HomeMy WebLinkAbout20101790 RESOLUTION
RE: APPROVE 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 a 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,and ending June 30, 2011,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 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.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 9th day of August, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
WELD CO 1N Y, COLORADO
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David E. Long
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MEMORANDUM
4$40tA DATE: August 5, 2010
ID
TO: Douglas Rademacher, Chair, Board of C mm' Toners
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II O�•FROM Jud A. Gie o Director H an Se ices De ent
COLORADO y r g '
SUBJECT: Single Entry Point Contract etween the Weld County
Department of Human Services' Area Agency on
Aging and the Colorado Department of Health Care
Policy and Financing for Fiscal Year 2011
Enclosed for Board approval is the Fiscal Year 2011 Single Entry Point Contract between
the Weld County Department of Human Services' Area Agency on Aging and the
Department of Health Care Policy and Financing. This Contract was presented at the
Board's June 21, 2010, Work Session.
The Department's Area Agency on Aging provides case management services for Medicaid
clients who fall under the responsibility of the Single Entry Point. The contact amount is
$1,030,958.63. The effective dates of the Contract are September 1, 2010 through June 30,
2011.
If you have any questions, give me a call at extension 6510.
2010-1790
Contract Routing Number 3011-1322
STATE OF COLORADO
Department of Health Care Policy and Financing
Contract with
Weld County Department of Human Services by and through the Weld
County Board of Commissioners
For Single Entry Point Case Management
and Utilization Review for Medicaid Home
and Community Based Services Waiver and
Long Term Home Health Clients and Applicants
TABLE OF CONTENTS
1. PARTIES 2
2. EFFECTIVE DATE AND NOTICE OF NONLIABILITY 2
3. RECITALS 2
4. DEFINITIONS 3
5. TERM AND EARLY TERMINATION 4
6. STATEMENT OF WORK 4
7. PAYMENTS TO CONTRACTOR 5
8. REPORTING-NOTIFICATION 6
9. CONTRACTOR RECORDS 7
10. CONFIDENTIAL INFORMATION 8
11. CONFLICTS OF INTEREST 10
12. REPRESENTATIONS AND WARRANTIES I 1
13. INSURANCE 12
14. BREACH 14
15. REMEDIES 15
16. NOTICES AND REPRESENTATIVES 18
17. RIGHTS IN DATA, DOCUMENTS, AND COMPUTER SOFTWARE 18
18. GOVERNMENTAL IMMUNITY . 19
19. NOT USED 19
20. GENERAL PROVISIONS 19
21. ADDITONAL GENERAL PROVISIONS 22
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
1. PARTIES
This Contract(hereinafter called "Contract") is entered into by and between Weld County
Department of Human Services by and through the Weld County Board of
Commissioners located at 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 the "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 (hereinafter called the "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 be bound by any provision
hereof prior to the Effective Date.
3. RECITALS
A. Authority, Appropriation, and Approval
Authority to enter into this Contract exists in C.R.S. 25.5-6-105 and C.R.S. 25.5-
6-106 and funds have been budgeted, appropriated and otherwise made available
pursuant to C.R.S. 25.5-6-107, C.R.S. 26-1-122 and C.R.S. 26-2-114 and a
sufficient unencumbered balance thereof remains available for payment. Required
approvals, clearance and coordination have been accomplished from and with
appropriate agencies.
B. 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 Contract.
C. Purpose
The purpose of this Contract is 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.
D. References
All references in this Contract to sections (whether spelled out or using the §
symbol), subsections, exhibits or other attachments, are references to sections,
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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: 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
C. "Goods" means tangible material acquired, produced, or delivered by Contractor
either separately or in conjunction with the Services Contractor renders
hereunder.
D. "Party" means the State or Contractor and Parties means both the State and
Contractor.
E. "Review" means examining Contractor's Work to ensure that it is adequate,
accurate, correct and in accordance with the standards described in this Contract.
F. "Services" means the required services to be performed by Contractor pursuant to
this Contract.
G. "Subcontractor" means third parties, if any, engaged by Contractor to aid in
performance of its obligations.
H. "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.
L "Work Product" means the tangible or intangible results of Contractor's Work,
including, but not limited to, software, research, reports, studies, data,
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photographs, negatives or other finished or unfinished documents, drawings,
models, surveys, maps, materials, or work product of any type, including drafts.
5. TERM AND EARLY TERMINATION
A. Initial Term-Work Commencement
The contract shall be effective upon approval by the State Controller, or designee.
The Parties' respective performances under this Contract shall commence on the
Effective Date. This Contract shall expire on June 30, 2011, unless sooner
terminated or further extended as specified elsewhere herein.
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.
