified diets
including medical foods as feasible and appropriate, and other services as
appropriate. The program offers nutrition education services, meal preparation
and delivery of nutritious meals to senior centers, dining centers, nutrition sites,
or consumer homes or residence.
The program promotes and emphasizes comprehensive preventive approaches,
which utilize community nutrition services to maintain the health and
independence of consumers.
With regard to programs provided, in accordance with the provisions contained
herein, the Contractor shall:
a. Provide modified diets in accordance with Section 339 of the OAA;
b. When prescribed as necessary to treat a diagnosed medical condition,
provide or make referrals to resources for medical nutritional food as a
meal replacement;
c. The registered dietitian, or individual of comparable expertise, shall:
1. Approve menu nutrient content to ensure compliance;
2. Approve nutrition education materials; and
3. Conduct nutrition education presentations and/or nutrition
education learning activities at each congregate meal site.
d. The registered dietitian shall:
1. Provide nutrition counseling; and,
2. Oversee and monitor all modified diets, including medical
nutritional foods.
e. Coordinate consultations between the registered dietitian, or individual of
comparable expertise, and the Nutrition Director to:
1. Determine feasibility and appropriateness of modified diets and
medical nutritional foods;
2. Monitor method and results of nutrient analysis to ensure
compliance;
3. Monitor referrals to internal and external nutrition resources.
4. Review food safety and sanitation procedures, monitoring, and
staff and volunteer training;
5. Review food service operations training; and
6. Complete an approved annual training with the State Unit on
Aging.
2. Nutrition Program Staff Training Requirements: The individual responsible for
overseeing the Nutrition Program or his or her designee shall be required to
participate in six hours of State Unit on Aging training annually for the Nutrition
Program.
Page 14 of 16
3 Nutrition Program Requirements: Nutrition Program services shall meet
standards as defined in the Older Americans Act including but not limited to the
current Dietary Guidelines for Americans and Dietary Reference Intakes.
Nutrition Service Providers shall provide meals that:
a. Comply with the most recent Dietary Guidelines for Americans, published by
the Secretary of Health and Human Services and the Secretary of
Agriculture;
b. Provide each participating consumer a minimum of 33 1/3 percent of the
Dietary Reference Intakes (DRI) standard from the most current release
from the Food and Nutrition Board of the Institute of Medicine of the
National Academy of Sciences if only one meal per day is provided; or 66
2/3 percent of the dietary reference intakes if two (2) meals per day are
provided; or 100 percent of the dietary reference intakes if three (3)
meals per day are provided;
c. Are adjusted, as feasible and appropriate, to the maximum extent
practical to meet any special dietary needs of program consumers
including, special health, religious, or ethnic requirements;
d. Provide information and assistance about the Supplemental Nutrition
Assistance Program, SNAP (formerly known as the Food Assistance
Program) to consumers who may be eligible for such benefits; and,
e. Inform older consumers if the nutrition program accepts the SNAP
Program (a/k/a Food Stamps).
f. Nutrition providers shall maintain and make available for review an
approved copy of the menu cycles and analyses on file at the nutrition
site(s), and available for review by the Contractor or State at any time.
g. Menus and recipes shall be analyzed using a nutrient analysis software
package to ensure compliance with the Dietary Guidelines for Americans,
and Dietary Reference Intakes, and shall be approved by a registered
dietitian, or individual of comparable expertise.
h. Substitutions or deviations from the approved menu(s) shall be
documented and approved by the registered dietitian, or individual of
comparable expertise.
Menu cycles and nutrient analysis shall be maintained for a minimum of
three (3) years for audit purposes unless disposition is authorized by the
State.
Page 15 of 16
4. Home Delivered Meals Eligibility and Assessment: Home delivered meals are the
provision of meals or medical nutritional food to an eligible consumer at their
place of residence or home.
With regard to programs provided, in accordance with the provisions contained
herein, as well as the Older Americans Act, Older Coloradans Act, and Staff
Manual Volume 10, the Contractor shall:
a. Assess consumers requesting home-delivered meals;
b. Provide home delivered meals only to consumers determined to be
homebound or geographically isolated; and,
c. Perform homebound status assessments to ensure or determine
eligibility. Homebound status shall be reassessed as prescribed by the
State Unit on Aging in policies and procedures.
M. NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM (NFCSP)
The National Family Caregiver services shall meet the requirements described in Staff
Manual Volume 10. These services shall include, but are not limited to: information,
access assistance, respite, counseling, and supplemental services, such as medical
equipment, offered to caregivers of consumers and grandparents raising children under
the age of eighteen.
Page 16 of 16
ATTACHMENT A TO EXHIBIT A
DEFINITIONS
Within this contract the following terms are defined.
"Activities of Daily Living" (ADLs) means activities that are regularly necessary for
personal care. These activities include: transfers in and out of a bed or chair, toileting,
walking, dressing, bathing, hygiene, and eating.
"Additional Cost Alternative" means(per Code of Federal Regulations, Program
Income, 74.24 (h) and (b)(1)) as "[program income shall be] added to funds committed to
the project or program, and used to further [the] eligible project or program objectives."
"Administration" means the Administration on Aging of the United States Department
of Health and Human Services.
"Area Agency on Aging (AAA)" means a private, nonprofit, or public agency
designated by the State Unit on Aging (SUA) to administer the Older Americans Act and
related programs within a Planning and Service Area (PSA) in the State of Colorado.
"Area Agency on Aging Advisory Council" means a representative body of
laypersons and service providers, designated by the AAA to represent the interests of
older adults within the boundaries of a Planning and Service Area.
"Area Plan" means a document submitted by the Area Agency on Aging (AAA) to the
State Unit on Aging (SUA) every four years in a format specified by the State
Department, which includes goals and measurable objectives; and identifies planning,
coordination, administration, supportive, and nutrition services, as well as evaluation
activities to be undertaken.
"Assessment" means the process of determining eligibility for a program, and may be
used to measure the changes in a client due to participation in a program.
"Carry-Over" means the estimated or actual portion of the funds made available to a
contractee for a budget year which are not expended during that budget year, and which
may be available for use (carried over) during a subsequent budget year, or reallocated
as necessary.
"Case Management" means assistance, either in the form of access or care
coordination, in circumstances where the eligible individual and/or their caregivers are
experiencing diminished functioning capacities, personal conditions, or other
characteristics which require the provision of services by formal service providers.
Activities of case management shall include: assessing needs, developing care plans,
authorizing services, arranging services, coordinating the provision of services among
providers, follow-up, and reassessment, as required.
"Cash and Counseling" means the range of services provided or paid for through
allowance, vouchers, or cash that are provided to the consumer so that the consumer
can obtain the supportive services that are needed.
"Cash Match" means local cash received from non-Federal and non-State sources,
passing to the control of the contractee or sub-contractee or contract agencies, which is
used for the payment of allowable costs charged to the contract, and for the satisfaction
of requirements for non-Federal/non-State share of program expenses.
Page 1 of 8
"Chore services" means those services designed to increase the safety of older adults
living at home such as assistance with heavy housework, yard work or sidewalk
maintenance. Chore service activities are one-time, seasonal or occasional in nature,
and shall be planned with input from the older adult based on an evaluation of the older
adult's strengths and needs, and the degree of physical and/or cognitive impairment of
the older adult.
