HomeMy WebLinkAbout20111508.tiff RESOLUTION
RE: APPROVE CONTRACT FOR PARTICIPATION AS A PRIMARY CARE MEDICAL
PROVIDER IN ACCOUNTABLE CARE COLLABORATIVE PROGRAM 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 Participation as a Primary
Care Medical Provider in the Accountable Care Collaborative Program between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Weld County Department of Public Health and Environment, and the Colorado
Department of Health Care Policy and Financing commencing upon full execution, and ending
December 31, 2020, 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 Participation as a Primary Care Medical Provider
in the Accountable Care Collaborative Program between the County of Weld, State of Colorado,
by and through the Board of County Commissioners of Weld County, on behalf of the Weld
County Department of Public Health and Environment, and the Colorado Department of Health
Care Policy and Financing be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said contract.
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() 2011-1508
-�0 1 1 l l HL0038
CONTRACT FOR PARTICIPATION AS A PRIMARY CARE MEDICAL PROVIDER IN
ACCOUNTABLE CARE COLLABORATIVE PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 20th day of June, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLO ADO
ATTEST: 0, ;. .! /
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• rbara Kirkmeyer, air
Weld County Clerk to the B to I a`�'���''•
CUSED
'*' an P. Conway, Pro-Tem
BY:
Deputy Clerk to the Board �� !` EXCUSED
F. Garcia
AP D M: n1
avid E. Long
sun Attorney �ar5
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Date of signature:
2011-1508
HL0038
1 8 6 1 20 Memorandum
TO: Barbara Kirkmeyer, Chair
Board of County Commissioners
W E L DEC O U N T Y FROM: Mark E. Wallace, MD, MPH, Director
I ' Department of Public Health and
uEnvironment c °\"11L _
DATE: June 1, 2011 1 V
SUBJECT: Contract for Medicaid Accountable Care
Collaborative: Colorado Department of
Health Care Policy & Financing
Enclosed for Board review and approval is a contract between the Colorado Department of
Health Care Policy & Financing (HCPF) and the Board of County Commissioners of Weld
County on behalf of the Department of Public Health and Environment (Department). This
contract is for medical home and care management services for women served under the
Department's Women's Health and Family Planning programs. The Department is currently
reimbursed for eligible services through the Medicaid program under a master agreement with
HCPF.
If approved, the Department will receive a per member per month payment for each eligible
client enrolled in the program. Department staff members will continue to provide medical
home, care navigation, referral management, and care coordination services to Medicaid
beneficiaries enrolled in the program. The program is designed to improve quality while
lowering the costs of care by decreasing avoidable hospital admissions, preventable emergency
department visits, and utilization of high cost—low yield diagnostic tests. The Department would
participate in the program in collaboration with area providers including Sunrise Community
Health and Banner Health.
The term of this contract is until December 31, 2020 unless terminated earlier by either party.
Funding for this contract depends on the number of clients who voluntarily enroll in the program.
The Department will receive $4 per member per month. The Department anticipates serving less
than 200 clients per month under the program. I recommend approval of the contract.
Enclosure
2011-1508
CO�POO DEPART,he2�
° COLORADO DEPARTMENT OF HEALTH CARE POLICY & FINANCING
z 1570 Grant Street, Denver,CO 80203-1818 •(303)866-2993• (303)866-4411 Fax•(303)866-3883 TTY
O.9A11rest P John W.Hickenlooper,Governor • Susan E.Birch MBA,BSN,RN,Acting Executive Director
RFPOLIC &
August 3, 2011
Dear Primary Care Medical Provider,
Enclosed is a copy of your fully executed Primary Care Medical Provider(PCMP) contract with the
Department of Health Care Policy& Financing (HCPF).
We are excited you have chosen to be a part of the Accountable Care Collaborative program and provide
medical home services to Medicaid Members. If you have questions or concerns, please don't hesitate to
contact your Regional Care Collaborative Organization (RCCO):
Regional Care Collaborative Organizations
County RCCO
Region 1 Rocky Mountain Health Plans
Archuleta,Delta,Dolores,Eagle,Garfield,Grand,Gunnison,Hinsdale, Customer Service:
Jackson, La Plata,Larimer,Mesa,Moffat, Montezuma,Montrose,Ouray, 970-254-5771/800-667-6434
Pitkin,Rio Blanco,Routt,San Juan,San Miguel,Summit
Region 2 Colorado Access
Cheyenne,Kit Carson,Lincoln,Logan,Morgan,Phillips,Sedgwick, Customer Service:
Washington,Weld,Yuma 303-368-0035/855-267-2094
Region 3 Colorado Access
Adams,Arapahoe,Douglas Customer Service:
303-368-0037/855-267-2095
Region 4 Integrated Community Health Partners
Alamosa,Baca,Bent,Chaffee,Conejos,Costilla,Crowley,Custer,Fremont, Customer Service:
Huerfano,Kiowa,Lake,Las Animas,Mineral,Otero, Prowers,Pueblo,Rio 855-959-7340
Grande,Saguache
Region 5 Colorado Access
Denver Customer Service:
303-368-0038/855-384-7926
Region 6 Colorado Community Health Alliance
Boulder,Broomfield,Clear Creek,Gilpin,Jefferson Customer Service:
303-260-2888/877-919-2888
Region 7 Community Care of Central Colorado
El Paso,Elbert,Park,Teller Customer Service:
866-938-5091
"The mission of the Department of Health Care Policy&Financing is to improve access to cost-effective,quality health care services for Coloradans"
colorado.gov/hcpf
Finalized PCMP contract letter
Page 2 of 2
Your HCPF contract manager is also available to provide assistance:
• Region 1 and 4- Kathryn Jantz 303-866-5972/kathryn.jantz@state.co.us
• Region 2, 3, and 5—Curtis Johnson 303-866-3830/curtis.johnson@state.co.us
• Region 6 and 7—Greg Trollan 303-866-3674/greg.trollan@state.co.us
We look forward to working with you and the Regional Care Collaborative Organization in your area to
improve health outcomes for program Members and control the cost of care.
Sincerely,
The ACC Contracting Team
"The mission of the Department of Health Care Policy&Financing is to improve access to cost-effective,quality health care services for Coloradans"
colorado.gov/hcpf
it-O04/t/
STATE OF COLORADO
Department of Health Care Policy and Financing
Contract with
Weld County Government (dba Weld County Department of Public Health)
For Participation as a Primary Care Medical Provider in the Accountable
Care Collaborative Program
TABLE OF CONTENTS
1. PARTIES 1
2. EFFECTIVE DATE AND NOTICE OF NONLIABILITY 1
3. RECITALS 2
4. DEFINITIONS 2
5. TERM 2
6. STATEMENT OF WORK 3
7. PAYMENTS TO CONTRACTOR 3
8. REPORTING NOTIFICATION 4
9. CONTRACTOR RECORDS 4
10. CONFIDENTIAL INFORMATION 5
11. CONFLICTS OF INTEREST 6
12. REPRESENTATIONS AND WARRANTIES 6
13. INSURANCE 7
14. BREACH 7
15. REMEDIES 7
16. NOTICES AND REPRESENTATIVES 9
17. GOVERNMENTAL IMMUNITY 10
18. GENERAL PROVISIONS 10
19. ADDITIONAL GENERAL PROVISIONS 11
20. SPECIAL PROVISIONS 14
EXHIBIT A, STATEMENT OF WORK
EXHIBIT B, ELIGIBLE MEMBER CATEGORIES
1. PARTIES
This Contract ("Contract") is entered into by and between Weld County Government dba
Weld County Department of Public Health, 1555 N 17 Avenue, GreeleJ; CO
80631
("Contractor"), and the STATE OF COLORADO acting by and through the Department of
Health Care Policy and Financing, 1570 Grant Street, Denver, Colorado 80203 ("State" or
"Department"). Contractor and the State hereby agree to the following terms and conditions:
2. EFFECTIVE DATE AND NOTICE OF NONLIABILITY
This Contract shall not be effective or enforceable until it is approved and signed by the Colorado
State Controller or designee ("Effective Date"). The State shall not be liable to pay or reimburse
Contractor for any performance hereunder including, but not limited to, costs or expenses
incurred, or he bound by any provision hereof prior to the Effective Date.
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3. RECITALS
A. Authority,Appropriation,and Approval
Authority to enter into this Contract exists in Colorado Medical Assistance Act (Section 25.5-4-
104, et seq. C.R.S.) and Title XIX of the Social Security Act and funds have been budgeted,
appropriated and otherwise made available and a sufficient unencumbered balance thereof
remains available for payment. Required approvals, clearance and coordination have been
accomplished from and with appropriate agencies.
B. Purpose
The purpose of this Contract is for the Contractor to participate in the Accountable Care
Collaborative Program as a PCMP in order to provide a Medical Home for Clients.
C. References
All references in this Contract to sections (whether spelled out or using the § symbol),
subsections, exhibits or other attachments, are references to sections, subsections, exhibits or
other attachments contained herein or incorporated as a part hereof, unless otherwise noted.