C. Extension Amendments
The State may require continued performance for a period of one year at the same
rates and same terms specified in the Contract, unless modified by the extension
amendment. Such extension shall be made by contract amendment. An extension
amendment is not effective until approved and signed by the Colorado State
Controller or an authorized designee. The extended contract shall be considered to
include this renewal provision. The total duration of this Contract, including any
extension amendments under this clause, shall not exceed five years.
6. STATEMENT OF WORK
A. Completion
Contractor shall complete the Work and its other obligations as described in this
Contract on or before June 30, 2011. 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. Goods and Services
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Contractor shall procure Goods and Services necessary to complete the Work.
Such procurement shall not increase the maximum amount payable hereunder by
the State.
C. Independent Contractor
All persons employed by Contractor or Subcontractors to perform Work under
this Contract shall be Contractor's or Subcontractors' 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 CONTRAC'T'OR
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. Maximum Amount
The maximum amount payable under this Contract to Contractor by the State for
Work performed, including the Holdover period is:
State Fiscal Year 2010-11 51,030,958.63
B. Payment
Payment pursuant to this Contract will be made as earned. Any advance payments
allowed under this Contract shall comply with State Fiscal Rules and be made in
accordance with the provisions of this Contract. Contractor shall initiate any
payment requests by submitting invoices to the State in the form and manner
prescribed by the State.
C. Interest
The State shall fully pay each invoice within forty-five (45) days of receipt
thereof if the amount invoiced represents peformance by Contractor previously
accepted by the State. Uncontested amounts not paid by the State within forty-five
(45) days shall bear interest on the unpaid balance beginning on the forty-sixth
(46") day at a rate not to exceed one percent (1%) per month until paid in full;
provided, however, that interest shall not accrue on unpaid amounts that are
subject to a good faith dispute. Contractor shall invoice the State separately for
accrued interest on delinquent amounts. The billing shall reference the delinquent
payment, the number of days' interest to be paid and the interest rate.
D. Available Funds-Contingency-Termination
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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.
E. 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 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
Reports required under this Contract shall be in accordance with the procedures and in
such form as prescribed by the State.
A. Quarterly Reports
The Contractor shall submit to the Department by the end of each quarter
(September 30, December 31, March 31 and June 15 (for final quarter reporting
purposes) of each year), all quarterly reports as documented in Section 5 of
Exhibit A.
B. Monthly Reports
The Contractor shall provide to the Department on a monthly basis, a written
program report specifying the number and type of Medicaid Long Term Care
clients and applicants served and the specific services provided. Such written
reports shall be in accordance with the procedures developed and prescribed by
the Department. Required reports shall be submitted to the Department not later
than the 30111 day of each subsequent calendar month, or at such time as otherwise
specified.
The Contractor shall provide to the Department on a monthly basis, a written
program report identifying the monthly operating expenses incurred by the
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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 30th day of each subsequent calendar month, or at such time as otherwise
specified.
C. 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.
D. 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 or Goods
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 occuring, 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"). All such records, documents,
communications and other materials shall be the property of the State, and shall
be maintained by the Contractor in a central location and the Contractor shall be
custodian on behalf of the State.
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,
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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 duty
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 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
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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")
Federal Law and Regulations
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.
ii. Business Associate Contract
Federal law and regulations governing the privacy of certain health
information requires a "Business Associate Contract" between the State
and the Contractor. 45 C.F.R. Section 164.504(e). Attached and
incorporated herein by reference and agreed to by the parties is a HIPAA
Business Associate Addendum ("Addendum") for HIPAA compliance.
Terms of the Addendum shall be considered binding upon execution of
this Contract and shall remain in effect during the term of the Contract
including any extensions.
iii. Confidentiality of Records
Whether or not an Addendum is attached to this Contract, the Contractor
shall protect the confidentiality of all records and other materials
containing personally identifying information that are maintained in
accordance with the Contract and comply with HIPAA rules and
regulations. Except as provided by law, no information in possession of
the Contractor about any individual constituent shall be disclosed in a
form including identifying information without the prior written consent
of the person in interest, a minor's parent, or guardian. The Contractor
shall have written policies governing access to, duplication and
dissemination of, all such information. The Contractor shall advise its
employees, agents and subcontractors, if any, that they are subject to these
confidentiality requirements. The Contractor shall provide its employees,
agents and subcontractors, if any, with a copy or written explanation of
these confidentiality requirements before access to confidential data is
permitted. No confidentiality requirements contained in this Contract
shall negate or supersede the provisions of the federal Health Insurance
Portability and Accountability Act of 1996.
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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 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.
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.