"Colorado Long-Term Care Ombudsman" (CLTCO) means an entity with expertise
and experience in the fields of long-term care and advocacy, serving on a full-time basis
to carry out the functions identified in the Older Americans Act.
"Community focal point" means a facility established to encourage the maximum
collaboration and coordination of services for older adults.
"Comprehensive and Coordinated Service Delivery System" means a system for
providing all necessary supportive services, including nutrition services, in a manner
designed to:
A. Facilitate the accessibility and use of interrelated social, supportive, and
nutrition services provided to meet the needs of older adults in a Planning
and Service Area;
B. Develop and make the most effective use of supportive services and
nutrition services in meeting the needs of older adults within the planning
and service area;
C. Use resources efficiently and with a minimum of duplication; and,
D. Encourage and assist public and private entities that have unrealized
potential for meeting the service needs of older adults to provide such
assistance on a voluntary basis.
"Conflict of Interest" means a direct official action on a matter in which the Area
Agency on Aging, provider, council member, or other interested party has the
opportunity for substantial financial, contractual, or employment gain.
"Congregate Meal" means the provision of a meal that meets all requirements as
specified in Staff Manual Volume 10 of these rules to an eligible older adult at a nutrition
site, senior center or some other congregate setting.
"Consumer" means an individual, over 60, or an individual who is eligible for services
from an Area Agency on Aging under the Older Americans or Older Coloradans Acts.
"Contract" means an agreement, allowable and enforceable by law, between two or
more competent parties, for a legal consideration. More specifically, in regard to these
rules, it is a legal written agreement between agencies or other entities to provide,
supply, or perform on the one part, and remunerate on the other part, a particular
service, goods, or materials, in (a) particular time frame(s) and location(s).
"Contractor" means an organization or person that provides goods, materials, and/or
services for remuneration under the stipulations of a contract.
Page 2 of 8
"Coordination" means a formal or informal arrangement through which the State Unit
on Aging (SUA), Area Agency on Aging (AAA), or another entity or coalition brings
together the planning and service resources of two (2) or more public and/or private
agencies in Colorado for the purpose of expanding or strengthening services for older
adults. Coordination refers to cooperative efforts, in support of common objectives,
directed toward joint planning and resource development, increased quality and quantity
of services, and the improvement of services to achieve a more effective and efficient
comprehensive system.
"Desk evaluation" means the process of a review of the direction, compliance with
regulations and policy and procedures, efficiency, and effectiveness of a program or part
of a program through use of written documentation requested of an AAA by the SUA.
"Dietetic Technician, Registered" means an individual who:
A. Has:
1. Completed a minimum of an Associate Degree granted by a U.S. accredited
college/university;
2. Completed a Dietetic Technician Program as accredited/approved by the
Commission on Accreditation/Approval for Dietetics Education of the American
Dietetic Association;
3. Successfully completed the Registration Examination for Dietetic Technicians;
and,
4. Accrued fifty (50) hours of approved continuing professional education every
five years;
B. Or has:
1. Completed the minimum of a Bachelor's degree granted by a U.S. regionally
accredited college or university, or foreign equivalent;
2. Met current minimum academic requirements (Didactic Program in Dietetics)
as approved by the Commission on Accreditation/Approval for Dietetics
Education of the American Dietetic Association;
3. Completed a supervised practice program under the auspices of a Dietetic
Technician Program as accredited/approved by The Commission on
Accreditation/Approval for Dietetics Education of the American Dietetic
Association;
4. Fully completed the Registration Examination for Dietetic Technicians; and,
5. Accrued fifty (50) hours of approved continuing professional education within
a specific five-year reporting period.
"Education" means a supportive service designed to assist older adults to better cope
with their economic, health, and personal needs through services such as consumer
education, continuing education, nutrition education, health education, pre-retirement
education, financial planning, and other education and training services which advances
the objectives of the Older Americans Act.
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"Elder abuse, neglect, and exploitation" means abuse, neglect, or exploitation, of an
older adult.
"Evaluation" means the process of a review of the direction, compliance with
regulations and policy and procedures, efficiency and effectiveness of a program or part
of a program through use of an evaluation tool developed by the SUA or MA including
completed written documentation of the findings.
"Evidence-based program" means a program that demonstrates impact to the
prevention.and mitigation of the effects of chronic disease and other conditions.
"Family Caregiver" means an adult family member or other individual, who is an
informal provider of in-home, and community care to an older adult or to an individual
with Alzheimer's disease or a related disorder with neurological and organic brain
dysfunction.
"Frail" means an older adult who is determined to be functionally impaired due to:
A. Inability to perform at least two (2) activities of daily living without substantial
human assistance, including verbal reminding, physical cueing, or supervision;
or,
B. A cognitive or other mental impairment, requiring substantial supervision
because the individual behaves in a manner that poses a serious health or safety
hazard to self or others.
"Funding Request" means the documentation submitted annually by each MA to the
SUA, in a format prescribed that includes updated budgetary information.
"Greatest Economic Need" means the need resulting from an income level at or below
the federal poverty guidelines.
"Greatest social need" means the need caused by non-economic factors, which
include: physical and mental disabilities; language barriers; and cultural, social, or
geographical isolation, including isolation caused by racial or ethnic status, that restricts
the ability of a person to perform normal daily tasks; or threatens the capacity of a
person to live independently.
"Health Promotion" means programs that promote health and well-being, such as
programs for multigenerational participation that may include, but not be limited to, art
therapy, dance therapy, music therapy, dental, hearing, immunization, medication
management screening and education, insurance counseling, physical fitness, and
vision.
"Homebound" means an older adult who is assessed as unable to leave his or her
home without human assistance, due to a disabling physical or emotional condition or an
environmental condition that may have a health related impact.
"Home-Delivered Meal" means the provision of a meal that meets all requirements as
described in Staff Manual Volume 10, of these rules to an eligible individual at that
person's home.
"Home Health Aide Services" means activities that provide basic health services to
older adults who can be cared for at home.
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"Homemaker Services" means providing assistance to persons who meet the eligibility
requirements for in-home services and who are unable to perform two or more of the
following instrumental activities of daily living: preparing meals, laundry, shopping for
personal items, managing money, using the telephone, or doing light housework.
"Home Modification" means specific adaptations, repairs, maintenance, renovation,
modifications, or improvements in a consumer's home setting.
"In-Kind Match" means services, goods, or property donated by a contractee or third
party, which are allowable costs of the contract, for which no cash reimbursement is
required, and which are applied to a requirement for the non-federal/non-state share of
program expenses.
"Instrumental Activities of Daily Living Skills" (IADLS) means activities necessary
for independent living, including: meal preparation, shopping, medication management,
housework, laundry, appointment management, money management, access resources,
transportation, and telephone.
"Internal Control" means processes designed to provide reasonable assurance
regarding the achievement of objectives in the following categories:
A. Effectiveness and efficiency of operations;
B. Reliability of financial reporting; and,
C. Compliance with applicable laws and regulations.
"Legal Assistance" means legal advice, counseling, and representation provided by an
attorney or other person acting under the supervision of an attorney.