4. DEFINITIONS
The following terms as used herein shall be construed and interpreted as follows:
A. "Contract" means this Contract, its terms and conditions, attached addenda, exhibits,
documents incorporated by reference under the terms of this Contract, and any future modifying
agreements, exhibits, attachments or references incorporated herein pursuant to Colorado State
law, Fiscal Rules,and State Controller Policies.
B. "Exhibits"and other"Attachments" means the following documents which are attached hereto
and incorporated by reference herein:
Exhibit A, Statement of Work; and
Exhibit B, Eligible Member Categories
C. "Party"means the State or Contractor and Parties means both the State and Contractor.
D. "Review" means examining Contractor's Work to ensure that it is adequate, accurate, correct
and in accordance with the standards described in this Contract.
E. "Services" means the required services to be performed by Contractor pursuant to this Contract.
F. "Subcontractor" means third-parties, if any, engaged by Contractor to aid in performance of its
obligations.
G. "Work" means the tasks and activities Contractor is required to perform to fulfill its obligations
under this Contract,including the performance of the Services and delivery of the Goods.
H. "Work Product" means the tangible or intangible results of Contractor's Work, including, but
not limited to, software, research, reports, studies, data,photographs, negatives or other finished
or unfinished documents, drawings, models, surveys, maps, materials, or work product of any
type, including drafts.
5. TERM
A. Initial Term-Work Commencement
The Parties' respective performances under this Contract shall commence on the Effective Date.
This Contract shall expire on December 31, 2020 unless sooner terminated or further extended as
specified elsewhere herein.
Version 1.2 Page 2 of 16
B. Two Month Extension
The State, at its sole discretion, upon written notice to Contractor as provided in §16, may
unilaterally extend the term of this Contract for a period not to exceed two months if the Parties
desire to continue the services and a replacement Contract has not been fully executed by the
expiration of any initial term or renewal term. The provisions of this Contract in effect when
such notice is given, including, but not limited to, prices, rates and delivery requirements, shall
remain in effect during the two month extension. The two month extension shall immediately
terminate when and if a replacement contract is approved and signed by the Colorado State
Controller or an authorized designee,or at the end of two months,whichever is earlier.
6. STATEMENT OF WORK
A. Completion
Contractor shall complete the Work and its other obligations as described in this Contract on or
before termination of this Contract. The State shall not be liable to compensate Contractor for
any Work performed prior to the Effective Date or after the expiration or termination of this
Contract.
B. Independent Contractor
All persons employed by Contractor or Subcontractor to perform Work under this Contract shall
be Contractor's or Subcontractor's employee(s) for all purposes hereunder and shall not be
employees of the State for any purpose as a result of this Contract.
7. PAYMENTS TO CONTRACTOR
The State shall,in accordance with the provisions of this § 7 and Exhibit A,Statement of Work,
pay Contractor in the amounts and using the methods set forth below:
A. Payment
In accordance with and subject to Section 5.0 of Exhibit A,the State shall pay Contractor for all
earned Per Member Per Month Payments and Primary Care Medical Provider incentive
payments.
B. Interest
The State shall not pay interest on any amounts due to Contractor hereunder.
C. Available Funds-Contingency-Termination
The State is prohibited by law from making commitments beyond the term of the State's current
fiscal year. Therefore, Contractor's compensation beyond the State's current fiscal year is
contingent upon the continuing availability of State appropriations as provided in the Colorado
Special Provisions, set forth below. If federal funds are used to fund this Contract, in whole or in
part, the State's performance hereunder is contingent upon the continuing availability of such
funds. Payments pursuant to this Contract shall be made only from available funds and the
State's liability for such payments shall be limited to the amount remaining of such available
funds. If State or federal funds are not appropriated, or otherwise become unavailable to fund
this Contract, the State may terminate this Contract immediately, in whole or in part, without
further liability notwithstanding any notice and cure period in § 14.B.
D. Erroneous Payments
At the State's sole discretion, payments made to Contractor in error for any reason, including,
but not limited to, overpayments or improper payments, may be recovered from Contractor by
deduction from subsequent payments under this Contract or other contracts,grants or agreements
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between the State and Contractor or by other appropriate methods and collected as a debt due to
the State. Such funds shall not be paid to any party other than the State.
8. REPORTING NOTIFICATION
A. Litigation Reporting
Within ten (10) days after being served with any pleading in a legal action filed with a court or
administrative agency, related to this Contract or which may affect Contractor's ability to
perform its obligations hereunder, Contractor shall notify the State of such action and deliver
copies of such pleadings to the State's principal representative as identified herein. If the State's
principal representative is not then serving, such notice and copies shall be delivered to the
Executive Director of the Department.
B. Noncompliance
Contractor's failure to provide reports and notify the State in a timely manner in accordance with
this § 8 may result in the delay of payment of funds and/or termination as provided under this
Contract.
9. CONTRACTOR RECORDS
A. Maintenance
Contractor shall make, keep, maintain, and allow inspection and monitoring by the State of a
complete file of all records, documents, communications, notes and other written materials,
electronic media files and electronic communications, pertaining in any manner to the Work or
the delivery of Services hereunder. Contractor shall maintain such records until the last to occur
of: (i)a period of six (6) years after the date this Contract expires or is sooner terminated, or(ii)
a period of six (6) years after final payment is made hereunder, or (iii) a period of six (6) years
after the resolution of any pending Contract matters, or(iv) if an audit is occurring,or Contractor
has received notice that an audit is pending, until such audit has been completed and its findings
have been resolved (collectively, the "Record Retention Period"). The State shall have access
to all such records, documents, communications and other materials, which shall be maintained
by the Contractor in a central location.
B. Inspection
Contractor shall permit the State, the federal government and any other duly authorized agent of
a governmental agency to audit, inspect, examine, excerpt, copy and/or transcribe Contractor's
records related to this Contract during the Record Retention Period, to assure compliance with
the terms hereof or to evaluate performance hereunder. The State reserves the right to inspect the
Work at all reasonable times and places during the term of this Contract, including any
extensions or renewals. If the Work fails to conform with the requirements of this Contract, the
State may require Contractor promptly to bring the Work into conformity with Contract
requirements, at Contractor's sole expense. If the Work cannot be brought into conformance by
re-performance or other corrective measures, the State may require Contractor to take necessary
action to ensure that future performance conforms to Contract requirements and exercise the
remedies available under this Contract, at law or in equity, in lieu of or in conjunction with such
corrective measures.
C. Monitoring
Contractor shall permit the State, the federal government and any other duly authorized agent of
a government agency, in their sole discretion, to monitor all activities conducted by Contractor
pursuant to the terms of this Contract using any reasonable procedure, including,but not limited
to: internal evaluation procedures, examination of program data, special analyses, on-site
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checking, formal audit examinations, or any other procedure. All monitoring controlled by the
State shall be performed in a manner that shall not unduly interfere with Contractor's
performance hereunder.
D. Final Audit Report
If an audit is performed on Contractor's records for any fiscal year covering a portion of the term
of this Contract, Contractor shall submit a copy of the final audit report to the State or its
principal representative at the address specified herein.
10. CONFIDENTIAL INFORMATION
Contractor shall comply with the provisions of this § 10 if it becomes privy to confidential
information in connection with its performance hereunder. Confidential information includes, but
is not necessarily limited to, any state records, personnel records, and information concerning
individuals. Such information shall not include information required to be disclosed pursuant to
the Colorado Open Records Act,CRS §24-72-101,et seq.
A. Confidentiality
Contractor shall keep all State records and information confidential at all times and comply with
all laws and regulations concerning confidentiality of information. Any request or demand by a
third party for State records and information in the possession of Contractor shall be immediately
forwarded to the State's principal representative.
B. Health Insurance Portability &Accountability Act of 1996("HIPAA")
Pursuant to federal law and regulations governing the privacy of certain health information, the
Contractor, to the extent applicable, shall comply with the Health Insurance Portability and
Accountability Act of 1996, 42 U.S.C. § 1320d — 1320d-8 ("HIPAA") and its implementing
regulations promulgated by the U.S. Department of Health and Human Services, 45 C.F.R. Parts
160 and 164 (the "Privacy Rule") and other applicable laws, as amended. If personally
identifying information is disclosed to the Contractor, the Contractor shall protect the
confidentiality of all records and other materials containing the personally identifying
information and comply with HIPAA rules and regulations.
C. Notification
Contractor shall notify its agents, employees, Subcontractors and assigns who may come into
contact with State records or other confidential information that each is subject to the
confidentiality requirements set forth herein, and shall provide each with a written explanation of
such requirements before permitting them to access such records and information.
D. Use, Security, and Retention
Confidential information of any kind shall not be distributed or sold to any third party or used by
Contractor or its agents in any way; except as authorized by this Contract or approved in writing
by the State. Contractor shall provide and maintain a secure environment that ensures
confidentiality of all State records and other confidential information wherever located.
Confidential information shall not be retained in any files or otherwise by Contractor or its
agents,except as permitted in this Contract or approved in writing by the State.
E. Disclosure-Liability
Disclosure of State records or other confidential information by Contractor for any reason may
be cause for legal action by third parties against Contractor, the State or their respective agents.