B. The Contractor (and Subcontractors or subgrantees permitted under the terms of
this Contract) shall maintain a written code of standards governing the
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performance of its employees engaged in the award and administration of
contracts. No employee, officer or agent of the Contractor, Subcontractor or
subgrantee shall participate in the selection, or in the award or administration of a
contract or subcontract supported by federal funds if a conflict of interest, real or
apparent, would be involved. Such a conflict would arise when:
i. The employee, officer or agent;
Any member of the employee's immediate family;
The employee's partner; or
iv. An organization which employs, or is about to employ, any of the above,
has a financial or other interest in the firm selected for award. The
Contractor's, Subcontractor's, or subgrantee's officers, employees, or
agents will neither solicit nor accept gratuities, favors, or anything of
monetary value from Contractors, potential Contractors, or parties to
subagreements.
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 care, skill and diligence in Contractor's industry, trade, or profession
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, Pennits, 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
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employees, agents, and Subcontractors 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
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 insurance as specified in this
section at all times during the term of this Contract. All policies evidencing the insurance
coverage required hereunder shall be issued by insurance companies satisfactory to
Contractor and the State.
A. Contractor
Public Entities
If Contractor is a "public entity" within the meaning of the Colorado
Governmental Immunity Act, CRS §24-10-101, et seq., as amended (the
"GIA"), then Contractor shall maintain at all times during the term of this
Contract such liability insurance, by commercial policy or self-insurance,
as is necessary to meet its liabilities under the GIA. Contractor shall show
proof of such insurance satisfactory to the State, if requested by the State.
Contractor shall require each contract with a Subcontractor that is a public
entity, to include the insurance requirements necessary to meet such
Subcontractor's liabilities under the GIA.
Non-Public Entities
If Contractor is not a "public entity" within the meaning of the GIA,
Contractor shall obtain and maintain during the term of this Contract
insurance coverage and policies meeting the requirements set forth in §
13.B.
B. Contractors—Subcontractors
Contractor shall require each contract with Subcontractors other than those that
are public entities, providing Goods or Services in connection with this Contract,
to include insurance requirements substantially similar to the following:
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Worker's Compensation
Worker's Compensation Insurance as required by State statute, and
Employer's Liability Insurance covering all of Contractor's or
Subcontractor's employees acting within the course and scope of their
employment.
General Liability
Commercial General Liability Insurance written on ISO occurrence form
CG 00 01 10/93 or equivalent, covering premises operations, fire damage,
independent contractors, products and completed operations, blanket
contractual liability, personal injury, and advertising liability with
minimum limits as follows:
a. S1,000,000 each occurrence;
b. 51,000,000 general aggregate;
c. S 1,000,000 products and completed operations aggregate; and
d. S50,000 any one fire.
If any aggregate limit is reduced below SI,000,000 because of claims
made or paid, Subcontractor shall immediately obtain additional insurance
to restore the full aggregate limit and furnish to Contractor a certificate or
other document satisfactory to Contractor showing compliance with this
provision.
iii. Automobile Liability
Automobile Liability Insurance covering any auto (including owned, hired
and non-owned autos) with a minimum limit of S1,000,000 each accident
combined single limit.
iv. Additional Insured
The State shall be named as additional insured on all Commercial General
Liability and Automobile Liability Insurance policies (leases and
construction contracts require additional insured coverage for completed
operations on endorsements CG 2010 11/85, CG 2037, or equivalent)
required of Contractor and any Subcontractors hereunder.
v. Primacy of Coverage
Coverage required of Contractor and Subcontractor shall be primary over
any insurance or self-insurance program carried by Contractor or the State.
vi. Cancellation
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The above insurance policies shall include provisions preventing
cancellation or non-renewal without at least thirty (30) days prior notice to
Contractor and the State by certified mail and in accordance with § 16.
vii. Subrogation Waiver
All insurance policies in any way related to this Contract and secured and
maintained by Contractor or its Subcontractors as required herein shall
include clauses stating that each carrier shall waive all rights of recovery,
under subrogation or otherwise, against Contractor or the State, its
agencies, institutions, organizations, officers, agents, employees, and
volunteers.
C. Certificates
Contractor and all Subcontractors shall provide certificates showing insurance
coverage required hereunder to the State within seven (7) business days of the
Effective Date of this Contract. No later than fifteen (15) days prior to the
expiration date of any such coverage, Contractor and each Subcontractor shall
deliver to the State or Contractor certificates of insurance evidencing renewals
thereof. In addition, upon request by the State at any other time during the term of
this Contract or any subcontract, Contractor and each Subcontractor shall, within
ten (10) days of such request, supply to the State evidence satisfactory to the State
of compliance with the provisions of this § 13.
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
Page 14 of 29
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.
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, Services and Goods 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, 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 become the State's property.
The Contractor shall be obligated to return any payment advanced under
the provisions of this Contract.