"Local Ombudsman" means an individual trained and designated as qualified by the
state Long-Term Care Ombudsman to act as a representative of the office of the state
Long-Term Care Ombudsman, Section 26-11.5-103(2) C.R.S.
"Long-Term Care Ombudsman Services" means actions taken to identify, investigate,
or seek to resolve complaints made by or on behalf of an older adult who resides in a
long-term care facility, relating to actions, inactions, or decisions of providers or public
agencies that may adversely affect the health, safety, welfare, and rights of the
residents.
"Low-income" means incomes at or below the Federal poverty level.
"Means Test" means the use of an older adult's income or resources to determine
eligibility pursuant to these rules.
"Medical Food" means a food formulated to be consumed or administered entirely
under supervision of a physician, and intended for the specific dietary management of a
disease or condition for which distinctive nutritional requirements, based on recognized
scientific principles, are established by medical evaluation.
"Monitoring" means a review by the contractor agency of one or more contract
activities, that may include on-site visits to the contractor agency; and/or data collection
activities of contractors and subcontractors, for the purpose of assuring that the contract
is being administered in accordance with the Older Americans Act programs, and that
the purposes of the contract are being met.
"Native American" means an American Indian or a Native Hawaiian.
"Native Hawaiian" means any individual whose ancestors were natives of the area that
consists of the Hawaiian Islands prior to 1778.
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"Nonprofit" as applied to any agency, institution, or organization, means an agency,
institution, or organization owned and/or operated by one or more corporations or
associations whose profits must be used exclusively for the charitable, educational or
scientific purpose for which it was formed.
"Nutrition Counseling" means the provision of individualized advice and guidance, by
a registered dietitian in accordance with federal or state law and/or policy, to individuals
or their caregivers, for those individuals at nutritional risk because of their health or
nutritional history, dietary intake, medication use, or chronic illnesses. Nutrition
counseling addresses the options and methods for improving nutrition status.
"Nutrition Education" means a program to promote better health by providing accurate
and culturally sensitive nutrition, information and instruction to older adults and
caregivers in a group or individual setting overseen by a dietitian or individual of
comparable expertise.
"Nutrition Screening" means the process of identifying older adults at nutritional risk or
with malnutrition.
"Nutrition Services" means services and activities intended to provide older adults with
assistance in maintaining a well-balanced diet, including congregate and home-delivered
meals, nutrition screening, nutrition counseling and nutrition education.
"Nutrition Services Incentive Program (NSIP)" means a program carried out by the
United States Department of Health and Human Services to allot cash, commodities, or
a combination of cash and commodities to States and grantees providing nutrition
services to older adults.
"Nutrition Site" means a location where congregate meals are provided, and may
include senior centers, community buildings, elderly housing complexes, and public
schools.
"Nutritionist" is defined as an individual who has:
A. Completed the minimum of a Bachelor's degree granted by a United States
accredited college or university in foods and nutrition or home economics; and,
B. Professional, verifiable experience of a minimum of six months in nutrition
education, menu design, and menu analysis.
"Older adult" means a person who is sixty (60) years of age or older.
"Older Americans Act funds" means Federal funds authorized under the Older
Americans Act.
"On-Site Evaluation" means the process of reviewing of the direction, compliance with
regulations and policies and procedures, efficiency and effectiveness of a program or
part of a program through both discussion, and review of documentation with relevant
persons by the SUA or AM.
"Personal Care" means providing personal assistance, stand-by assistance,
supervision or cues for persons who meet the eligibility requirements for in-home
services.
"Place of residence" means a permanent declared dwelling place.
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"Planning and Service Area" (PSA) means a geographic area of the state, designated
by the State Unit on Aging for purposes of planning, development, delivery, and overall
administration of services under an area plan.
"Poverty level" is based on the federal poverty guidelines.
"Program" means a particular set of services and activities authorized and funded.
"Program Income" means any income generated by a contractee from activities, part
or all of the cost of which is borne by the funding.
"Reassurance" means the process of contacting an older adult on a regular basis in
order to provide comfort and/or help.
"Registered Dietician" means an individual who has:
A. Completed the minimum of a Bachelor's degree granted by a United States
regionally accredited college or university;
B. Met current academic requirements (Didactic Program in Dietetics) as
approved by the Commission on Accreditation/Approval for Dietetics
Education of the American Dietetic Association;
C. Completed a minimum of nine hundred (900) supervised practice hours of
pre- professional experience accredited/approved by the Commission on
Accreditation/Approval for Dietetics Education of the American Dietetic
Association. Requirements referenced in A, B, and C shall not include
any later amendments to or editions of the incorporated material. Copies
of these materials are available for public inspection by contacting:
Colorado Department of Human Services, Division of Aging and Adult
Services, Manager, State Unit on Aging, 1575 Sherman Street, Denver,
Colorado 80203; or any State Publication Depository Library.
D. Successfully completed the Registration Examination for Dietitians; and,
E. Accrued seventy-five (75) hours of approved continuing professional
education every five years.
"Resident" means any older adult who is sixty (60) years of age or older, who is a
current, prospective, or former patient or consumer of any long-term care facility.
"Rural" means any area that is not defined as urban.
"State Funding for Senior Services (SFSS)" means any Colorado (State) funding,
including Older Coloradans Act funding and general funds, provided for service provision
for eligible consumers in Colorado, with the exception of State matching funds for
Federal program funding. The program delivery system and eligibility criteria for these
State-funded consumer services is mirrored after the Older Americans Act.
Page 7 of 8
"State Unit on Aging" (SUA) means the unit in the State, designated by the Exeutive
Director to administer the Colorado State Plan on Aging including Older Americans Act
programs. In Colorado, this agency is the Colorado Department of Human Services,
Division of Aging and Adult Services.
"Subcontract" shall be defined the same as "contract", except that subcontracts are
awarded by Area Agencies on Aging (AAA). An agency to which a contract is made by
the AAA to provide services pursuant to the Older Americans Act requirements is a
subcontractee.
"Supplemental Nutrition Assistance Program" (SNAP) formerly known as 'The Food
Assistance Program' provides food benefits to low-income households. Electronic
Benefit Transfer (EBT) cards are issued and are used like cash at most grocery stores to
buy food, ensuring that recipients have access to a healthy diet.
"Supportive services" means those services as described in these rules and as
included in the State Plan on Aging.
"Transportation" (one-way trip) means going from one location to another in a vehicle.
It does not include any other activity.
"Urban Area" means a central place and its adjacent densely settled territories with a
combined minimum population of 50,000 or an incorporated place or a census
designated place with 20,000 or more inhabitants.
Page 8 of 8
EXHIBIT B
MISCELLANEOUS PROVISIONS
A. If the Contractor fails to comply with State policies or has materially failed to comply
with the terms of this contract, or if the Contractor fails to carry out required
corrective action by the specified dates the State may suspend, terminate a
contract, in whole or in part, or withhold or recover funds in whole or in part from
the Area Agency on Aging. The process for terminating contracts and withdrawal
of designation of an Area Agency on Aging shall be done in accordance with rules
and regulations governing this process, as outlined in Staff Manual Volume 10.
B. The State shall document any non-compliance and shall notify the Contractor of the
required corrective action and the dates when such action is due.