Contractor shall indemnify, save, and hold harmless the State, its employees and agents, against
any and all claims, damages, liability and court awards including costs, expenses, and attorney
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fees and related costs, incurred as a result of any act or omission by Contractor, or its employees,
agents, Subcontractors or assignees pursuant to this § 10.
F. Colorado Open Records Act,C.R.S. 24-72-201 to 24-72-309 ("CORA")
This Contract and all amendments and rate documents are subject to public release as State
records under CORA.
11. CONFLICTS OF INTEREST
A. Contractor shall not engage in any business or personal activities or practices or maintain any
relationships which conflict in any way with the full performance of Contractor's obligations
hereunder. Contractor acknowledges that with respect to this Contract, even the appearance of a
conflict of interest is harmful to the State's interests. Absent the State's prior written approval,
Contractor shall refrain from any practices, activities or relationships that reasonably appear to
be in conflict with the full performance of Contractor's obligations to the State hereunder. If a
conflict or appearance exists, or if Contractor is uncertain whether a conflict or the appearance
of a conflict of interest exists, Contractor shall submit to the State a disclosure statement setting
forth the relevant details for the State's consideration. Failure to promptly submit a disclosure
statement or to follow the State's direction in regard to the apparent conflict constitutes a breach
of this Contract.
12. REPRESENTATIONS AND WARRANTIES
Contractor makes the following specific representations and warranties, each of which was relied
on by the State in entering into this Contract.
A. Standard and Manner of Performance
Contractor shall perform its obligations hereunder in accordance with the highest standards of
medical care, skill and diligence in the Contractor's community and in the sequence and manner
set forth in this Contract.
B. Legal Authority—Contractor Signatory
Contractor warrants that it possesses the legal authority to enter into this Contract and that it has
taken all actions required by its procedures, and bylaws, and/or applicable laws to exercise that
authority, and to lawfully authorize its undersigned signatory to execute this Contract, or any
part thereof, and to bind Contractor to its terms. If requested by the State, Contractor shall
provide the State with proof of Contractor's authority to enter into this Contract within five (5)
days of receiving such request.
C. Licenses, Permits, Etc.
Contractor represents and warrants that as of the Effective Date it has, and that at all times
during the term hereof it shall have and maintain, at its sole expense, all licenses, certifications,
approvals, insurance, permits and other authorizations required by law to perform its obligations
hereunder. Contractor warrants that it shall maintain all necessary licenses, certifications,
approvals, insurance, permits, and other authorizations required to properly perform this
Contract, without reimbursement by the State or other adjustment in the Contract. Additionally,
all employees, Subcontractors and agents of Contractor performing Services under this Contract
shall hold all required licenses or certifications, if any, to perform their responsibilities.
Contractor, if a foreign corporation or other foreign entity transacting business in the State of
Colorado, further warrants that it currently has obtained and shall maintain any applicable
certificate of authority to transact business in the State of Colorado and has designated a
registered agent in Colorado to accept service of process. Any revocation, withdrawal or non-
renewal of licenses, certifications, approvals, insurance, permits or any such similar
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requirements necessary for Contractor to properly perform the terms of this Contract is a
material breach by Contractor and constitutes grounds for termination of this Contract.
13. INSURANCE
Contractor and its Subcontractors shall obtain and maintain malpractice/general liability
insurance as required under current state and federal law and the provider application and
provider participation agreement between Contractor and State.
14. BREACH
A. Defined
In addition to any breaches specified in other sections of this Contract, the failure of the
Contractor to perform any of its material obligations hereunder in whole or in part or in a timely
or satisfactory manner constitutes a breach. The institution of proceedings under any bankruptcy,
insolvency, reorganization or similar law, by or against Contractor, or the appointment of a
receiver or similar officer for Contractor or any of its property, which is not vacated or fully
stayed within twenty (20) days after the institution or occurrence thereof, shall also constitute a
breach.
B. Notice and Cure Period
In the event of a breach, the State shall notify the Contractor of such in writing in the manner
provided in§ 16. If such breach is not cured within ten(10) days of receipt of written notice,the
State may exercise any of the remedies set forth in § 15. Notwithstanding anything to the
contrary herein, the State, in its sole discretion, need not provide advance notice or a cure period
and may immediately terminate this Contract in whole or in part if reasonably necessary to
preserve public safety or to prevent immediate public crisis.
15. REMEDIES
A. Termination for Cause and/or Breach
If Contractor is in breach under any provision of this Contract, the State shall have all of the
remedies listed in this § 15 in addition to all other remedies set forth in other sections of this
Contract, and without limiting its remedies otherwise available at law or equity, following the
notice and cure period set forth in § 14.B. Remedies are cumulative and the State may exercise
any or all of the remedies available to it, in its sole discretion, concurrently or consecutively. The
State may terminate this entire Contract or any part of this Contract. Exercise by the State of this
right shall not be a breach of its obligations hereunder.
i. Obligations and Rights
To the extent specified in any termination notice, Contractor shall not incur further
obligations or render further performance hereunder past the effective date of such notice,
and shall terminate outstanding orders and subcontracts with third parties. However,
Contractor shall complete and deliver to the State all Work and Services not cancelled by
the termination notice. Contractor shall continue performance of this Contract up to the
effective date of the termination. To the extent the Contract is not terminated, if any,
Contractor shall continue performance until the expiration of this Contract. At the sole
discretion of the State, Contractor shall assign to the State all of Contractor's right,title, and
interest under such terminated orders or subcontracts. Upon termination, Contractor shall
take timely, reasonable and necessary action to protect and preserve property in the
possession of Contractor in which the State has an interest. All materials owned by the
State in the possession of Contractor shall be immediately returned to the State. All Work
Product, at the option of the State, shall be delivered by Contractor to the State and shall
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become the State's property. The Contractor shall be obligated to return any payment
advanced under the provisions of this Contract.
ii. Payments
The State shall reimburse Contractor only for accepted performance up to the effective date
of the termination. If, after termination by the State, it is determined that Contractor was
not in breach or that Contractor's action or inaction was excusable, such termination shall
be treated as a termination in the public interest and the rights and obligations of the Parties
shall be the same as if this Contract had been terminated in the public interest, as described
herein.
iii. Damages and Withholding
Notwithstanding any other remedial action by the State, Contractor shall remain liable to
the State for any damages sustained by the State by virtue of any breach under this Contract
by Contractor and the State may withhold any payment to Contractor for the purpose of
mitigating the State's damages, until such time as the exact amount of damages due to the
State from Contractor is determined. The State may withhold any amount that may be due
Contractor as the State deems necessary to protect the State against loss, including loss as a
result of outstanding liens, claims of former lien holders, or for the excess costs incurred in
procuring similar services. Contractor shall be liable for excess costs incurred by the State
in procuring from third parties replacement Work or Services as cover.
B. Early Termination in the Public Interest
The State is entering into this Contract for the purpose of carrying out the public policy of the
State of Colorado, as determined by its Governor, General Assembly, and/or courts. If this
Contract ceases to further the public policy of the State, the State, in its sole discretion, may
terminate this Contract, in whole or in part. Exercise by the State of this right shall not constitute
a breach of the State's obligations hereunder. This subsection shall not apply to a termination of
this Contract by the State for cause or breach by Contractor, which shall be governed by § 15.A
or as otherwise specifically provided for herein.
i. Method and Content
The State shall notify Contractor of such termination in accordance with §16. The notice
shall specify the effective date of the termination, which shall be at least twenty (20) days,
and whether it affects all or a portion of this Contract.
ii. Obligations and Rights
Upon receipt of a termination notice, Contractor shall be subject to and comply with the
same obligations and rights set forth in § 15.A.i.
iii. Payments
If this Contract is terminated by the State pursuant to this § 15.B, Contractor shall be paid
an amount which bears the same ratio to the total reimbursement under this Contract as
Contractor's obligations that were satisfactorily performed bear to the total obligations set
forth in this Contract, less payments previously made.
C. Remedies
The State, in its sole discretion, may exercise one or more of the following remedies in addition
to other remedies available to it:
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i. Suspend Performance
Suspend Contractor's performance with respect to all or any portion of this Contract
pending necessary corrective action as specified by the State without entitling Contractor to
an adjustment in price/cost or performance schedule. Contractor shall promptly cease
performance of such portions of the Contract.
ii. Withhold Payment
Withhold payment to Contractor until Contractor's performance or corrections in
Contractor's performance are satisfactorily made and completed.
iii. Deny/Reduce Payment
Deny payment for those obligations not performed in conformance with Contract
requirements that, due to Contractor's actions or inactions, cannot be performed or, if
performed, would be of no value to the State; provided that any denial or reduction of
payment shall be reasonably related to the value to the State of the obligations not
performed.
iv. Removal
The State may request the removal from Work on the Contract of any of Contractor's
employees, agents, or Subcontractors whom the State justifies as being incompetent,
careless, insubordinate, unsuitable, or otherwise unacceptable, or whose continued relation
to this Contract is deemed to be contrary to the public interest or the State's best interest.
