HomeMy WebLinkAbout20113236.tiff RESOLUTION
RE: APPROVE AMENDMENT#2 TO CONTRACT TO PERFORM FUNCTIONS OF A SINGLE
ENTRY POINT AGENCY FOR MEDICAID LONG TERM CARE 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 Amendment#2 to the Contract to perform
the functions of a Single Entry Point Agency for Medicaid Long Term Care between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services,Area Agency on Aging,and the Colorado Department
of Health Care Policy and Financing, commencing upon full execution, with further terms and
conditions being as stated in said contract amendment, and
WHEREAS,after review,the Board deems it advisable to approve said contract amendment,
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 Amendment#2 to the Contract to perform the functions of a Single Entry
Point Agency for Medicaid Long Term Care between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of Health
Care Policy and Financing, Area Agency on Aging, and the Colorado Department of Human
Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said contract amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 19th day of December, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: V
Barbara r, hair J
Weld County Clerk to the Bo t1\� Elsa`
J-(9-A,
1 _ an P. Conway, Pro-Tem
BY: A
Deputy Cler i to the Boar )
E. Garcia
AP"'O DASTO je,c�M: rI' EQA1 £ 1
ki
Da id E. Long
C•. nt A orney u%Un
Douglas Rademacher
Date of signature: i / f
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, - - 1 I -\c/1-‘D- 2011-3236
HR0082
MEMORANDUM
1861 - 2011
•
DATE: December 15, 2011
W E L LR___C O U N T Y TO: Barbara Kirkmeyer, Chair, Board of County Co issioners
I� FROM: Judy A. Griego, Director, Hum ervi\4s Dep met'
�v
RE: Single Entry Point Contract Amendment No. 2 between the
Weld County Department of Human Services' Area Agency
on Aging and the Colorado Department of Health Care
Policy and Financing
Enclosed for Board approval is the Fiscal Year 2012 Single Entry Point contract Amendment No.
2 between the Department's Area Agency on Aging and the Colorado Department of Health Care
Policy and Financing. This Contract Amendment was reviewed under the Board's Pass-Around
Memorandum dated October 25, 2011, and approved for placement on the Board's Agenda.
The Amendment allows the Department of Health Care Policy and Financing to provide the
SEPs additional funds (through a reconciliation process) if funds are available and if the SEP has
exceeded the target numbers in the initial contract. The Weld SEP did exceed the target numbers
in FY11 and will be receiving additional funds. The exact fund amount has not been determined.
If you have questions, give me a call at extension 6510.
2011-3236
Department of Health Care Policy and Financing
Contract Routing Number
3012-9228
CMS #37974
CONTRACT AMENDMENT NO. 2
Original Contract Routing Number 3011-1322, CMS#20517
Amendment No. 1, 3011-9191, CMS # 30077
Option Letter No. 1, 3012-9074, CMS#33661
1. PARTIES
This Amendment to the above-referenced Original Contract(hereinafter called the "Contract") is
entered into by and between Weld County Department of Human Services by and through the
Weld County Board of Commissioners , PO Box 1805, Greeley, Colorado 80632, (hereinafter
called "Contractor"), and the STATE OF COLORADO, acting by and through the Department
of Health Care Policy and Financing, 1570 Grant Street, Denver, Colorado 80203 (hereinafter
called"Department"or"State").
2. EFFECTIVE DATE AND ENFORCEABILITY
This Amendment shall not be effective or enforceable until it is approved and signed by the
Colorado State Controller or designee (hereinafter called the "Effective Date"). The Department
shall not be liable to pay or reimburse Contractor for any performance hereunder, including, but
not limited to, costs or expenses incurred, or be bound by any provision hereof prior to the
Effective Date.
3. FACTUAL RECITALS
The parties entered into the Contract to secure home and community-based waiver and long term
home health case management and associated utilization review services for applicants and
clients of Medicaid Long Term Care. The purpose of this Amendment is to revise the annual
reconciliation process and reporting requirements.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained herein and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. LIMITS OF EFFECT
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments thereto, if any, remain in full force and effect except as specifically modified
herein.