C. The State shall notify the Contractor in writing ten (10) working days prior to the
effective date of the suspension or termination or withholding or recovering of
funds of the reason(s) for the suspension or termination or withholding or
recovering of funds. Such notification shall explain the right of the Contractor to
appeal such decision as outlined in the appeals and fair hearing section of the Staff
Manual Volume 10.
D. If in the State's judgment an emergency situation exists, the State may suspend or
terminate the contract or withhold or recover funds effective immediately.
E. Suspensions shall remain in effect until the Contractor has taken corrective action
satisfactory to the State, or has given evidence satisfactory to the State that such
corrective action will be taken.
F. New obligations against the contract in question incurred by the Contractor during the
suspension period shall not be allowed unless the State expressly authorizes the
new obligation in the notice of suspension or an amendment to the notice of
suspension.
G. If a contract or part thereof remains in suspension until the end of the contract period,
such contract or part thereof shall be automatically terminated.
H. If a contract is suspended or terminated, the State or its agent may administer the
Area Plan during the suspension period or until a new Contractor is designated
and receives funding from the State.
I. Termination on other grounds shall occur if any of the following conditions exist:
1. The State and Contractor mutually agree upon the terms;
2. The State notifies the Contractor in writing of the termination, effective
date, and in case of partial termination, the portion of the funding to be
terminated;
3. The State fails to comply with the terms set forth in the contract
agreement; and,
4. The Contractor fails to carryout required corrective action by the dates
specified by the State.
J. If, in the case of a partial termination, the Contractor determines that the remaining
portion of the contract will not accomplish the purposes for which the contract was
awarded, the Contractor may terminate the contract in its entirety.
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K. When a contract is terminated, the Contractor shall not incur new obligations for the
terminated portion after the effective date, and shall cancel as many outstanding
obligations as possible. The State shall allow full credit to the Contractor for the
non-cancelable obligations properly incurred by the Contractor prior to
termination.
L. The State may refuse to contract with and may take legal action against any
Contractor that breaches its contract with the State or fails to use or expend
Federal and State funds in accordance with applicable laws, regulations, policies
and the State directives.
M.The State shall notify the Contractor in writing of the required corrective action(s) and
due date(s). The Contractor or sub-contractor shall not incur new obligations
during periods of suspension unless authorized. If Contractor or sub-contractor
remains in suspension until the end of the contract period, the contract will
automatically be terminated. The Contractor or sub-contractor shall be notified of
rights to a hearing, appeal or other administrative actions.
N. The State may require continued performance for a period of one (1) year at the same
rates and same terms specified in the Contract. If the State exercises the option,
it will provide written notice to Contractor at least sixty (60) days prior to the end
of the current contract term in a form substantially equivalent to Exhibit E,
Sample Option Letter. If exercised, the provisions of the Option Letter shall
become part of and be incorporated into the original contract. The total duration
of this Contract, including the exercise of any options under this clause, shall not
exceed four (4) years.
O.The State may increase or decrease the quantity of goods/services described in
section/schedule/exhibit based upon the rates established in the Contract. If the
State exercises the option, it will provide written notice to Contractor as least 60
sixty (60) days prior to the end of the current contract term in a form substantially
equivalent to Exhibit E, Sample Option Letter. Delivery/performance of the
goods/service shall continue at the same rates and terms. If exercised, the
provisions of the Option Letter shall become part of and be incorporated into the
original contract.
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EXHIBIT C
HIPAA BUSINESS ASSOCIATE ADDENDUM
This Business Associate Addendum ("Addendum") is a part of the Contract dated July 1,
2011 between the Department of Human Services, Aging and Adult Services and Weld County
Department of Human Services, Weld County Area Agency on Aging, contract number 12 IHA
30636. For purposes of this Addendum, the State is referred to as "Covered Entity" or"CE" and
the Contractor is referred to as "Associate". Unless the context clearly requires a distinction
between the Contract document and this Addendum, all references herein to "the Contract" or
"this Contract" include this Addendum.
RECITALS
A. CE wishes to disclose certain information to Associate pursuant to the terms of the
Contract, some of which may constitute Protected Health Information ("PHI") (defined
below).
B. CE and Associate intend to protect the privacy and provide for the security of PHI
disclosed to Associate pursuant to this Contract in compliance with the Health Insurance
Portability and Accountability Act of 1996, 42 U.S.C. § 1320d — 1320d-8 ("HIPAA") as
amended by the American Recovery and Reinvestment Act of 2009 ("ARRA")/HITECH
Act (P.L. 111-005), and its implementing regulations promulgated by the U.S.
Department of Health and Human Services, 45 C.F.R. Parts 160, 162 and 164 (the
"Privacy Rule") and other applicable laws, as amended.
C. As part of the HIPAA regulations, the Privacy Rule requires CE to enter into a contract
containing specific requirements with Associate prior to the disclosure of PHI, as set
forth in, but not limited to, Title 45, Sections 160.103, 164.502(e) and 164.504(e) of the
Code of Federal Regulations ("C.F.R.") and contained in this Addendum.
The parties agree as follows:
1. Definitions.
a. Except as otherwise defined herein, capitalized terms in this Addendum shall have
the definitions set forth in the HIPAA Privacy Rule at 45 C.F.R. Parts 160, 162
and 164, as amended. In the event of any conflict between the mandatory
provisions of the Privacy Rule and the provisions of this Contract, the Privacy
Rule shall control. Where the provisions of this Contract differ from those
mandated by the Privacy Rule, but are nonetheless permitted by the Privacy Rule,
the provisions of this Contract shall control.
b. "Protected Health Information" or "PHI" means any information, whether oral or
recorded in any form or medium: (i) that relates to the past, present or future
physical or mental condition of an individual; the provision of health care to an
individual; or the past, present or future payment for the provision of health care
to an individual; and (ii) that identifies the individual or with respect to which
there is a reasonable basis to believe the information can be used to identify the
individual, and shall have the meaning given to such term under the Privacy Rule,
including, but not limited to, 45 C.F.R. Section 164.501.
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c. "Protected Information" shall mean PHI provided by CE to Associate or created
or received by Associate on CE's behalf. To the extent Associate is a covered
entity under HIPAA and creates or obtains its own PHI for treatment, payment
and health care operations, Protected Information under this Contract does not
include any PHI created or obtained by Associate as a covered entity and
Associate shall follow its own policies and procedures for accounting, access and
amendment of Associate's PHI.
2. Obligations of Associate.
a. Permitted Uses. Associate shall not use Protected Information except for the
purpose of performing Associate's obligations under this Contract and as
permitted under this Addendum. Further, Associate shall not use Protected
Information in any manner that would constitute a violation of the Privacy Rule if
so used by CE, except that Associate may use Protected Information: (i) for the
proper management and administration of Associate; (ii) to carry out the legal
responsibilities of Associate; or (iii) for Data Aggregation purposes for the Health
Care Operations of CE. Additional provisions, if any, governing permitted uses
of Protected Information are set forth in Attachment A to this Addendum.