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.
Page 15 of 29
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
goods or services. Contractor shall be liable for excess costs incurred by
the State in procuring from third parties replacement Work, Services or
substitute Goods 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.
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.
ii. 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. Additionally, if this Contract is
Page 16 of 29
less than 60% completed upon the effective date of such termination, the
State may reimburse Contractor for a portion of actual out-of-pocket
expenses (not otherwise reimbursed under this Contract) incurred by
Contractor prior to the effective date of the termination in the public
interest which are directly attributable to the uncompleted portion of
Contractor's obligations hereunder; provided that the sum of any and all
reimbursement shall not exceed the maximum amount payable to
Contractor hereunder.
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:
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.
Withhold Payment
Withhold payment to Contractor until Contractor's performance or
corrections in Contractor's performance are satisfactorily made and
completed.
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
Notwithstanding any other provision herein, the State may demand
immediate removal of any of Contractor's employees, agents, or
Subcontractors whom the State deems 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.
v. Intellectual Property
Page 17 of 29
If Contractor infringes on a patent, copyright, trademark, trade secret or
other intellectual property right while performing its obligations under this
Contract, Contractor shall, at the State's option:
a. Obtain for the State or Contractor the right to use such products
and services;
b. Replace any Goods, Services, or other product involved with non-
infringing products or modify them so that they become non-
infringing; or,
c. If neither of the foregoing alternatives are reasonably available,
remove any infringing Goods, Services, or products and refund the
price paid therefore to the State.
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: W. Sean Bryan
Department of Health Care Policy and Financing
1570 Grant Street
Denver, Colorado 80203
william.bryan@state.co.us
For the Contractor: Eva Jewell
SEP Administrator
Weld County Department of Human Services by and
through the Weld County Board of Commissioners
PO Box 1805
Greeley, Colorado 80632
17. RIGHTS IN DATA, DOCUMENTS, AND COMPUTER SOFTWARE
Any software, research, reports, studies, data, photographs, negatives or other documents,
drawings, models, materials, or Work Product of any type, including drafts, prepared by
Page 18 of 29
Contractor in the performance of its obligations under this Contract shall be the exclusive
property of the State, and all Work Product shall be delivered to the State by Contractor
upon completion or termination hereof The State's exclusive rights in such Work
Product shall include, but not be limited to, the right to copy, publish, display, transfer,
and prepare derivative works. Contractor shall not use, willingly allow, cause or permit
such Work Product to be used for any purpose other than the performance of Contractor's
obligations hereunder without the prior written consent of the State.
18. 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.
19. NOT USED
20. 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. All assignments, subcontracts, or Subcontractors are subject to all
of the provisions hereof. Contractor shall be solely responsible for all of the Work
performed under this Contract, regardless of whether Subcontractors are used and
for all aspects of subcontracting arrangements and performance. Copies of any
and all subcontracts entered into by Contractor to perform its obligations
hereunder shall be in writing and submitted to the State upon request. Any and all
subcontracts entered into by Contractor related to its performance hereunder shall
require the Subcontractor to perform in accordance with the terms and conditions
of this Contract and to comply with all applicable federal and state laws. Any and
all subcontracts shall include a provision that such subcontracts are governed by
the laws of the State of Colorado.
B. Binding Effect
Except as otherwise provided in §20.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. Captions
Page 19 of 29
The captions and headings in this Contract are for convenience of reference only,
and shall not be used to interpret, define, or limit its provisions.
D. Counterparts
This Contract may be executed in multiple identical original counterparts, all of
which shall constitute one agreement.
E. 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.
F. 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 etseq.,or the Federal Tort Claims Act, 28 U.S.C.
2671 et seq., as applicable, as now or hereafter amended.
G. 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.
H. Modification
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.
Page 20 of 29
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 automatically shall be
incorporated into and be part of this Contract on the effective date of such
change, as if fully set forth herein.
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:
Colorado Special Provisions
I-IPAA Business Associate Addendum
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
J. 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.
K. 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.
L. Taxes
The State is exempt from all federal excise taxes under IRC Chapter 32 (No. 84-
730123K) and from all State and local government sales and use taxes under CRS
§39-26-101 and 201, et seq. Such exemptions apply when materials are purchased
Page 21 of 29
or services are rendered to benefit the State; provided, however, that certain
political subdivisions (e.g., City of Denver) may require payment of sales or use
taxes even though the product or service is provided to the State. Contractor shall
be solely liable for paying such taxes as the State is prohibited from paying or
reimbursing Contractor for such taxes.
M. 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.
N. Waiver
Waiver of any breach under a term, provision, or requirement of this Contract, or
any right or remedy hereunder, whether explicitly or by lack of enforcement, shall
not be construed or deemed as a waiver of any subsequent breach of such term,
provision or requirement, or of any other term, provision, or requirement.