6. MODIFICATIONS
The Contract and all prior amendments thereto, if any, arc modified as follows:
A. Section 4, Definitions, Definition B, Exhibits and other Attachments, is hereby
deleted in its entirety and replaced with the following:
B. Exhibits and other Attachments: The following documents are attached hereto and
incorporated by reference herein:
HIPAA Business Associate Addendum
Exhibit A, Statement of Work
Exhibit B, Case Management Agency (CMA) Administrative Review Tool
Exhibit C, Statement of Operating Expenses
Exhibit D, Case Manager Training Report Template
Exhibit E, Complaint Trends/Remedial Action Report Template
Exhibit F, Critical Incident Trends/Remedial Action Report Template
Exhibit G, Rate Schedule, SFY 2010-11
Exhibit G-1, Rate Schedule, SFY 2011-12
Exhibit H, Sample Option Letter
B. Section 5, Term, Paragraph D, Reconciliation after Contract Expiration, is hereby
added as follows:
D. Reconciliation after Contract Expiration
A three month final reconciliation period shall follow the expiration or termination of
the Contract. The Contractor shall provide all reports required by the Contract.
Reports required by the Contract shall be completed and submitted by the Contractor
to include all required information through to the Contract expiration or termination
date. The Department will complete a final reconciliation in accordance with the
procedures set forth in Exhibit A, Statement of Work, Section 6, Billing Procedures
and Reconciliation. Any Overpayment or Underpayment adjustment to the Contract
maximum amount shall be by Option Letter. Any Overpayment recovery or
Underpayment payment shall be completed within the three month final
reconciliation period.
C. Section 8, Reporting — Notification, is hereby deleted in its entirety and replaced
with the following:
8. REPORTING—NOTIFICATION
A. Quarterly Reports
i. The Contractor shall submit to the Department all quarterly reports as required in
Section 5 of Exhibit A by the 15th of the month following the end of each
calendar quarter.
ii. The Contractor shall provide to the Department on a quarterly basis, a written
program report specifying the number and type of Medicaid Long Term Care
clients and applicants served and the specific services provided per month. Such
written reports shall be in accordance with the procedures developed and
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prescribed by the Department. Required reports shall be submitted to the
Department not later than the 15 days after the end of each calendar quarter, or at
such time as otherwise specified.
B. Monthly Reports
For State Fiscal Year 2010-1 I only, the Contractor shall provide to the Department on
a monthly basis, a written program report identifying the monthly operating expenses
incurred by the Contractor in the satisfaction of the terms and conditions of this
Contract. Such written reports shall be in accordance with the procedures developed
and prescribed by the Department in the format as provided in Exhibit C, Statement
of Operating Expenses. Reports shall be submitted to the Department not later than
the 30t day of each subsequent calendar month, or at such time as otherwise
specified.
D. Section 20, General Provisions, Subsection 1,Order of Precedence, is hereby deleted
in its entirety and replaced with the following:
I. 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. HIPAA Business Associate Addendum
iii. The provisions of the main body of this Contract
iv. Exhibit A, Statement of Work
v. Exhibit B, Case Management Agency (CMA) Administrative Review Tool
vi. Exhibit C, Statement of Operating Expenses
vii. Exhibit D, Case Manager Training Report Template
viii. Exhibit E,Complaint Trends/Remedial Action Report Template
ix. Exhibit F, Critical Incident Trends/Remedial Action Report Template
x. Exhibit G, Rate Schedule, SFY 2010-11
xi. Exhibit G-I, Rate Schedule SFY 2011-12
xii. Exhibit H, Sample Option Letter
E. Exhibit A, Statement of Work Section 2, Definitions, Definition M, Mid-Period
Reforecast, Definition N, Overpayment, Definition O, Underpayment, Definition P,
Uncommitted Funds, and Definition Q, State Fiscal Year, is hereby added as
follows:
M. "Mid-Period Reforecast" means the use of nine months, July through March, actual
client and activity counts reported by the Contractor averaged and used to recalculate
the Contract maximum payable for the full twelve months of the current Contract
period by forecasting the final three months of the Contract period.