Associate accepts full responsibility for any penalties incurred as a result of
Associate's breach of the Privacy Rule.
b. Permitted Disclosures. Associate shall not disclose Protected Information in any
manner that would constitute a violation of the Privacy Rule if disclosed by CE,
except that Associate may disclose Protected Information: (i) in a manner
permitted pursuant to this Contract; (ii) for the proper management and
administration of Associate; (iii) as required by law; (iv) for Data Aggregation
purposes for the Health Care Operations of CE; or (v) to report violations of law
to appropriate federal or state authorities, consistent with 45 C.P.R. Section
164.5026)(1). To the extent that Associate discloses Protected Information to a
third party, Associate must obtain, prior to making any such disclosure: (i)
reasonable assurances from such third party that such Protected Information will
be held confidential as provided pursuant to this Addendum and only disclosed as
required by law or for the purposes for which it was disclosed to such third party;
and (ii) an agreement from such third party to notify Associate within two
business days of any breaches of confidentiality of the Protected Information, to
the extent it has obtained knowledge of such breach. Additional provisions, if
any, governing permitted disclosures of Protected Information are set forth in
Attachment A.
c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are
necessary to prevent the use or disclosure of Protected Information other than as
permitted by this Contract. Associate shall comply with the requirements of the
Security Rules, 164.308, 164.310, 164.312, and 164.316. Associate shall
maintain a comprehensive written information privacy and security program that
includes administrative, technical and physical safeguards appropriate to the size
and complexity of the Associate's operations and the nature and scope of its
activities.
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d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing
any use or disclosure of Protected Information other than as provided for by this
Contract within five (5) business days of becoming aware of such use or
disclosure.
e. Associate's Agents. If Associate uses one or more subcontractors or agents to
provide services under the Contract, and such subcontractors or agents receive or
have access to Protected Information, each subcontractor or agent shall sign an
agreement with Associate containing substantially the same provisions as this
Addendum and further identifying CE as a third party beneficiary with rights of
enforcement and indemnification from such subcontractors or agents in the event
of any violation of such subcontractor or agent agreement. Associate shall
implement and maintain sanctions against agents and subcontractors that violate
such restrictions and conditions and shall mitigate the effects of any such
violation.
f. Access to Protected Information. Associate shall make Protected Information
maintained by Associate or its agents or subcontractors in Designated Record Sets
available to CE for inspection and copying within ten (10) business days of a
request by CE to enable CE to fulfill its obligations to permit individual access to
PHI under the Privacy Rule, including, but not limited to, 45 C.F.R. Section
164.524.
g. Amendment of PHI. Within ten business (10) days of receipt of a request from
CE for an amendment of Protected Information or a record about an individual
contained in a Designated Record Set, Associate or its agents or subcontractors
shall make such Protected Information available to CE for amendment and
incorporate any such amendment to enable CE to fulfill its obligations with
respect to requests by individuals to amend their PHI under the Privacy Rule,
including, but not limited to, 45 C.F.R. Section 164.526. If any individual
requests an amendment of Protected Information directly from Associate or its
agents or subcontractors, Associate must notify CE in writing within five (5)
business days of receipt of the request. Any denial of amendment of Protected
Information maintained by Associate or its agents or subcontractors shall be the
responsibility of CE.
h. Accounting Rights. Within ten (10) business days of notice by CE of a request
for an accounting of disclosures of Protected Information, Associate and its agents
or subcontractors shall make available to CE the information required to provide
an accounting of disclosures to enable CE to fulfill its obligations under the
Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.528. As set
forth in, and as limited by, 45 C.F.R. Section 164.528, Associate shall not provide
an accounting to CE of disclosures: (i) to carry out treatment, payment or health
care operations, as set forth in 45 C.F.R. Section 164.506; (ii) to individuals of
Protected Information about them as set forth in 45 C.F.R. Section 164.502; (iii)
pursuant to an authorization as provided in 45 C.F.K. Section 164.508; (iv) to
persons involved in the individual's care or other notification purposes as set forth
in 45 C.F.R. Section 164.510; (v) for national security or intelligence purposes as
set forth in 45 C.F.R. Section 164.512(k)(2); (vi) to correctional institutions or
law enforcement officials as set forth in 45 C.F.R. Section 164.512(k)(5); (vii)
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incident to a use or disclosure otherwise permitted by the Privacy Rule; (viii) as
part of a limited data set under 45 C.F.R. Section 164.514(e); or (ix) disclosures
prior to April 14, 2003. Associate agrees to implement a process that allows for an
accounting to be collected and maintained by Associate and its agents or
subcontractors for at least six (6) years prior to the request, but not before the
compliance date of the Privacy Rule. At a minimum, such information shall
include: (i) the date of disclosure; (ii) the name of the entity or person who
received Protected Information and, if known, the address of the entity or person;
(iii) a brief description of Protected Information disclosed; and (iv) a brief
statement of purpose of the disclosure that reasonably informs the individual of
the basis for the disclosure, or a copy of the individual's authorization, or a copy
of the written request for disclosure. In the event that the request for an
accounting is delivered directly to Associate or its agents or subcontractors,
Associate shall within five (5) business days of the receipt of the request forward
it to CE in writing. It shall be CE's responsibility to prepare and deliver any such
accounting requested. Associate shall not disclose any Protected Information
except as set forth in Section 2(b) of this Addendum.
Governmental Access to Records. Associate shall make its internal practices,
books and records relating to the use and disclosure of Protected Information
available to the Secretary of the U.S. Department of Health and Human Services
(the "Secretary"), in a time and manner designated by the Secretary, for purposes
of determining CE's compliance with the Privacy Rule. Associate shall provide to
CE a copy of any Protected Information that Associate provides to the Secretary
concurrently with providing such Protected Information to the Secretary.
j. Minimum Necessary. Associate (and its agents or subcontractors) shall only
request, use and disclose the minimum amount of Protected Information
necessary to accomplish the purpose of the request, use or disclosure, in
accordance with the Minimum Necessary requirements of the Privacy Rule
including, but not limited to 45 C.F.R. Sections 164.502(b) and 164.514(d).
k. Data Ownership. Associate acknowledges that Associate has no ownership rights
with respect to the Protected Information.
1. Retention of Protected Information. Except upon termination of the Contract as
provided in Section 4(d) of this Addendum, Associate and its subcontractors or agents
shall retain all Protected Information throughout the term of this Contract and shall
continue to maintain the information required under Section 2(h) of this Addendum for a
period of six (6) years.
m. Associate's Insurance. Associate shall maintain casualty and liability insurance
to cover loss of PHI data and claims based upon alleged violations of privacy
rights through improper use or disclosure of PHI. All such policies shall meet or
exceed the minimum insurance requirements of the Contract (e.g., occurrence
basis, combined single dollar limits, annual aggregate dollar limits, additional
insured status and notice of cancellation).