For any requested removal of Contractor's employees, agents or Subcontractors, the State
shall provide written notice to Contractor identifying each element of dissatisfaction and
Contractor shall have ten (10) business days from receipt of such written notice to provide
the State with a written action plan to remedy each stated point of dissatisfaction.
Contractor's written action plan may or may not include the removal of such employees,
agents or Subcontractors from Work on the Contract.
16. NOTICES AND REPRESENTATIVES
Each individual identified below is the principal representative of the designating Party. All
notices required to be given hereunder shall be hand delivered with receipt required or sent by
certified or registered mail to such Party's principal representative at the address set forth below.
In addition to, but not in lieu of, a hard-copy notice, notice also may be sent by e-mail to the e-
mail addresses, if any, set forth below. Either Party may from time to time designate by written
notice substitute addresses or persons to whom such notices shall be sent. Unless otherwise
provided herein,all notices shall be effective upon receipt.
For the State: Curtis Johnson
Department of Health Care Policy and Financing
1570 Grant Street
Denver, Colorado 80203
curtis.johnson@state.co.us
For the Contractor: Mark E Wallace, MD, MPH
Executive Director
Weld County Department of Public Health
1555 N 17 Avenue
Greeley, CO 80631
mwallace@co.weid.co.us
Version 1.2 Page 9 of 16
17. GOVERNMENTAL IMMUNITY
Liability for claims for injuries to persons or property arising from the negligence of the State of
Colorado, its departments, institutions, agencies, boards, officials, and employees is controlled
and limited by the provisions of the Colorado Governmental Immunity Act, CRS §24-10-101, et
seq., and the risk management statutes, CRS §24-30-1501, et seq., as now or hereafter amended.
18. GENERAL PROVISIONS
A. Assignment and Subcontracts
Contractor's rights and obligations hereunder are personal and may not be transferred, assigned
or subcontracted without the prior, written consent of the State. Any attempt at assignment,
transfer or subcontracting without such consent shall be void.
B. Binding Effect •
Except as otherwise provided in § 18.A, all provisions herein contained, including the benefits
and burdens, shall extend to and be binding upon the Parties' respective heirs, legal
representatives,successors,and assigns.
C. Entire Understanding
This Contract represents the complete integration of all understandings between the Parties and
all prior representations and understandings, oral or written, are merged herein. Prior or
contemporaneous additions, deletions, or other changes hereto shall not have any force or effect
whatsoever,unless embodied herein.
D. Indemnification
Contractor shall indemnify, save, and hold harmless the State, its employees and agents, against
any and all claims, damages, liability and court awards including costs, expenses, and attorney
fees and related costs, incurred as a result of any act or omission by Contractor,or its employees,
agents, Subcontractors or assignees pursuant to the terms of this Contract; however, the
provisions hereof shall not 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 et seq., or the Federal Tort Claims Act, 28 U.S.C. 2671 et seq.,
as applicable,as now or hereafter amended.
E. Jurisdiction and Venue
All suits or actions related to this Contract shall be filed and proceedings held in the State of
Colorado and exclusive venue shall be in the City and County of Denver.
F. Modification
i. By the Parties
Except as specifically provided in this Contract,modifications of this Contract shall not be
effective unless agreed to in writing by the Parties in an amendment to this Contract,
properly executed and approved in accordance with applicable Colorado State law and
State Fiscal Rules. Modifications permitted under this Contract, other than contract
amendments, shall conform to the policies of the Office of the State Controller, including,
but not limited to, the policy entitled MODIFICATIONS OF CONTRACTS - TOOLS
AND FORMS.
ii. By Operation of Law
This Contract is subject to such modifications as may be required by changes in Federal or
Colorado State law, or their implementing regulations. Any such required modification
Version 1.2 Page 10 of 16
automatically shall be incorporated into and be part of this Contract on the effective date of
such change,as if fully set forth herein.
G. Order of Precedence
The provisions of this Contract shall govern the relationship of the State and Contractor. In the
event of conflicts or inconsistencies between this Contract and its exhibits and attachments,
including,but not limited to,those provided by Contractor, such conflicts or inconsistencies shall
be resolved by reference to the documents in the following order of priority:
i. Colorado Special Provisions
ii. The provisions of the main body of this Contract; and
iii. Exhibit A, Statement of Work
iv. Exhibit B, Eligible Member Categories
H. Severability
Provided this Contract can be executed and performance of the obligations of the Parties
accomplished within its intent, the provisions hereof are severable and any provision that is
declared invalid or becomes inoperable for any reason shall not affect the validity of any other
provision hereof.
I. Survival of Certain Contract Terms
Notwithstanding anything herein to the contrary, provisions of this Contract requiring continued
performance, compliance, or effect after termination hereof, shall survive such termination and
shall be enforceable by the State if Contractor fails to perform or comply as required.
J. Third Party Beneficiaries
Enforcement of this Contract and all rights and obligations hereunder are reserved solely to the
Parties. Any services or benefits which third parties receive as a result of this Contract are
incidental to the Contract, and do not create any rights for such third parties.
19. ADDITIONAL GENERAL PROVISIONS
A. Compliance With Applicable Law
The Contractor shall at all times during the execution of this Contract strictly adhere to, and
comply with, all applicable federal and state laws, and their implementing regulations, as they
currently exist and may hereafter be amended, which are incorporated herein by this reference as
terms and conditions of this Contract. The Contractor shall also require compliance with these
statutes and regulations in subcontracts and subgrants.The federal laws and regulations include:
Age Discrimination Act of 1975,as amended 42 U.S.C. 6101,et seq.
Age Discrimination in Employment Act of 1967 29 U.S.C. 621-634
Americans with Disabilities Act of 1990 (ADA) 42 U.S.C. 12101, et seq.
Clean Air Act 42 U.S.C. 7401,et seq.
Equal Employment Opportunity E.O. 11246, as amended by
E.O. 11375, amending E.O.
11246 and as supplemented by
41 CFR Part 60
Equal Pay Act of 1963 29 U.S.C. 206(d)
Version 1.2 Page 11 of 16
Federal Water Pollution Control Act, as amended 33 U.S.C. 1251,et seq.
Immigration Reform and Control Act of 1986 8 U.S.C. 1324b
Section 504 of the Rehabilitation Act of 1973, as 29 U.S.C. 794
amended
Title VI of the Civil Rights Act of 1964,as 42 U.S.C. 2000d,et seq.
amended
Title VII of the Civil Rights Act of 1964 42 U.S.C. 2000e
Title IX of the Education Amendments of 1972,as 20 U.S.C. 1681
amended
State laws include:
Civil Rights Division Section 24-34-301, CRS,et
seg.
The Contractor also shall comply with any and all laws and regulations prohibiting
discrimination in the specific program(s) which is/are the subject of this Contract. In
consideration of and for the purpose of obtaining any and all federal and/or sate financial
assistance,the Contractor makes the following assurances,upon which the State relies.
i. The Contractor will not discriminate against any person on the basis of race, color,national
origin, age, sex, religion or handicap, including Acquired Immune Deficiency Syndrome
(AIDS) or AIDS-related conditions, in performance of Work under this Contract.
ii. At all times during the performance of this Contract, no qualified individual with a
disability shall, by reason of such disability, be excluded from participation in, or denied
benefits of the service, programs, or activities performed by the Contractor, or be subjected
to any discrimination by the Contractor.
The Contractor shall take all necessary affirmative steps, as required by 45 CFR 92.36(e),
Colorado Executive Order and Procurement Rules, to assure that small and minority businesses
and women's business enterprises are used, when possible, as sources of supplies, equipment,
construction, and services purchased under this Contract.
B. Debarment and Suspension
i. If this is a covered transaction or the Contract amount exceeds $100,000, the Contractor
certifies to the best of its knowledge and belief that it and its principals and Subcontractors
are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded by any federal department or agency.
ii. This certification is a material representation of fact upon which reliance was placed when
the State determined to enter into this transaction. If it is later determined that the
Contractor knowingly rendered an erroneous certification, in addition to other remedies
available at law or by contract,the State may terminate this Contract for default.
iii. The Contractor shall provide immediate written notice to the State if it has been debarred,
suspended, proposed for debarment, declared ineligible or voluntarily excluded by any
federal department or agency.
iv. The terms "covered transaction," "debarment," "suspension," "ineligible," "lower tier
covered transaction," "principal," and "voluntarily excluded," as used in this paragraph,
have the meanings set out in 2 CFR Parts ISO and 376.
Version 1.2 Page 12 of 16
v. The Contractor agrees that it will include this certification in all lower tier covered
transactions and subcontracts that exceed$100,000.
C. Force Majeure
Neither the Contractor nor the State shall be liable to the other for any delay in, or failure of
performance of, any covenant or promise contained in this Contract, nor shall any delay or
failure constitute default or give rise to any liability for damages if, and only to the extent that,
such delay or failure is caused by "force majeure." As used in this Contract, "force majeure"
means acts of God; acts of the public enemy; acts of the state and any governmental entity in its
sovereign or contractual capacity; fires; floods; epidemics; quarantine restrictions; strikes or
other labor disputes; freight embargoes; or unusually severe weather.