21. 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 permitted under this contract. The
federal laws and regulations include:
Age Discrimination Act of 1975, as 42 U.S.C. 6101, et seq.
amended
Age Discrimination in Employment Act 29 U.S.C. 621-634
of 1967
Americans with Disabilities Act of 1990 42 U.S.C. 12101, et seq.
(ADA)
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
Page 22 of 29
Equal Pay Act of 1963 29 U.S.C. 206(d)
Federal Water Pollution Control Act, as 33 U.S.C. 1251, et seq.
amended
Immigration Reform and Control Act of 8 U.S.C. I324b
1986
Section 504 of the Rehabilitation Act of 29 U.S.C. 794
1973, as amended
Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, et seq.
as amended
Title VII of the Civil Rights Act of 1964 42 U.S.C. 2000e
Title IX of the Education Amendments of 20 U.S.C. 1681
1972, as amended
State laws include:
Civil Rights Division Section 24-34-301, CRS, et seq.
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 state financial assistance, the Contractor makes the following
assurances, upon which the State relies.
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.
Page 23 of 29
B. Federal Audit Provisions
Office of Management and Budget (OMB) Circular No. A-133 Audits of States,
Local Governments, and Non-Profit Organizations defines audit requirements
under the Single Audit Act of 1996 (Public Law 104-156). All state and local
governments and non-profit organizations expending $500,000 or more from all
sources (direct or from pass-through entities) are required to comply with the
provisions of Circular No. A-133. The Circular also requires pass-through
entities to monitor the activities of subrecipients and ensure that subrecipients
meet the audit requirements. To identify its pass-through responsibilities, the
State of Colorado requires all subrecipients to notify the State when expected or
actual expenditures of federal assistance from all sources equal or exceed
$500,000.
C. Debarment and Suspension
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.
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 180
and 376.
v. The Contractor agrees that it will include this certification in all lower tier
covered transactions and subcontracts that exceed S100,000.
D. 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
Page 24 of 29
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 govennnental entity in its sovereign or
contractual capacity; fires; floods; epidemics; quarantine restrictions; strikes or
other labor disputes; freight embargoes; or unusually severe weather.
E. 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.
F. Lobbying
Contractor certifies, to the best of his or her knowledge and belief, that:
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.
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
Page 25 of 29
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 S10,000 and not more than S100,000 for each such failure.
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Page 26 of 29
SPECIAL PROVISIONS
(The Special Provisions apply to all contracts except where noted in italics.)
CON'TROLLER'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.
2. FUND AVAILABILITY. CRS§24-30-202(5.5). Financial obligations of the State payable after the current fiscal year arc
contingent upon funds for that purpose being appropriated,budgeted,and otherwise made available.
3. GOVERNMENTAL IMMUNITY. No term or condition of this contract shall be construed or interpreted as a waiver,
express or implied,of any of the immunities,rights,benefits,protections,or other provisions,of the Colorado Governmental
Immunity Act,CRS§24-10-101 et seq.,or the Federal Tort Claims Act,28 U.S.C. §§1346(6)and 2671 et seq.,as applicable
now or hereafter amended.
4. INDEPENDENT CONTRACTOR. Contractor shall perform its duties hereunder as an independent contractor and not as
an employee.Neither Contractor nor any agent or employee of Contractor shall be deemed lobe an agent or employee of the
State. Contractor and its employees and agents are not entitled to unemployment insurance or workers compensation
benefits through the State and the State shall not pay for or otherwise provide such coverage for Contractor or any of its
agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if
such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment
taxes and income taxes and local head taxes incurred pursuant to this contract. Contractor shall not have authorization,
express or implied, to bind the State to any agreement, liability or understanding, except as expressly set forth herein.
Contractor shall (a) provide and keep in force workers'compensation and unemployment compensation insurance in the
amounts required by law,(b)provide proof thereof when requested by the State,and(c)be solely responsible for its acts and
those of its employees and agents.
5. COMPLIANCE WITH LAW. Contractor shall strictly comply with all applicable federal and State laws, rules, and
regulations in effect or hereafter established, including, without limitation, laws applicable to discrimination and unfair
employment practices.
6. CHOICE OF LAW. Colorado law,and rules and regulations issued pursuant thereto, shall be applied in the interpretation,
execution, and enforcement of this contract. Any provision included or incorporated herein by reference which conflicts
with said laws,rules,and regulations shall be null and void Any provision incorporated herein by reference which purports
to negate this or any other Special Provision its whole or in part shall not he valid or enforceable or available in any action at
law, whether by way of complaint, defense, or otherwise. Any provision rendered null and void by the operation of this
provision shall not invalidate the remainder of this contract,to the extent capable of execution.