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n. Notification of Breach. During the term of this Contract, Associate shall notify
CE within two business days of any suspected or actual breach of security,
intrusion or unauthorized use or disclosure of PHI and/or any actual or suspected
use or disclosure of data in violation of any applicable federal or state laws or
regulations Such notice shall include the identification of each individual whose
unsecured PHI has been, or is reasonably believed to have been accessed,
acquired or disclosed during the breach. . Associate shall take (i) prompt
corrective action to cure any such deficiencies and (ii) any action pertaining to
such unauthorized disclosure required by applicable federal and state laws and
regulations.
o. Audits, Inspection and Enforcement. Within ten (10) business days of a written
request by CE, Associate and its agents or subcontractors shall allow CE to
conduct a reasonable inspection of the facilities, systems, books, records,
agreements, policies and procedures relating to the use or disclosure of Protected
Information pursuant to this Addendum for the purpose of determining whether
Associate has complied with this Addendum; provided, however, that: (P
Associate and CE shall mutually agree in advance upon the scope, timing and
location of such an inspection; (ii) CE shall protect the confidentiality of all
confidential and proprietary information of Associate to which CE has access
during the course of such inspection; and (iii) CE shall execute a nondisclosure
agreement, upon terms mutually agreed upon by the parties, if requested by
Associate. The fact that CE inspects, or fails to inspect, or has the right to inspect,
Associate's facilities, systems, books, records, agreements, policies and
procedures does not relieve Associate of its responsibility to comply with this
Addendum, nor does CE's (i) failure to detect or (ii) detection, but failure to
notify Associate or require Associate's remediation of any unsatisfactory
practices, constitute acceptance of such practice or a waiver of CE's enforcement
rights under the Contract.
P. Safeguards During Transmission. Associate shall be responsible for using
appropriate safeguards to maintain and ensure the confidentiality, privacy and
security of Protected Information transmitted to CE pursuant to the Contract, in
accordance with the standards and requirements of the Privacy Rule, until such
Protected Information is received by CE, and in accordance with any
specifications set forth in Attachment A.
q. Restrictions and Confidential Communications. Within ten (10) business days of
notice by CE of a restriction upon uses or disclosures or request for confidential
communications pursuant to 45 C.F.R. 164.522, Associate will restrict the use or
disclosure of an individual's Protected Information, provided Associate has
agreed to such a restriction. Associate will not respond directly to an individual's
requests to restrict the use or disclosure of Protected Information or to send all
communication of Protect Information to an alternate address. Associate will
refer such requests to the CE so that the CE can coordinate and prepare a timely
response to the requesting individual and provide direction to Associate.
Page 5 of 10
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev.07/10
3. Obligations of CE.
a. Safeguards During Transmission. CE shall be responsible for using appropriate
safeguards to maintain and ensure the confidentiality, privacy and security of PHI
transmitted to Associate pursuant to this Contract, in accordance with the
standards and requirements of the Privacy Rule, until such PHI is received by
Associate, and in accordance with any specifications set forth in Attachment A.
b. Notice of Changes. CE shall provide Associate with a copy of its notice of
privacy practices produced in accordance with 45 C.F.R. Section 164.520, as well
as any subsequent changes or limitation(s) to such notice, to the extent such
changes or limitations may effect Associate's use or disclosure of Protected
Information. CE shall provide Associate with any changes in, or revocation of,
permission to use or disclose Protected Information, to the extent it may affect
Associate's permitted or required uses or disclosures. To the extent that it may
affect Associate's permitted use or disclosure of PHI, CE shall notify Associate of
any restriction on the use or disclosure of Protected Information that CE ha
agreed to in accordance with 45 C.F.R. Section 164.522. CE may effectuate any
and all such notices of non-private information via posting on CE's web site.
Associate shall review CE's designated web site for notice of changes to CE's
HIPAA privacy policies and practices on the last day of each calendar quarter.
4. Termination.
a. Material Breach. In addition to any other provisions in the Contract regarding
breach, a breach by Associate of any provision of this Addendum, as determined
by CE, shall constitute a material breach of this Contract and shall provide
grounds for immediate termination of this Contract by CE pursuant to the
provisions of the Contract covering termination for cause, if any. If the Contract
contains no express provisions regarding termination for cause, the following
terms and conditions shall apply:
(1) Default. If Associate refuses or fails to timely perform any of the
provisions of this Contract, CE may notify Associate in writing of the non-
performance, and if not promptly corrected within the time specified, CE
may terminate this Contract. Associate shall continue performance of this
Contract to the extent it is not terminated and shall be liable for excess
costs incurred in procuring similar goods or services elsewhere.
(2) Associate's Duties. Notwithstanding termination of this Contract, and
subject to any directions from CE, Associate shall take timely, reasonable
and necessary action to protect and preserve property in the possession of
Associate in which CE has an interest.
(3) Compensation. Payment for completed supplies delivered and accepted
by CE shall be at the Contract price. In the event of a material breach
under paragraph 4a, CE may withhold amounts due Associate as CE
deems necessary to protect CE against loss from third party claims of
improper use or disclosure and to reimburse CE for the excess costs
incurred in procuring similar goods and services elsewhere.
Page 6 of 10
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev.07/10
(4) Erroneous Termination for Default. If after such termination it is
determined, for any reason, that Associate was not in default, or that
Associate's action/inaction was excusable, such termination shall be
treated as a termination for convenience, and the rights and obligations of
the parties shall be the same as if this Contract had been terminated for
convenience, as described in this Contract.
b. Reasonable Steps to Cure Breach. If CE knows of a pattern of activity or practice
of Associate that constitutes a material breach or violation of the Associate's
obligations under the provisions of this Addendum or another arrangement and
does not terminate this Contract pursuant to Section 4(a), then CE shall take
reasonable steps to cure such breach or end such violation, as applicable. If CE's
efforts to cure such breach or end such violation are unsuccessful, CE shall either
(i) terminate the Contract, if feasible or (ii) if termination of this Contract is not
feasible, CE shall report Associate's breach or violation to the Secretary of the
Department of Health and Human Services.
c. Judicial or Administrative Proceedings. Either party may terminate the Contract,
effective immediately, if(i) the other party is named as a defendant in a criminal
proceeding for a violation of HIPAA, the I-IIPAA Regulations or other security or
privacy laws or (ii) a finding or stipulation that the other party has violated any
standard or requirement of HIPAA, the HIPAA Regulations or other security or
privacy laws is made in any administrative or civil proceeding in which the party
has been joined.
d. Effect of Termination.
(1) Except as provided in paragraph (2) of this subsection, upon termination
of this Contract, for any reason, Associate shall return or destroy all
Protected Information that Associate or its agents or subcontractors still
maintain in any form, and shall retain no copies of such Protected
Information. If Associate elects to destroy the PHI, Associate shall certify
in writing to CE that such PHI has been destroyed.
(2) If Associate believes that returning or destroying the Protected
Information is not feasible, Associate shall promptly provide CE notice of
the conditions making return or destruction infeasible. Upon mutual
agreement of CE and Associate that return or destruction of Protected
Information is infeasible, Associate shall continue to extend the
protections of Sections 2(a), 2(b), 2(c), 2(d) and 2(e) of this Addendum to
such information, and shall limit further use of such PHI to those purposes
that make the return or destruction of such PHI infeasible.
5. Injunctive Relief CE shall have the right to injunctive and other equitable and legal relief against Associate or any of
its subcontractors or agents in the event of any use or disclosure of Protected Information in violation of this
Contract or applicable law.