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N. "Overpayment" means the Contract maximum amount that is greater than the amount
calculated for actual client and activities counts multiplied by the applicable rates.
Overpayment may apply in a Mid-Period Reforecast or in an annual reconciliation.
O. "Underpayment" means the Contract maximum amount that is less than the amount
calculated for actual client counts and actual activities multiplied by the applicable
rates. Underpayment may apply in a Mid-Period Reforecast or in an annual
reconciliation.
P. "Uncommitted Funds" means any amount from an appropriation designated for the
SEP contracts that remains unallocated to the SEP Contracts after all allocations are
made to the SEP contracts.
Q. "State Fiscal Ycar (SFY)" means the twelve month period beginning July 1st and
ending June 30th.
F. Exhibit A, Statement of Work, Section 6, Training, Complaints, Appeals, Critical
Incidents and Administrative Oversight Requirements, Subsection D, Critical
Incident Reporting, is hereby deleted in its entirety and replaced with the following:
D. Critical Incident Reporting:
1. The Contractor shall document critical incidents in the Department prescribed
system;
2. The Contractor shall take appropriate action to address substantiated critical
incidents;
3. For State Fiscal Year 2010-11 only, the Contractor shall perform critical incident
trend analyses at least quarterly. The Contractor shall submit to the Department
by the end of each quarter and using the reporting template attached to this
contract as Exhibit F, Critical Incident Trends/Remedial Action Report Template,
a trend analysis and corrective action report indicating any concerning critical
incident-oriented trends observed since the effective date of this contract and the
remedial actions taken to address them.
G. Exhibit A, Statement of Work, Section 7, Billing Procedures and Reconciliation, is
hereby deleted in its entirety and replaced with the following:
7. BILLING PROCEDURES AND RECONCILIATION
A. Contract Maximum Amount Calculation
1. The Contract maximum amount shall be calculated using the rates, quantities
or percentages identified on the rate schedule attached as Exhibit G. Rates
shall remain the same unless changed through a formal Contract amendment.
Each Option Letter issued for the addition or deletion of funds shall include a
new exhibit identified with the letter G and a consecutive number. (Examples:
Option Letter #01 with Exhibit GI attached; then Option Letter #02 with
Exhibit G2 attached.) Each Option Letter with its attached exhibit shall be for
one of the following purposes:
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a. The Contract maximum for the State Fiscal Year funding based on the
forecast.
b. The Contract change to the maximum for the Mid-Period Reforecast.
c. The Contract change from the annual reconciliation.
2. The exhibit(s) shall identify the average client counts, activities, and rates
associated with each individual appropriation.
3. The maximum amount of the Contract for each appropriation shall be the
lesser of:
a. The total of all SEP contractors' projected client and activity counts
multiplied by the applicable rates; or
b. A pro-rata share of Department's total appropriations based on the
percentage of the SEP contractors' projected client and activity counts to
the total of all projected client and activity counts.
4. The Department shall apply this Contract maximum amount calculation for
the Contract renewal period prior to the start of that period. The Department
shall notify the Contractor of the new Contract maximum amount calculation
through the Option Letter in a form substantially equivalent to Exhibit H,
Sample Option Letter, prior to the start of each Contract period.
5. Following the receipt of the January through March client and activities
report, due April 15th, the Department shall perform a Mid-Period Reforecast
to adjust, if applicable, the Contract maximum amount based on the actual
client and activity counts reported by the Contractor. The adjustment shall be
the difference between the Contract maximum amount for the current Contract
period and the value of the calculated Contract maximum amount from the
Mid-Period Reforecast.
a. Overpayment Mid-Period Reforecast and Calculation of Available Funds
By appropriation, Uncommitted Funds, if any, shall be the first funds used
to cover underpayment(s) in the Mid-Period Reforecast.
i. If the Uncommitted Funds fully cover the Mid-Period Reforecasted
underpayment adjustments, those SEP contractors that evidence
reforecastcd Overpayment adjustments shall not receive an Option
Letter to decrease the Contract maximum. However, the Overpayment
reforecast calculation will be sent to the applicable SEP contractors for
information purposes only.