D. Disputes
Except as herein specifically provided otherwise, disputes concerning the performance of this
Contract which cannot be resolved by the designated Contract representatives shall be referred in
writing to a senior departmental management staff designated by the State and a senior manager
designated by the Contractor. Failing resolution at that level, disputes shall be presented in
writing to the Executive Director of the State and the Contractor's Chief Executive Officer for
resolution. This process is not intended to supersede any other process for the resolution of
controversies provided by law.
E. Lobbying
Contractor certifies,to the best of his or her knowledge and belief,that:
i. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of any Federal
contract,the making of any Federal grant, the making of any Federal loan, the entering into
of any cooperative Contract, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan,or cooperative Contract.
ii. If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an office or employee of any agency, a
Member of Congress, an office or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative Contract, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying,"in accordance with its instructions.
iii. The undersigned shall require that the language of this certification be included in the
award documents for all sub awards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative Contracts) and that all subrecipients shall
certify and disclose accordingly.
iv. This certification is a material representation of fact upon which reliance was placed when
the transaction was made or entered into. Submission of the certification is a requisite for
making or entering into transaction imposed by Section 1352, Title 31, U.S. Code. Any
person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
Version 1.2 Page 13 of 16
20. SPECIAL PROVISIONS
The Special Provisions apply to all contracts except where noted in italics.
A. CONTROLLER'S APPROVAL. CRS §24-30-202(1). This Contract shall not be valid until it
has been approved by the Colorado State Controller or designee.
B. 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.
C. 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.
D. 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.
E. 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.
F. 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.
G. 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.
H. 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
Page 14 of 16
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.
I. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST. CRS §§24-I8-201
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.
J. 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.
K. 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.
L. 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.
Page 15 of 16
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 Government
Legal Name of Contracting Entity
By: 'a'G,J�_
AA Susan E. B. ch, MBA, BSN, RN Executive
By' �iQ(Q� , (/L Director
. Signature of Au orized O cer Department of Health Care Policy and
Financing
Barbara Kirkmeyer
Printed Name of Authorized Officer Date: `7I 2--7._/ I I
Chair LEGAL REVIEW:
Printed Title of Authorized Officer John W. Suthers, Attorney General
Date: JUN 2 0 2011 By:
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 services provided hereunder.
ST TE OLLER:
d J.McDermott,CPA
By:
Date:
Page 16 of 16
, C//—/5/T
EXHIBIT A, STATEMENT OF WORK
SECTION 1.0 TERMINOLOGY
1.1. ACRONYMS, ABBREVIATIONS AND DEFINITIONS
1.1.1. Acronyms and abbreviations are defined at their first occurrence in this Statement of Work.
The following list of acronyms, abbreviations and definitions is provided to assist the reader in
understanding acronyms, abbreviations and terminology used throughout this document.
1.1.1.I. ACC—Accountable Care Collaborative
1.1.1.2. ACC Program — The Department program designed to affordably optimize Client health,
functioning, and self-sufficiency with the primary goals to improve Medicaid Client health
outcomes and control costs.
1.1.1.3. C.C.R.-Colorado Code of Regulations
1.1.1.4. CFR—Code of Federal Regulations
1.1.1.5. Client—An individual eligible for and enrolled in the Colorado Medicaid Program.
1.1.1.6. Contractor's Member— A Member that has selected the Contractor to be their PCMP or has
been attributed to the Contractor by the Department. A Member is considered a Contractor's
Member during any month in which that Member was enrolled in the ACC Program and had
selected the Contractor as their PCMP as of the first day of that month.
1.1.1.7. Contractor's RCCO — The RCCO with which the Contractor enters into an agreement to
participate in the ACC Program.
1.1.1.8. CRS—Colorado Revised Statutes
1.1.1.9. EPSDT—Early Periodic Screening, Diagnosis and Treatment, the child health component of
the Medicaid Program, as defined by the Federal Health Resources and Services
Administration.
1.1.1.10. Expansion Phase — The period of time starting from the end of the Initial Phase until the
termination of this Contract.
1.1.1.11. Federally Qualified Health Center—A provider defined under 10 C.C.R. 2505-10 §8.700.1.
1.1.1.12. FQHC—Federally Qualified Health Center
1.1.1.13. Initial Phase — The period of time from when the Department authorizes the Contractor's
RCCO to enter the Initial Phase until June 30, 2012 or until the Department authorizes the
Contractor's RCCO to enter the Expansion Phase,whichever is later.
1.1.1.14. Medical Home — An approach to providing comprehensive primary-care that facilitates
partnerships between individual Clients, their providers, and, where appropriate, the Client's
family,that meets the requirements described in Section 3 of this Statement of Work.
1.1.1.15. Member — Any individual Client who is enrolled with the Contractor's RCCO or another
RCCO.
1.1.1.16. PCCM—Primary Care Case Manager
1.1.1.17. PCMP—Primary Care Medical Provider
Exhibit A Page 1 of 12
1.1.1.18. Primary Care Case Manager—A physician, a physician group practice, a physician assistant,
nurse practitioner, certified nurse-midwife or entity that employs or arranges with providers
to furnish primary care case management services or as described 42 CFR 438.2.
1.1.1.19. Primary Care Medical Provider—A primary care provider who serves as a Medical Home for
Members and may be an FQHC, RHC, clinic or other group practice that provides the
majority of a Member's comprehensive primary, preventive and sick care. Individual PCMPs
or pods can be physicians, advanced practice nurses, or physician assistants with a focus on
primary care, general practice, internal medicine, pediatrics, geriatrics or obstetrics and
gynecology.
1.1.1.20. PMPM—Per Member Per Month
1.1.1.21. PMPM Payment—A monthly payment to the Contractor for providing medical home service
for each Member who has selected the Contractor as a PCMP.
1.1.1.22. RCCO—Regional Care Collaborative Organization
1.1.1.23. Region — A geographical area containing specific counties, within the State of Colorado, as
designated by the Department,that is served by a RCCO.
1.1.1.24. Regional Care Collaborative Organization — One of seven (7) Regional entities contracted
with the Department to support the ACC Program by improving the health outcomes for
Members and controlling the cost of care.
1.1.1.25. RHC—Rural Health Clinic
1.1.1.26. Rural Health Clinic—A provider or practice as defined in 10 C.C.R.2505-10 §8.740.
SECTION 2.0 ACC PROGRAM AND REGION
2.1. ACC PROGRAM
2.1.1. The Contractor shall be a Primary Care Medical Provider (PCMP) participating in the
Department's Accountable Care Collaborative (ACC) Program. The Contractor shall be a
current Medicaid provider for the State of Colorado and shall comply with all requirements of
the provider application and provider application agreement between the Contractor and the
State.
2.2. REGIONAL CARE COLLABORATIVE ORGANIZATION(RCCO)
2.2.1. The Department has designated a RCCO for each of the seven (7) Regions. The Contractor
may enter into an agreement with any RCCO for a Region in which the Contractor has an office
(the Contractor's RCCO), and to participate in the ACC Program, the Contractor shall enter
into an agreement with at least one(1) RCCO.
2.2.2. In addition to the requirements of this Contract, the Contractor shall comply with all
requirements of any contract or agreement into which it enters with the Contractor's RCCO.
SECTION 3.0 PCMP REQUIREMENTS
3.1. FEDERAL PRIMARY CARE CASE MANAGER REQUIREMENTS
3.1.1. As a PCMP, the Contractor shall be a Primary Care Case Manager (PCCM) as described in 42
CFR 438.2. As a PCCM, the Contractor shall:
3.1.1.1. Provide reasonable hours of operation, including twenty-four (24) hour availability of
information,referral and treatment for emergency medical conditions.
Exhibit A Page 2 of 12
3.1.1.2. Restrict acceptance of Members to those who reside sufficiently near the Contractor's
location, or one of the Contractor's locations if the Contractor has multiple, so that the
Member can reach that location in a reasonable time using available and affordable modes of
transportation.
3.1.1.3. Provide for arrangements with or referrals to a sufficient number of physicians and other
providers to ensure that the services under this Contract can be furnished to a Member
promptly and without compromise to the Member's quality of care.
3.1.1.4. Prohibit discrimination in which the Members which the Contractor accepts are based on the
Member's health status or need for health care services or the Member's race, color or
national origin.
3.1.1.4.1. The Contractor shall not use any policy or practice that has the effect of discriminating on
the basis of race, color or national origin.
3.1.1.5. Ensure that when it accepts Members, the Contractor accepts those Members in the order in
which they enrolled, up to the maximum number of Members that the Contractor is willing to
accept.
3.1.1.5.1. A Member may voluntarily select the Contractor as their PCMP, and the Contractor shall
accept all Members who select the Contractor to be their PCMP up to the maximum
number of Members that the Contractor is willing to accept.
3.1.1.5.2. Any Member shall be automatically reenrolled with the Contractor if:
3.1.1.5.2.1. The Member had selected the Contractor to be the Member's PCMP;
3.1.1.5.2.2. The Member was disenrolled from the ACC Program solely because that Member
became ineligible for Medicaid; and
3.1.1.5.2.3. The Member's ineligibility lasted for a period of two(2)months or less.
3.1.1.6. Allow any Member to select to disenroll with the Contractor, in accordance with 42 CFR
438.56(c).