7. BINDING ARBITRATION PROHIBITED. The State of Colorado does not agree to binding arbitration by any extra-
judicial body or person. Any provision to the contrary in this contact or incorporated herein by reference shall be null and
void.
8. SOFTWARE PIRACY PROHIBITION. Governor's Executive Order D 002 00. State or other public funds payable
under this contract shall not be used for the acquisition, operation, or maintenance of computer software in violation of
federal copyright laws or applicable licensing restrictions. Contractor hereby certifies and warrants that, during the term of
this contract and any extensions,Contractor has and shall maintain in place appropriate systems and controls to prevent such
improper use of public funds. If the State determines that Contractor is in violation of this provision,the State may exercise
any remedy available at law or in equity or under this contract,including,without limitation,immediate termination of this
contract and any remedy consistent with federal copyright laws or applicable licensing restrictions.
9. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST. CRS §§24-18-201 and 24-50-507. The
signatories aver that to their knowledge,no employee of the State has any personal or beneficial interest whatsoever in the
service or property described in this contract.Contractor has no interest and shall not acquire any interest,direct or indirect,
that would conflict in any manner or degree with the performance of Contractor's services and Contractor shall not employ
any person having such known interests.
10. VENDOR OFFSET. CRS §§24-30-202(1)and 24-30-202.4. [Not Applicable to intergovernmental agreements]Subject
to CRS §24-30-202.4(3.5), the State Controller may withhold payment under the State's vendor offset intercept system for
debts owed to State agencies for: (a) unpaid child support debts or child support arrearages; (b) unpaid balances of tax,
accrued interest,or other charges specified in CRS§39-21-101,et seq.;(c)unpaid loans due to the Student Loan Division of
the Department of Higher Education; (d) amounts required to be paid to the Unemployment Compensation Fund; and(e)
other unpaid debts owing to the State as a result of final agency determination or judicial action.
Issued by the Office of the State Controller Date Issued: 7/1/74
Rule 3-1 Page 27 of 29 Date Revised: I/I/09
SPECIAL PROVISIONS
(The Special Provisions apply to all contracts except where noted in italics.)
II. 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-I 02(5)(e), 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 tenminate this contract for breach and,if so terminated,Contractor shall be
liable for damages.
12. PUBLIC CONTRACTS WITH NATURAL PERSONS.CRS§24-76.5-101.Contractor,if a natural person eighteen(18)
years of age or older,hereby swears and affirms under penalty of perjury that he or she(a)is a citizen or otherwise lawfully
present in the United States pursuant to federal law, (b)shall comply with the provisions of CRS§24-76.5-101 et seq.,and
(c)has produced one form of identification required by CRS §24-76.5-103 prior to the effective date of this contract.
Issued by the Office of the State Controller Date Issued: 7/1l74
Rule 3-1 Page 28 of 29 Date Revised, 111/09
Contract Routing Number 3011-1322
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:
Weld County Department of Human
Services by and through the Weld Bill Ritter, Jr., Governor
County Board of Commissioners
Legal Name of Contracting Entity
By:
By: mtc✓ Joa Henneberry, Executive Dire for
gnature of uthorized Officer D rtment of Health Care Policy and
Financing
Douglas Rademacher, Chair
Printed Name of Authorized Officer Date: b I L (e. (ID
LEGAL REVIEW:
Printed Title of Authorized Officer John W. Suthers, Attorney General
Date: AUG 0 9 2010 By: /- t A
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid
until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin
performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not
obligated to pay Contractor for such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER:
avid J. ermott, CPA
By:
Date: r (O
Page 29 of 29
ao/e- /790
HIPAA BUSINESS ASSOCIATE ADDENDUM
This Business Associate Addendum ("Addendum") is part of the Contract between the
State of Colorado, Department of Health Care Policy and Financing, and Weld County
Department of Human Services by and through the Weld County Board of Commissioners,
contract number 3011-1322. For purposes of this Addendum, the State is referred to as
"Department", "Covered Entity" or "CE" and the Contractor is referred to as "Associate".
Unless the context clearly requires a distinction between the Contract document and this
Addendum, all references herein to "the Contract" or"this Contract" include this Addendum.
RECITALS
A. CE wishes to disclose certain information to Associate pursuant to the terms of the
Contract, some of which may constitute Protected Health Information ("PHI") (defined
below).
B. CE and Associate intend to protect the privacy and provide for the security of PHl
disclosed to Associate pursuant to this Contract in compliance with the Health Insurance
Portability and Accountability Act of 1996, 42 U.S.C. § 1320d— 1320d-8 ("HIPAA") 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.