6. No Waiver of Immunity. No term or condition of this Contract shall be construed or interpreted as a waiver,express
or implied, of any of the immunities, rights, benefits, protection, or other provisions of the Colorado
Governmental Immunity Act, CRS 24-10-101 e/seq. or the Federal Tort Claims Act, 28 U.S.C. 2671 e1 seg. as
applicable,as now in effect or hereafter amended.
Page 7 of 10
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev.07/10
7. Limitation of Liability. Any limitation of Associate's liability in the Contract shall be
inapplicable to the terms and conditions of this Addendum.
8. Disclaimer. CE makes no warranty or representation that compliance by Associate with
this Contract, HIPAA or the HIPAA Regulations will be adequate or satisfactory for
Associate's own purposes. Associate is solely responsible for all decisions made by
Associate regarding the safeguarding of PHI.
9. Certification. To the extent that CE determines an examination is necessary in order to
comply with CE's legal obligations pursuant to HIPAA relating to certification of its
security practices, CE or its authorized agents or contractors, may, at CE's expense,
examine Associate's facilities, systems, procedures and records as may be necessary for
such agents or contractors to certify to CE the extent to which Associate's security
safeguards comply with HIPAA, the HIPAA Regulations or this Addendum.
10. Amendment.
a. Amendment to Comply with Law. The parties acknowledge that state and federal
laws relating to data security and privacy are rapidly evolving and that
amendment of this Addendum may be required to provide for procedures to
ensure compliance with such developments. The parties specifically agree to take
such action as is necessary to implement the standards and requirements of
HIPAA, the Privacy Rule, and the Final HIPAA Security regulations at 68 Fed.
Reg. 8334 (Feb20, 2003), 45 C.F.R. § 164.314 and other applicable laws relating
to the security or privacy of PHI. The parties understand and agree that CE must
receive satisfactory written assurance from Associate that Associate will
adequately safeguard all Protected Information. Upon the request of either party,
the other party agrees to promptly enter into negotiations concerning the terms of
an amendment to this Addendum embodying written assurances consistent with
the standards and requirements of HIPAA, the Privacy Rule or other applicable
laws. CE may terminate this Contract upon thirty (30) days written notice in the
event (i) Associate does not promptly enter into negotiations to amend this
Contract when requested by CE pursuant to this Section or (ii) Associate does not
enter into an amendment to this Contract providing assurances regarding the
safeguarding of PHI that CE, in its sole discretion, deems sufficient to satisfy the
standards and requirements of HIPAA and the Privacy Rule.
b. Amendment of Attachment A. Attachment A may be modified or amended by
mutual agreement of the parties in writing from time to time without formal amendment
of this Addendum.
11. Assistance in Litigation or Administrative Proceedings. Associate shall make itself, and
any subcontractors, employees or agents assisting Associate in the performance of its
obligations under the Contract, available to CE, at no cost to CE up to a maximum of 30
hours, to testify as witnesses, or otherwise, in the event of litigation or administrative
proceedings being commenced against CE, its directors, officers or employees based
upon a claimed violation of HIPAA, the Privacy Rule or other laws relating to security
and privacy or PHI, except where Associate or its subcontractor, employee or agent is a
named adverse party.
12. No Third Party Beneficiaries. Nothing express or implied in this Contract is intended to
confer, nor shall anything herein confer, upon any person other than CE, Associate and
Page 8 of 10
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev.07/10
their respective successors or assigns, any rights, remedies, obligations or liabilities
whatsoever.
13. Interpretation and Order of Precedence. The provisions of this Addendum shall prevail
over any provisions in the Contract that may conflict or appear inconsistent with any
provision in this Addendum. Together, the Contract and this Addendum shall be
interpreted as broadly as necessary to implement and comply with HIPAA and the
Privacy Rule. The parties agree that any ambiguity in this Contract shall be resolved in
favor of a meaning that complies and is consistent with HIPAA and the Privacy Rule.
This Contract supercedes and replaces any previous separately executed HIPAA
addendum between the parties.
14. Survival of Certain Contract Terms. Notwithstanding anything herein to the contrary,
Associate's obligations under Section 4(d) ("Effect of Termination") and Section 12 ("No
Third Party Beneficiaries") shall survive termination of this Contract and shall be
enforceable by CE as provided herein in the event of such failure to perform or comply
by the Associate. This Addendum shall remain in effect during the term of the Contract
including any extensions.
15. Representatives and Notice.
a Representatives. For the purpose of the Contract, the individuals identified
elsewhere in this Contract shall be the representatives of the respective parties. If
no representatives are identified in the Contract, the individuals listed below are
hereby designated as the parties' respective representatives for purposes of this
Contract. Either party may from time to time designate in writing new or
substitute representatives.
b. Notices. All required notices shall be in writing and shall be hand delivered or
given by certified or registered mail to the representatives at the addresses set
forth below.
State/Covered Entity Representative:
Name: Pauline Burton
Title: Deputy Executive Director
Department and Division: Colorado Department of Human Services
Office of Self-Sufficiency and Independence
Address: 1575 Sherman 8th Floor
Denver, CO 80203
Contractor/Business Associate Representative:
Name: Judy A. Griego
Title: Director
Department and Division: Weld County Department of Human Services, Weld.County
Area Agency on Aging
Address: 315 C N. 11th Ave., P.O. Box 1805
Greeley, Co 80632
Page 9 of 10
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev.07/10
ATTACHMENT A TO EXHIBIT C
This Business Associate Addendum ("Addendum") is a part of the Contract dated July 1,
2011 between the Department of Human Services, Aging and Adult Services and Weld County
Department of Human Services, Weld County Area Agency on Aging, contract number 12 IHA
30636. For purposes of this Addendum, the State is referred to as "Covered Entity" or "CE" and
the Contractor is referred to as "Associate". Unless the context clearly requires a distinction
between the Contract document and this Addendum, all references herein to "the Contract" or
"this Contract" include this Addendum.
1. Additional Permitted Uses. In addition to those purposes set forth in Section 2(a) of the
Addendum, Associate may use Protected Information as follows:
None except as otherwise directed in writing by the State
2. Additional Permitted Disclosures. In addition to those purposes set forth in Section 2(b)
of the Addendum, Associate may disclose Protected Information as follows:
None except as otherwise directed in writing by the State
3. Subcontractor(s). The parties acknowledge that the following subcontractors or agents of
Associate shall receive Protected Information in the course of assisting Associate in the
performance of its obligations under this Contract:
None except as otherwise directed in writing by the State
4. Receipt. Associate's receipt of Protected Information pursuant to this Contract shall be
deemed to occur as follows, and Associate's obligations under the Addendum shall commence
with respect to such PHI upon such receipt:
Upon the effective date of the contract.
5. Additional Restrictions on Use of Data. CE is a Business Associate of certain other
Covered Entities and, pursuant to such obligations of CE, Associate shall comply with the
following restrictions on the use and disclosure of Protected Information:
As may be directed in writing by the State
6. Additional Terms. [This section may include specifications for disclosure format,
method of transmission, use of an intermediary, use of digital signatures or PKI, authentication,
additional security of privacy specifications, de-identification or re-identification of data and
other additional terms.]