3.1.1.7. Notify all Members, who have selected the Contractor as their PCMP, of the Contractor's
termination in the ACC Program in the event that the Contractor stops its participation in the
ACC Program for any reason.
3.1.1.8. Allow any Member to obtain emergency services from any other provider regardless of
whether the Contractor referred the Member for those services.
3.1.2. Eligibility and Enrollment
3.1.2.1. The Department will enroll Clients into the ACC Program in accordance with its existing
policies and procedures. The Department may enroll any Client who is included in any of the
eligibility categories shown in Exhibit B, Eligible Member Categories.
3.1.3. Disenrollment
3.1.3.1. The Contractor may only request the disenrollment of a Member from the ACC Program
under the following circumstances:
3.1.3.1.1. The Member moves out of the Contractor's Region.
3.1.3.1.2. The Contractor's plan does not, because of moral or religious reasons, cover the service the
Member seeks.
Exhibit A Page 3 of 12
3.1.3.1.3. The Member needs related services to be performed at the same time, not all related
services are available within the network and the Member's PCMP or another provider
determines that receiving the services separately would subject the Member to unnecessary
risk.
3.1.3.1.4. Other reasons, including but not limited to, lack of access to services covered under the
Contract or lack of access to providers experienced in dealing with the Member's health
care needs.
3.1.3.1.5. Abuse or intentional misconduct consisting of any of the following:
3.1.3.1.5.1. Behavior of the Member that is disruptive or abusive to the extent that the Contractor's
ability to furnish services to either the Member or other Members is impaired.
3.1.3.1.5.2. A documented, ongoing pattern of failure on the part of the Member to keep scheduled
appointments or meet any other Member responsibilities.
3.1.3.1.5.3. Behavior of the Member that poses a physical threat to the Contractor, to Contractor staff
or to other Members.
3.1.3.1.5.4. The Contractor shall provide one oral warning, to any Member exhibiting abusive
behavior or intentional misconduct, stating that continuation of the behavior or
misconduct will result in a request for disenrollment. If the Member continues the
behavior or misconduct after the oral warning, the Contractor shall send a written
warning that the continuation of the behavior or misconduct will result in disenrollment
from the Contractor's plan. The Contractor shall send a copy of the written warning and
a written report of its investigation into the behavior, to the Department, no less than
thirty (30) days prior to the disenrollment. If the Member's behavior or misconduct
poses an imminent threat to the Contractor, to other staff of the Contractor, to other
providers or to other Members, the Contractor may request an expedited disenrollment
after it has provided the Member exhibiting the behavior or misconduct an oral warning.
3.1.3.1.6. Any other reason determined to be acceptable by the Department.
3.1.3.2. The Contractor may not request disenrollment of a Member because of:
3.1.3.2.1. Adverse changes in the Member's health status.
3.1.3.2.2. Change in the Member's utilization of medical services.
3.1.3.2.3. The Member's diminished mental capacity.
3.1.3.2.4. Any behavior of the Member resulting from the Member's special needs, as determined by
the Department, unless those behaviors seriously impair the Contractor's ability to furnish
services to that Member or other Members.
3.1.3.3. The Department may disenroll a Member from the ACC Program upon that Member's
request. A Member may request disenrollment, in writing from the Department, and the
Department may grant the Member's request:
3.1.3.3.1. For cause, at any time. A disenrollment for cause may occur under the following
circumstances:
3.1.3.3.1.1. The Member moves out of the Contractor's Region.
3.1.3.3.1.2. The Contractor does not, because of moral or religious objections, cover the service the
Member needs.
Exhibit A Page 4 of 12
3.1.3.3.1.3. Administrative error on the part of the Department or its designee or the Contractor
including, but not limited to, system error.
3.1.3.3.1.4. Poor quality of care,as documented by the Department.
3.1.3.3.1.5. Lack of access to covered services, as documented by the Department.
3.1.3.3.1.6. Lack of Contractor's experience in dealing with the Member's health care needs.
3.1.3.3.2. Without cause during the ninety (90) days following the date of the Member's initial
enrollment with the Contractor.
3.1.3.3.2.1. A Member may request disenrollment, without cause, at least once every twelve (12)
months after the first ninety(90)day period.
3.1.3.3.2.2. A Member may request disenrollment, without cause,upon automatic reenrollment under
42 CFR 438.56(g),if the temporary loss of Medicaid eligibility has caused the Member to
miss the annual disenrollment opportunity.
3.1.3.4. The Department shall review any request for disenrollment from the Contractor or a Member.
The Department may grant a request for disenrollment in it sole discretion.
3.1.3.5. In the event that the Department grants a request for disenrollment, either from the Contractor
or from a Member, the effective date of that disenrollment shall be no later than the first day
of the second month following the month in which the Member or Contractor files the
request. If the Department fails to either approve or deny the request in this timeframe, the
request shall be considered approved.
3.1.4. Marketing
3.1.4.1. The Contractor shall engage in marketing that is accurate and does not mislead, confuse, or
defraud any Members or the Department.
3.1.4.2. The Contractor shall distribute any materials to the Contractor's entire service area.
3.1.4.3. The Contractor shall not seek to influence enrollment in conjunction with the sale or offering
of any private insurance.
3.1.4.4. The Contractor shall not, directly or indirectly, engage in door-to-door, telephone, or other
cold call marketing activities.
3.1.4.5. Marketing materials shall not contain any assertion or statement,whether written or oral, that
the potential Member must enroll with the Contractor to obtain benefits or not to lose
benefits.
3.1.4.6. Marketing Materials shall not contain any assertion or statement,whether written or oral,that
Contractor is endorsed by the Centers for Medicare and Medicaid Services, the Federal or
State government or similar entity.
3.1.5. All materials that the Contractor creates for distribution to any Client or Member shall be
culturally and linguistically appropriate to the recipient.
3.1.5.1. The Contractor shall ensure that any Member information materials provided by the
Contractor are written in an easily understood manner and format. Written materials shall be
available in the prevalent non-English languages spoken in the area the Contractor serves and
available in alternative formats to accommodate Members with special needs. The
Contractor shall notify its Members that this written information is available in prevalent
languages and alternative formats and how Members can access those services/formats.
Exhibit A Page 5 of 12
3.1.6. The Contractor shall provide oral interpretation services for any Members that do not speak the
same language as the Contractor. In the event that the Contractor's RCCO provides this service
for the Contractor, the Contractor may use an interpreter or interpretation service provided by
the Contractor's RCCO to fulfill this obligation. The Contractor shall notify all Members it
serves of the availability of these interpretation services.
3.1.7. Debarment
3.1.7.1. In addition to the Debarment and Suspension provisions in §19(B) of this Contract, the
Contractor shall not knowingly have a relationship with any of the following entities:
3.1.7.1.1. An individual who is debarred, suspended, or otherwise excluded from participating in
procurement activities under the Federal Acquisition Regulation or from participating in
non-procurement activities under regulations issued under Executive Order No.12549 or
under guidelines implementing Executive Order No. 12549.
3.1.7.1.2. An individual who is an affiliate, as defined in the Federal Acquisition Regulation, of a
person described in the prior paragraph.
3.1.7.2. For the purposes of this section,a relationship is described as:
3.1.7.2.1. A director, officer or partner of the Contractor.
3.1.7.2.2. A person or entity with more than five percent(5%)beneficial ownership of the Contractor.
3.1.7.2.3. A person with an employment, consulting or other arrangement with the Contractor that is
responsible for any of the Contractor's obligations under this Contract.
3.1.8. Federal Disclosures of Information on Ownership and Control
3.1.8.1. The Contractor shall provide all disclosures required by 42 CFR 455.104, as amended or
hereinafter amended. These disclosures currently include:
3.1.8.1.1. The name and address of any person, either an individual or a corporation, with an
ownership or control interest in the Contractor. For a corporate entity, the address shall
include the primary business address, the address of each business location if there is more
than one location and any applicable P.O. Box address.
3.1.8.1.1.1. The date of birth and social security number for any individual with an ownership or
control interest in the Contractor.
3.1.8.1.1.2. The tax identification number of any corporate entity with an ownership or control
interest in the Contractor or in any subcontractor in which the Contractor has a five
percent(5%) or greater interest.
3.1.8.1.2. Whether any person, either an individual or a corporation, with an ownership or control
interest in the Contractor is related to another person with ownership or control interest in
the Contractor as a spouse,parent,child or sibling.
3.1.8.1.3. Whether any person, either an individual or a corporation, with an ownership or control
interest in the any subcontractor in which the Contractor has a five percent (5%) or greater
interest is related o another person with ownership or control interest in the Contractor as a
spouse,parent,child or sibling.
3.1.8.1.4. The name of any other entity required to disclose under 42 CFR 455.104 in which any
owner of the Contractor has an ownership or control interest.
Exhibit A Page 6 of 12
3.1.8.1.5. The name, address, date of birth and Social Security Number of any managing employee of
the Contractor.