Example:
Uncommitted Funds arc $6,000.00
Total Mid-Period Reforecasted Underpayments all $4,800.00
SEP Contracts
Mid-Period Reforecasted Overpayment Adjustment $0.00
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ii. If Uncommitted Funds are not available or do not fully cover the total
amount of the Mid-Period Reforecasted Underpayment adjustments,
an Option Letter to decrease the Contract maximum amount by 95% of
any reforecasted Overpayment adjustment shall be issued by the
Department to the applicable SEP contractors.
Example:
Uncommitted Funds are $6,000.00
Total Mid-Period Reforecasted Underpayments all $10,800.00
SEP Contracts
Mid-Period Reforecasted Overpayment Amount $1,000.00
Mid-Period Reforecasted Overpayment Adjustment:
Option Letter to Decrease Contract Maximum by
95%of Overpayment Amount($1,000 times 95%) ($950.00)
b. Underpayment Mid-Period Reforecast and Distribution of Available
Funds
By appropriation, the Department shall use any Uncommitted Funds and
funds available from reforecasted Overpayment adjustments from 5.a.ii.,
to distribute to those SEP contractors that evidence reforecasted
Underpayment adjustments.
i. If the total of all Underpayment adjustments are less than the total
available funds, the Contractor shall be issued an Option Letter to
increase the Contract maximum amount by the reforecasted
Underpayment adjustment amount.
Example:
Total Available Funds to Distribute to $8,800.00
Underpayments
Total Mid-Period Reforecasted Underpayment $7,000.00
Amount all SEP Contracts
Mid-Period Reforecasted Underpayment for a SEP $1,000.00
Contract
Mid-Period Reforecasted Underpayment Adjustment:
Option Letter to Increase Contract Maximum $1,000.00
ii. If the total of all Underpayment adjustments are more than the total
available funds, the Contractor shall be issued an Option Letter to
increase the Contract maximum amount by a percentage of the
reforceasted Underpayment adjustment amount. The percentage of
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each Underpayment adjustment shall be based on the total of all SEP
contract reforecasted Underpayment adjustments.
Example:
Uncommitted Funds are $6,000.00
Total Funds from Mid-Period Reforecasted $2,800.00
Overpayment Adjustments
Total Available Funds to Distribute to $8,800.00
Underpayments
Total Mid-Period Reforecasted Underpayment $10,000.00
Amount all SEP Contracts
Mid-Period Reforecasted Underpayment for a SEP $2,000.00
Contract
Mid-Period Reforecasted Underpayment Adjustment:
Option Letter to Increase Contract Maximum by 20%
($2,000 is 20% of$10,000) of Total Available Funds $1,760.00
($8,800 times 20%)
B. Payments
1. At the end of State Fiscal Year 2009-10, a Holdover Letter was issued that
extended the prior Contract period through August 31, 2010. Payments for the
Holdover period shall be made to the Contractor in monthly amounts based on
the State Fiscal Year 2009-10 Contract amount.
2. Payments to the Contractor for the period September 1, 2010, through June
30, 2011, shall be made in equal monthly payments calculated by the Contract
maximum amount less the amounts paid to the Contractor for the Holdover
period. The total of all monthly payments for the Holdover period and the
remainder of State Fiscal Year shall not exceed the maximum amount stated
in §7.A. of the Contract.
3. For subsequent Contract renewal periods, payments to the Contractor shall be
made monthly. Monthly payment amounts shall be calculated by dividing the
Contract maximum amount by the number of months in the Contract period.
The total of all monthly payments made shall not exceed the maximum
amount stated in the Contract. An increase or decrease of the Contract
maximum amount by Option Letter for the Mid-period Reforecast adjustment
shall change the monthly payment amount for the final two months of the
Contract period.