C. As part of the HIPAA regulations, the Privacy Rule requires CE to enter into a contract
containing specific requirements with Associate prior to disclosure of PHI, as set forth in,
but not limited to, Title 45, Sections 160.103, 164.502(e) and 164.504(e) of the Code of
Federal Regulations ("C.F.R.") and contained in this Addendum.
The parties agree as follows:
I. Definitions.
a. Except as otherwise defined herein, capitalized terms in this Addendum shall have the
definitions set forth in the HIPAA Privacy Rule at 45 C.F.R. Parts 160 and 164, as amended. In
the event of any conflict between the mandatory provisions of the Privacy Rule and the
provisions of this Contract, the Privacy Rule shall control. Where the provisions of this Contract
differ from those mandated by the Privacy Rule, but are nonetheless permitted by the Privacy
Rule, the provisions of this Contract shall control.
b. "Protected Health Information" or "PHI" means any information, whether oral or
recorded in any form or medium: (i) that relates to the past, present or fidure physical or mental
condition of an individual; the provision of health care to an individual; or the past, present or
future payment for the provision of health care to an individual; and (ii) that identifies the
individual or with respect to which there is a reasonable basis to believe the information can be
used to identify the individual, and shall have the meaning given to such term under the Privacy
Rule, including, but not limited to, 45 C.F.R. Section 164.501.
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c. "Protected Information" shall mean PHI provided by CE to Associate or created or
received by Associate on CE's behalf To the extent Associate is a covered entity under HIPAA
and creates or obtains its own PHI for treatment, payment and health care operations, Protected
Information under this Contract does not include any PHI created or obtained by Associate as a
covered entity and Associate shall follow its own policies and procedures for accounting, access
and amendment of Associate's PHI.
2. Obligations of Associate.
a. Permitted Uses. Associate shall not use Protected Information except for the purpose
of performing Associate's obligations under this Contract and as permitted under this
Addendum. Further, Associate shall not use Protected Information in any manner that would
constitute a violation of the Privacy Rule if so used by CE, except that Associate may use
Protected Information: (i) for the proper management and administration of Associate; (ii) to
carry out the legal responsibilities of Associate; or (iii) for Data Aggregation purposes for the
Health Care Operations of CE. Additional provisions, if any, governing permitted uses of
Protected Information are set forth in Attachment A to this Addendum.
b. Permitted Disclosures. Associate shall not disclose Protected Information in any
manner that would constitute a violation of the Privacy Rule if disclosed by CE, except that
Associate may disclose Protected Information: (i) in a manner permitted pursuant to this
Contract; (ii) for the proper management and administration of Associate; (iii) as required by
law; (iv) for Data Aggregation purposes for the Health Care Operations of CE; or (v) to report
violations of law to appropriate federal or state authorities, consistent with 45 C.F.R. Section
164.502(j)(1). To the extent that Associate discloses Protected Information to a third party,
Associate must obtain, prior to making any such disclosure: (i) reasonable assurances from such
third party that such Protected Information will be held confidential as provided pursuant to this
Addendum and only disclosed as required by law or for the purposes for which it was disclosed
to such third party; and (ii) an agreement from such third party to notify Associate within two
business days of any breaches of confidentiality of the Protected Information, to the extent it has
obtained knowledge of such breach. Additional provisions, if any, governing permitted
disclosures of Protected Information are set forth in Attachment A.
c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are
necessary to prevent the use or disclosure of Protected Information other than as permitted by
this Contract. Associate shall maintain a comprehensive written information privacy and
security program that includes administrative, technical and physical safeguards appropriate to
the size and complexity of the Associate's operations and the nature and scope of its activities.
d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing any
use or disclosure of Protected Information other than as provided for by this Contract within five
(5) business days of becoming aware of such use or disclosure.
e. Associate's Agents. If Associate uses one or more subcontractors or agents to
provide services under the Contract, and such subcontractors or agents receive or have access to
Protected Information, each subcontractor or agent shall sign an agreement with Associate
containing substantially the same provisions as this Addendum and further identifying CE as a
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third party beneficiary with rights of enforcement and indemnification from such subcontractors
or agents in the event of any violation of such subcontractor or agent agreement. Associate shall
implement and maintain sanctions against agents and subcontractors that violate such restrictions
and conditions shall mitigate the effects of any such violation.
f Access to Protected Information. Associate shall make Protected Information
maintained by Associate or its agents or subcontractors in Designated Record Sets available to
CE for inspection and copying within ten (10) business days of a request by CE to enable CE to
fulfill its obligations to permit individual access to PHI under the Privacy Rule, including, but
not limited to,45 C.F.R. Section 164.524.