3.1.8.2. "Ownership interest" and "person with an ownership or control interest" shall have the
meaning specified in 42 CFR 455.101, as amended or hereinafter amended. "Subcontractor",
for purposes of this subsection 3.1.8 only, shall have the meaning specified in 42 CFR
455.101,as amended or hereinafter amended.
3.1.8.3. The Contractor shall complete and deliver these disclosures to the Department:
3.1.8.3.1. Upon submitting the Contractor's provider application to the Department.
3.1.8.3.2. Upon executing the Contractor's provider agreement with the Department.
3.1.8.3.3. Upon the Department's request during the re-validation of enrollment process under 42
CFR 455.414.
3.1.8.3.4. Within thirty-five (35) days of the any change in ownership of the Contractor.
3.1.8.4. The Contractor shall provide this disclosure to the Department's Medicaid fiscal agent.
3.1.9. Federal Intermediate Sanctions
3.1.9.1. The Department may implement any intermediate sanctions, as described in 42 CFR 438.702,
if the Department makes the determination to impose sanctions under 42 CFR 438.700.
3.1.9.2. Before imposing any intermediate sanctions, the Department shall give the Contractor timely
written notice that explains:
3.1.9.2.1. The basis and nature of the sanction.
3.1.10. Termination under Federal Regulations
3.1.10.1. The Department may terminate this Contract for cause if the Department determines that the
Contractor has failed to:
3.1.10.1.1. Carry out the substantive terms of its contracts.
3.1.10.1.2. Meet applicable requirements in sections 1932, 1903(m) and 1905(t) of the Social Security
Act(42 U.S.C. 401).
3.1.10.2. Before terminating the Contractor's Contract as described in this section, the Department
shall:
3.1.10.2.1. Provide the Contractor a cure notice that includes,at a minimum, all of the following:
3.1.10.2.1.1. The Department's intent to terminate.
3.1.10.2.1.2. The reason for the termination.
3.1.10.2.1.3. The time and place for the pre-termination hearing.
3.1.10.2.2. Conduct a pre-termination hearing.
3.1.10.2.3. Give the Contractor written notice of the decision affirming or reversing the proposed
termination of the Contract.
3.1.10.2.4. If the Department determines, after the hearing, to terminate the Contract for cause, then
the Department shall send a written termination notice to the Contractor that contains the
effective date of the termination.
3.1.10.2.4.1. Upon receipt of the termination notice, the Contractor shall give Members enrolled with
Exhibit A Page 7 of 12
the Contractor notice of the termination and information, consistent with 42 CFR 438.10,
on their options for receiving Medicaid services following the effective date of
termination.
3.1.10.3. Once the Department has notified the Contractor of its intent to terminate under this section,
the Department may:
3.1.10.3.1. Give the Members enrolled with the Contractor written notice of the State's intent to
terminate the Contract.
3.1.10.3.2. Allow Members enrolled with the Contractor to disenroll immediately,without cause.
3.1.11. Termination by the Contractor
3.1.11.1. The Contractor may terminate this Contract by giving written notice of termination to the
Department and specifying the effective date thereof. The effective date of any such
termination shall be the last day of a month. The Contractor shall provide its notice of
termination at least forty-five (45) days before the effective date of such termination. Upon
issuance of written notice of termination, Contractor shall be subject to and comply with the
same obligations and rights set forth in § 15.A.i of the Contract. Upon termination pursuant to
this §3.1.11, Contractor shall be paid only for Services provided through the effective date of
the termination.
3.2. GENERAL PCMP REQUIREMENTS
3.2.1. To participate in the ACC Program as a PCMP, the Contractor shall be committed to the
following principles of the Medical Home model as amended by the Department:
3.2.1.1. The care provided is:
3.2.1.1.1. Member/family-centered;
3.2.1.1.2. Whole-person oriented and comprehensive;
3.2.1.1.3. Coordinated and integrated;
3.2.1.1.4. Provided in partnership with the Member and promotes Member self-management;
3.2.1.1.5. Outcomes-focused;
3.2.1.1.6. Consistently provided by the same provider as often as possible so a trusting relationship
can develop; and
3.2.1.1.7. Provided in a culturally competent and linguistically sensitive manner.
3.2.1.2. The Contractor is:
3.2.1.2.1. Accessible, aiming to meet high access-to-care standards, such as:
3.2.1.2.1.1. 24/7 phone coverage with access to a clinician that can triage;
3.2.1.2.1.2. Extended daytime and weekend hours;
3.2.1.2.1.3. Appointment scheduling within 48 hours for urgent care, 10 days for symptomatic, non-
urgent care and 45 days for non-symptomatic routine care; and
3.2.1.2.1.4. Short waiting times in the Contractor's reception area;
3.2.1.2.2. Committed to operational and fiscal efficiency;
Exhibit A Page 8 of 12
3.2.1.2.3. Able and willing to coordinate with the Contractor's RCCO on medical management, care
coordination, and case management of Members;
3.2.1.2.4. Committed to initiating and tracking continuous performance and process improvement
activities, such as improving tracking and follow-up on diagnostic tests, improving care
transitions, and improving care coordination with specialists and other Medicaid providers,
etc;
3.2.1.2.5. Willing to use proven practice and process improvement tools, such as assessments, visit
agendas,screenings,Member self-management tools and plans;
3.2.1.2.6. Willing to spend the time to teach Members about their health conditions and the
appropriate use of the health care system as well as inspire confidence and empowerment in
Members' health care ownership;
3.2.1.2.7. Focused on fostering a culture of constant improvement and continuous learning;
3.2.1.2.8. Willing to accept accountability for outcomes and the Member/family experience;
3.2.1.2.9. Able to give Members and designated family members easy access to their medical records
when requested; and
3.2.1.2.10. Committed to working as a partner with the Contractor's RCCO in providing the highest
level of care to Members. This commitment includes data-sharing, access to medical
records when requested, cooperation on referrals, participation in performance
improvement activities and initiatives, willingness to give feedback and potentially
participate on committees and provide clinical expertise, and use the data available to the
practice to better manage Members and their health needs.
3.3. PCMP REQUIREMENTS
3.3.1. In order to participate as a PCMP in the ACC Program,the Contractor shall:
3.3.1.1. Be enrolled as a provider in the Colorado Medicaid program;
3.3.1.2. Be any of the following:
3.3.1.2.1. Certified by the Department as a provider in the Medicaid and CHP+ Medical Homes for
Children program;
3.3.1.2.2. A Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or a clinic or
other group practice with a focus on primary care, general practice, internal medicine,
pediatrics,geriatrics, or obstetrics and gynecology;or
3.3.1.2.3. An individual physician, advanced practice nurse or physician assistant with a focus on
primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and
gynecology;
3.3.1.3. Act as the dedicated source of primary care for Members and be capable of delivering the
majority of the Members' comprehensive primary,preventive, and sick medical care;
3.3.1.4. Be currently licensed by the Colorado Medical Board to practice medicine in the State of
Colorado.
3.3.2. In the event that the Contractor participates in the ACC Program as a practice, the Contractor
shall provide a list of all individual providers who are part of the Contractor's practice, to the
Department, within five (5)days after the Effective Date of this Contract.
Exhibit A Page 9 of 12
3.3.2.1. The Contractor shall submit an updated list of individual providers who are part of the
Contractor's practice,to the Department, within thirty (30) days after the addition or removal
of any provider in the practice.
3.4. OTHER DEPARTMENT PROGRAMS
3.4.1. The Contractor may participate in any other programs within the Department, such as the
Medicaid and CHP+ Medical Homes for Children Program. If the Contractor does choose to
participate in any other program within the Department, then the Contractor shall abide by all
of the requirements of that program.
SECTION 4.0 CARE COORDINATION
4.1. RCCO COOPERATION
4.1.1. When the Contractor provides care to a Member, the Contractor shall cooperate with the RCCO
with which the Member is enrolled, even if this is not the Contractor's RCCO. This
cooperation shall include, but is not limited to, providing all requested information relating to
the Member's care, providing any required or requested referrals for the Member and meeting
all requirements of any written agreement between the RCCO and the Contractor.
4.1.1.1. The Contractor may accept and act on recommendations or advice given to the Contractor by
a RCCO,but shall not make any decision regarding any Member's treatment or regarding that
Member's health care at the direction of the RCCO. In the event that the Contractor
determines the proper decision regarding any Member's treatment or regarding that
Member's health care is the same as any direction given by a RCCO,then the Contractor may
act upon their own determination, regardless of the RCCO's direction.
4.1.2. The Contractor shall provide the Contractor's RCCO accurate contact and practice information
upon enrollment with the Contractor's RCCO, within ten (10) business days of any change to
the information or as required in its agreement with the RCCO. This contact and practice
information shall include, at a minimum, all of the following:
4.1.2.1. The name of the Contractor's practice;
4.1.2.2. The names of all providers in the Contractor's practice;
4.1.2.3. The telephone number for the Contractor's practice;
4.1.2.4. The address of the Contractor's practice;
4.1.2.5. Whether the Contractor is accepting new Members;and
4.1.2.6. The field or fields in which the Contractor practices.
4.1.3. The Contractor may engage in care coordination activities as allowed in any contract or
agreement that the Contractor has with the Contractor's RCCO.