C. Annual Reconciliation
I. Contractor payments will be reconciled at the end of each Contract period.
The reconciliation shall consist of collecting actual client and activity counts
reported by the Contractor, calculating to average or total as noted in the table
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below and multiplying the calculation by the rates in Exhibit G, and
comparing the total to the total of all monthly payments by appropriation paid
to the Contractor for the Contract period. Actual client and activity counts
shall be applied to each rate based on the following:
a. Base Rate Average of 12 months of
actual number of all clients
b. Appeals Average of 12 months of
actual number of all clients
c. Long-term Home Health (LTHH)PAR Average of 12 months of
actual number of all clients
Average of 12 months of
d. Mental Illness (MI) Differential actual number of specified
clients
e. Consumer Directed Attendant Support Average of 12 months of
Services(CDASS) Differential actual number of specified
clients
Total 12 months of actual
f. Assessment number of initial
assessments
g. Community Transition Services Total 12 months of actual
number of CTS
Actual number of counties
h. Multiple Counties if contract services cover
multiple counties
i. Utilization Review Average of 12 months of
actual number of clients
2. The reconciliation will reflect Overpayment or Underpayment for each
specified appropriation funding applicable to the Contract.
3. An Overpayment occurs when the Contractor's total monthly payments for the
Contract period arc higher than the actual client and activity counts
reconciliation. Any Overpayment made to the Contractor shall result in the
issuance of an Option Letter to decrease the Contract maximum amount for
that State Fiscal Year and a recovery notice. The Contractor shall remit the
amount of the Overpayment to the Department within 60 days of receipt of the
overpayment recovery notice. Recovery of Overpayments must be completed
no later than September 30'h of each year.
4. An Underpayment occurs when the Contractor's total monthly payments for
the Contract period arc lower than the actual client and activity counts
reconciliation. By appropriation, the Department shall add Uncommitted
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Funds plus Overpayment recovery funds to calculate the amount of funds
available for distribution to underpaid SEP contractors.
a. If all SEP contractor Underpayments are less than the total available
funds, the Contractor shall be issued an Option Letter to increase the
Contract maximum amount for the Underpayment amount calculated in
the reconciliation.
b. If all SEP contractor Underpayments are more than the total available
funds, the Contractor shall be issued an Option Letter to increase the
Contract maximum amount by a percentage of the Underpayment amount
calculated in the reconciliation. The percentage applied to each
Underpayment adjustment shall be based on the total Underpayment
amounts of all SEP contracts.
5. Additional payments to the Contractor as identified through the reconciliation
process described in this section C. may only be made in the event that the
payment does not cause the Department to exceed its total appropriation for
all SEP contracts as identified in the corresponding Exhibit Gs for all SEP
contracts for that State Fiscal Year, for each specific appropriation.
6. The reconciliation process is completed for a specific appropriation. Funds
from one appropriation may not be used to pay underpayments for a different
appropriation.
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
Except for the Special Provisions and the HIPAA Business Associates Addendum, in the event
of any conflict, inconsistency, variance, or contradiction between the provisions of this
Amendment and any of the provisions of the Contract, the provisions of this Amendment shall in
all respects supersede, govern, and control. The most recent version of the Special Provisions
incorporated into the Contract or any amendment shall always control other provisions in the
Contract or any amendments.
9. AVAILABLE FUNDS
Financial obligations of the state payable after the current fiscal year are contingent upon funds
for that purpose being appropriated, budgeted, or otherwise made available to the Department by
the federal government, state government and/or grantor.
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• •
Contract Routing Number 3012-9228
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
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:
Weld County Department of Human John W. Hickenlooper, Governor
Services by and through the Weld
County Board of Commissioners
By: C4 ti i` ;�' ;u.,/ ,� By:
Signature of AutYorized Office', Susan E. Birch, MBA, BSN, RN
Executive Director
Department of Health Care Policy and
Financing
Date: DEC 19 2011 Date: l 1 t
Barbara Kirkmeyer LEGAL REVIEW:
Printed Name of Authorized Officer John W. Suthers, Attorney General
Chair
Printed Title of Authorized Officer By: rI/E}
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not
valid until signed and dated below by the State Controller or delegate. Contractor is not
authorized to begin performance until such time. If Contractor begins performing prior thereto,
the State of Colorado is not obligated to pay Contractor for such performance or for any goods
and/or services provided hereunder.
STA CONTROLLER:
d . cDermott, CPA
By:
Depart ent f He th C c Policy and Financing
Date: / P 72—
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