None
Page 10 of 10
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev.07/10
EXHIBIT D
SAMPLE AAA FUNDING REQUEST
(SEE FOLLOWING PAGES)
Page 1 of 6
TITLE III FUNDING REQUEST
Return to Instructions Region 0
Funding Award* 0
Revision* 0
Date
Funding Request Period: from„ulv t.2011 to June 30,,•2012
Funding
Transfer Request
Potential Award R- •uest
ADMINISTRATION
AMAIN CARRYOVER $ 0 $ C}
ADMIN NEW ALLOC(FFY05) $ 0 $ 0
TOTAL ADMIN $ 0 $ 0
SERVICES
PART B NEW ALLOC (FFY05) $ $ a
TOTAL-PART B' $ ,,i' -" „,.'y .`.` 0
PART Cl NEW ALLOC(FFY05) $ O $ O
TOTAL PART Cf \ ;`' .$ 0
PART C2 NEW ALLOCcIFFY05) 4 F {`' $ O
TOTAL', }--C2 '.;:`,,.‘:'4',,' 71-1..4 :1:7,,,l- ;", 'S L. $re- -3, V
PART D NEW ALLOC(FFY05) `j " $ D
TOTAL PARTD Ni.4-'I S ti - 0
PART E NEW ALLOC (FFY05) $ 0 $ O
TdTAL '.#SRT.?.,..` :``�;' _ :'-*'�a a4"-�' Z, .x t
TOTAL SVC.NEW ALLOC 444.;',.;!'t.-:^ -, 'I % A`.14, - M F
TOTAL SERVICES $i -e -$ .. $ 0
Title VII Funding Request
Total Programmatic Programmatic
Award Transfer Total
EAP NEW ALLOC(FFY05) $ -\$ - S 0
rorrAL A WAnD '-'-',*4-',; '-- : fir ` , eet- ,,- .,Y VA,rO7-..,:',.:4*-s7.1 v;sr* <„:0
LTC OMB NEW ALLO SFFY05) $ 0 $ $ 0
TOTAL OvB WARD -,1:4:,7:: yea r., .,• u ,,4 , 0
TOTAL TITLE VII :$ 0 $ - $ 0
Page 2 of 6
Return to Instructions Region 0
Fiscal Year
Revision# 0
Date
AREA AGENCY ADMINISTRATION BUDGET
Line Item Budget Federal Budget Local Cash et In-Kind Budget Total Budget
Personnel $ - $ - $Travel $ - $ � - $
E•ui. era $ 1u� - - $
Other Direct ►il \�� $ -•
$
ndired $ `� \ '.,- - - $
Total
Total Admin from AAS 200
' Match must be 25%of total budget
(Match=Local Cash Budget+In-Kind budget)
Federal Funds= 3= $ - This is the minimum
match required-
' Actual Match= $ -
Over/(Under)Match
Page 3 of 6
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EXHIBIT E
SAMPLE OPTION LETTER
Exhibit
SAMPLE OPTION LETTER
Date: State Fiscal Year: Option Letter No. CMS Routing #
1)---OP-TIONS:Choose all applicable options-listed-in-§l and an-§F-and-delete-the-restTalsso-delete all-yellow
highlighted text].
a Option to renew only(for an additional term)
b. Change in the amount of goods within current term
c. Change in amount of goods in conjunction with renewal for additional term
d. Level of service change within current term
e. Level of service change in conjunction with renewal for additional term
2) REQUIRED PROVISIONS.All Option Letters shall contain the appropriate provisions set forth below:
For use with Options 1(a-e): In accordance with Section(s) of the Original Contract routing number
between the State of Colorado, Department of Human Services, and Contractor's Name,the State
hereby exercises its option for an additional term beginning Insert start date and ending on Insert ending date
at a cost/price specified in Section ,AND/OR an increase/decrease in the amount of goods/services at
the same rate(s) as specified in Identify the Section, Schedule,Attachment, Exhibit etc.
For use with all Options: The amount of the current Fiscal Year contract value is increased/decreased by $
amount of change to a new contract value of Insert New$Amt to as consideration for services/goods
ordered under the contract for the current fiscal year indicate Fiscal Year. The first sentence in Section
is hereby modified accordingly. The total contract value including all previous amendments,option
letters, etc. is Insert New$Amt.
3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Human Services
Reggie Bicha, Executive Director
By: Name&Title of Person Signing for Agency or IHE
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State Contracts.This Contract 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.
STATE CONTROLLER
David J. McDermott, CPA
By:
Vain Gimple
Date:
Effective Date: 1/6/09-Rev 8/25/09
Page 1 of 1
•
• EXHIBIT F
.♦
FUNDING REQUEST NUMBER 1 SFY12
2012 TITLE III FUNDING REQUEST
Region 2B
Funding # 02B-88
Revision# 1
Date 7/1/2011
Fundin. Re.uest Period: from Jul 1 2010 throu.h June 30 2011
ADMINISTRATION Potential Fundin• nintflundin. Re.uest
•dmin Reallocated $ - • $ -
•DMINNEWALLOC $ 67,460 $ - $�- -- 67,460
`'.b .. .'-'21177c47:171,1177•71-
.: "s :...,er 4n ' B � .,u .s :-". A7 �._:$. . ;8
:t
SERVICES
REALLOCATED $ 1,326 $ 1,326
PART B NEW ALLOC $ 198,371 $ - $ 198,371
REALLOCATED $ 1,559 $ 1,559
PART C1 NEW ALLOC $ 243,594 $ - $ 243,594
REALLOCATED $ 529 $ 529
PART C2 NEW ALLOC $ 122,747 $ - $ 122,747
REALLOCATED -
PART D NEW ALLOC $ 11,912 $ 11,912
NA $ - $ -
REALLOCATED $ 344 $ 344
PART E NEW ALLOC $ 73,802 $ 73,802
OTAL SVC CARRY
OVER Vis.
OTAL SVC. NEW ALLOC y , r +�' - I re-117 4' �{.y'i[`�
P84:fi I ..d b`�•u ��ah� ...,�f _.. ...,l LC_._.....-� ....' s ipta... i... _._ u ...9 ' .:_,.._�4Gd..W.
Title VII Funding Request
Total Programmatic Programmatic
Fundin. Transfer Total
EAP REALLOCATED $ 33 $ - $ 33
EAP NEW ALLOC $ 2,005 $ - $ 2,005
,...f ni^t apt • E's p,�;. � > ,._. `�'tIS
LTC OMB REALLOCATED $ 69 $ $ 69
LTC OMB NEW ALLOC $ 7,029 $ - $ 7,029
• .;tl�,• ' 1.— ,^�1' • ma m"n t�,k' ' .fL '. ., .M„ .. .�.,y 1£ ':.a n,,.�r:4:Pt
Page 1 of 2
•i EXHIBIT F
FUNDING REQUEST NUMBER 1 SFY12
Weld County Area Agency On Aging Northern Region
State Funding Request:
State Fiscal Year: 2012
Total Budget Total Revised
State Funding For Senior Services: (SFSS) Award Move Bud.et
VAILABLE SERVICE FUNDS $368,778 $0 $368,778
•VAILABLE ADMINISTRATIVE FUNDS $40,975 $0 $40,975
National Famil Care.fiver General Fund Match)* $6,605 _ ' $6,605
OTAL: $416,358 $0 $416,358
Page 2 of 2
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