4.2. REFERRALS
4.2.1. The Contractor may refer a Member to any other specialist or Medicaid provider, if the
Contractor determines that such a referral is appropriate to that Member's care. In the event
that the Contractor determines such a referral is appropriate, the Contractor shall provide a
referral,which includes the Contractor's Medicaid ID number and the reason for the referral, to
the other provider for any Member that receives care or other services from that provider A
referral from the Contractor is not required for the following services:
4.2.1.1. Emergency care.
Exhibit A Page 10 of 12
4.2.1.2. EPSDT screenings.
4.2.1.3. Emergency and non-emergent medical transportation.
4.2.1.4. Anesthesiology services.
4.2.1.5. Dental services.
4.2.1.6. Vision services.
4.2.1.7. Family planning services.
4.2.1.8. Behavioral health services.
4.2.1.9. Home and Community-Based Waiver services, as defined in the waivers that the Department
has submitted to the Centers for Medicare and Medicaid Services.
4.2.1.10. Obstetrical care.
SECTION 5.0 COMPENSATION AND PAYMENTS
5.1. PER MEMBER PER MONTH (PMPM)PAYMENT
5.1.1. The Department shall pay the Contractor a PMPM Payment for each of the Contractor's
Members, regardless of the RCCO in which the Member is enrolled, that was enrolled in the
ACC Program as of the first day of the month for which the Department is making the PMPM
Payment.
5.1.2. The Department shall calculate the number of the Contractor's Members based on the
information in the Department's Medicaid Management Information System.
5.1.3. The Department shall remit all PMPM Payments to the Contractor on of before the last day of
the month for which the PMPM Payment applies.
5.1.4. PMPM Payments shall commence in the first full month in which the Contractor is enrolled and
continue for all subsequent months until the termination of this Contract.
5.1.5. PMPM Payments pursuant to this contract shall be made in accordance with the State's
Medicaid state plan and at the rates shown on the PMPM Payment schedule of rates posted on
the Provider Services page of the Department's website.
5.2. EXPANSION PHASE PCMP INCENTIVE PAYMENTS
5.2.1. The Department has instituted an incentive program with each RCCO that may make a PMPM
incentive payment, for each of the RCCO's Members, to the RCCO if the RCCO meets certain
performance targets. In the event that a RCCO receives an incentive payment, the Department
shall pay the Contractor an amount equal to that RCCO's PMPM incentive payment for each of
the Contractor's Members who reside in that RCCO's Region.
5.2.1.1. In the event that the Contractor serves Members in different Regions, then the incentive
payment shall be based on the Region in which the Member who received care resides. In
this event, the incentive payment for each Region shall only be paid for the number of the
Contractor's Members who reside in that Region. This may result in the Contractor receiving
different incentive payments for different Members.
5.2.2. In no event shall any incentive payment for any Member exceed the amount received by the
RCCO, for the Region in which the Member resides,for that Member.
Exhibit A Page 11 of 12
5.2.3. The Department shall remit all incentive payments to the Contractor on a quarterly basis within
one-hundred and twenty (120) days from the last day of the quarter in which the incentive
payments were earned. The Department will calculate the incentive payment separately for
each month in a quarter, and the Contractor may receive different amounts for each month
within a quarter based on the specific performance targets the Contractor's RCCO was able to
meet during each specific month.
5.3. GENERAL COMPENSATION
5.3.1. If the Contractor is certified by the Medicaid and CHP± Medical Homes for Children Program,
the Contractor will continue to receive pay-for-performance under that program for any
children from the Medical Homes for Children Program, that are also enrolled in the ACC
Program, until the beginning of the Expansion Phase. In the event that the Contractor receives
any compensation under the Medical Homes for Children Program for any Member during a
month, the Contractor shall not receive any PMPM Payment or any incentive payments for that
Member and that Member shall not be counted toward the calculation of the number of the
Contractor's Members during that month.
5.3.2. If the Contractor is a FQHC, RHC or a clinic or other group practice enrolled with the Colorado
Medicaid program, then any PMPM Payments or incentive payments for the providers
employed or contracted by that entity shall be paid to the employing or contracting entity.
5.3.3. The Contractor's RCCO, or any other RCCO, may develop additional compensation methods
or payments for the Contractor under the ACC Program. The existence or amount of these
payments, or the absence thereof, shall not impact any payments required by this Contract in
any way.
5.4. PAYMENT CALCULATION DISPUTES
5.4.1. In the event that the Contractor believes that the calculation or determination of any incentive
payment or PMPM Payment is incorrect, the Contractor shall notify the Department of its
dispute within thirty (30) days of the receipt of the payment. The Department shall review
calculation or determination and may make changes based on this review. The determination
or calculation that results from the Department's review shall be final. No disputed payment
shall be due until after the Department has concluded its review.
Exhibit A Page 12 of 12
EXHIBIT B,ELIGIBLE MEMBER CATEGORIES
Clients in the following categories, described in the Department's State Plan, are eligible for enrollment
in the ACC Program:
1) Aid to Families with Dependent Children—Adults(AFDC—A)
2) Aid to Families with Dependent Children—Children (AFDC—C)
3) Aid to the Needy Disabled/Aid to the Blind(AND/AB)
4) Baby Care/Kids Care—Adults (BCKC-A)
5) Baby Care/Kids Care—Children(BCKC-C)
6) Foster Care(FC)
7) Old Age Pensioners—Age 65+(OAP-A)
8) Old Age Pensioners under Age 65 (OAP-B)
9) Refugee Medical Assistance—Adults(RMA-A)
10) Refugee Medical Assistance—Children (RMA-C)
11) Adults Without Dependent Children(AWDC),as described in CRS 25.5-4-402.3(4)(b)(IV)(C)
12) Any other Medicaid eligibility category that is eligible for full Medicaid benefits,except for
Clients in the following circumstances:
a) During the Initial Phase,any Client who is eligible for both Medicare and Medicaid. Clients
that are eligible for both Medicare and Medicaid shall only be eligible for the ACC Program
during the Expansion Phase.
b) Clients residing in any federal,state or county institution at the time of enrollment. Any
Member who becomes a resident of an institution after their enrollment in the ACC Program
may choose to remain in the program or request disenrollment for cause at the Member's
discretion.
Exhibit B Page 1 of 1
PRIMARY CARE MEDICAL PROVIDER (PCMP) INFORMATION FORM
PCMP BILLING PROVIDER ID (PRACTICE) INFORMATION
FULL LEGAL Name: Weld County Governmenld,:
(Full LEGAL name as used in PCMP Contract)
DBA Name: Weld County Department o£ Public Health
(Indicates Doing Business As(DBA)Group Practice name or Clinic name)
Medicaid Billing Provider ID#: 04421095 and 04005542
NPI It(National Provider Identifier): 1174515258
Type of Practice: (Check only one ❑ Individual ❑ Group ❑ Rural Health Clinic
9 Federally Qualified Health Clinic 9 Indian Health Clinic x Public
Primary PCMP Location Address:
(Your primary practice/clinic location that is located in the RCCO with which you contracted)
Business Street Address: 1555 N 17th Avenue
City: Greeley State: CO Zip: 80631
Telephone: (970) 304-6420 Fax: (970) 304-6421
Business email address: mwallace@co.weld.co.us
RCCO Affiliations (RCCO 1,3, etc.): RCCO 2
(List the RCCOs with which the PCMP has contracted with)
I
Secondary PCMP Location Address: if applicable
(Additional practice/clinic locations which may,or may not, be located in the RCCO with which your primary
practice location has contracted)
Business Street Address: 4209 WCR 24-1/2
City: Longmont State: CO Zip: 80504
Telephone: (720) 652-4238 Fax: (720) 6n-4239.
mwallace@dd.,taeld.co.us
Business email address:
Additional PCMP Location Address: if applicable
Business Street Address:
City: State: Zip:
Telephone: Fax:
Business email address:
PLEASE LIST ALL ADDITIONAL PRACTICE LOCATIONS ASSOCIATED WITH THIS PCMP BILLING PROVIDER ID; USE
ADDITIONAL SHEETS IF NECESSARY.
. 8 6 . 20 Memorandum
TO: Office of Clerk to the Board to the
Weld County Commissioners
W E L DEC O U N T Y FROM: Administration Division-Department of
Public Health and Environment
DATE: Septcmbey 7, a C I
SUBJECT: Yltedicaias AGGounfable Can Cbijobbra
Attached to this memo is the finalized contract that the Health Department has received.
Please sign and date below indicating you have received the finalized contract and return
this signed memo to the Administration Division of the Health Department.
Please send the confirmation receipt to my attention. Thank you for your assistance with
the processing of this document.
ATTN: '1 O 1JCL)
/vlCave Collab0Yek1'yt '
r Medl Cai of :CCountabltContract Name: Colo✓ado (nepartmct { aitnCdu✓cV0llcl E Fin
ar-10n 63
Resolution Number: e201) — / 561
Finalized Contract Received By: IC�Y1C� CiS. __
t
Date Received: q - S" � �
Enclosure
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