g. Amendment of PHI. Within ten (10) business days of receipt of a request from CE
for an amendment of Protected Information or a record about an individual contained in a
Designated Record Set, Associate or its agents or subcontractors shall make such Protected
Information available to CE for amendment and incorporate any such amendment to enable CE
to fulfill its obligations with respect to requests by individuals to amend their PHI under the
Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.526. If any individual requests
an amendment of Protected Information directly from Associate or its agents or subcontractors,
Associate must notify CE in writing within five (5) business days of receipt of the request. Any
denial of amendment of Protected Information maintained by Associate or its agents or
subcontractors shall be the responsibility of CE.
h. Accounting Rights. Within ten (10) business days of notice by CE of a request for an
accounting of disclosures of Protected Information, Associate and its agents or subcontractors
shall make available to CE the information required to provide an accounting of disclosures to
enable CE to fulfill its obligations under the Privacy Rule, including, but not limited to, 45
C.F.R. Section 164.528. As set forth in, and as limited by, 45 C.F.R. Section 164.528, Associate
shall not provide an accounting to CE of disclosures: (i) to carry out treatment, payment or
health care operations, as set forth in 45 C.P.R. Section 164.506; (ii) to individuals of Protected
Information about them as set forth in 45 C.F.R. Section 164.502; (iii) pursuant to an
authorization as provided in 45 C.F.R. Section 164.508; (iv) to persons involved in the
individual's care or other notification purposes as set forth in 45 C.F.R. Section 164.510; (v) for
national security or intelligence purposes as set forth in 45 C.F.R. Section 164.512(k)(2); (vi) to
correctional institutions or law enforcement officials as set fort in 45 C.F.R. Section
164.512(k)(5); (vii) incident to a use or disclosure otherwise permitted by the Privacy Rule; (viii)
as part of a limited data set under 45 C.F.R. Section 164.514(e); or(ix) disclosures prior to April
14, 2003. Associate agrees to implement a process that allows for an accounting to be collected
and maintained by Associate and its agents or subcontractors for at least six (6) years prior to the
request, but not before the compliance date of the Privacy Rule. At a minimum, such
information shall include: (i) the date of disclosure; (ii) the name of the entity or person who
received Protected Information and, if known, the address of the entity or person; (iii) a brief
description of Protected Information disclosed; and (iv) a brief statement of purpose of the
disclosure that reasonably informs the individual of the basis for the disclosure, or a copy of the
individual's authorization, or a copy of the written request for disclosure. In the event that the
request for an accounting is delivered directly to Associate or its agents or subcontractors,
Associate shall within five (5) business days of the receipt of the request forward it to CE in
writing. It shall be CE's responsibility to prepare and deliver any such accounting requested.
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Associate shall not disclose any Protected Information except as set forth in Section 2(b) of this
Addendum.
i. Governmental Access to Records. Associate shall make its internal practices, books
and records relating to the use and disclosure of Protected Information available to the Secretary
of the U.S. Department of Health and Human Services (the "Secretary"), in a time and manner
designated by the Secretary, for purposes of determining CE's compliance with the Privacy Rule.
Associate shall provide to CE a copy of any Protected Information that Associate provides to the
Secretary concurrently with providing such Protected Information to the Secretary.
j. Minimum Necessary. Associate(and its agents or subcontractors) shall only request,
use and disclose the minimum amount of Protected Information necessary to accomplish the
purpose of the request, use or disclosure, in accordance with the Minimum Necessary
requirements of the Privacy Rule including, but not limited to, 45 C.P.R. Sections 164.502(b)
and 164.514(d).
k. Data Ownership. Associate acknowledges that Associate has no ownership rights
with respect to the Protected Information.
L Retention of Protected Information. Except upon termination of the Contract as
provided in Section 4(d) of this Addendum, Associate and its agents or subcontractors shall
retain all Protected Information throughout the term of this Contract and shall continue to
maintain the information required under Section 2(h) of this Addendum for a period of six (6)
years.
m. Associate's Insurance. Associate shall maintain casualty and liability insurance to
cover loss of PHI data and claims based upon alleged violations of privacy rights through
improper use or disclosure of PHI. All such policies shall meet or exceed the minimum
insurance requirements of the Contract (e.g., occurrence basis, combined single dollar limits,
annual aggregate dollar limits, additional insured status and notice of cancellation).
n. Notification of Breach. During the term of this Contract, Associate shall notify CE
within two (2) business days of any suspected or actual breach of security, intrusion or
unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in
violation of any applicable federal or state laws or regulations. Associate shall take (i) prompt
corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized
disclosure required by applicable federal and state laws and regulations.
o. Audits, Inspections and Enforcement. Within ten (10) business days of a written
request by CE, Associate and its agents or subcontractors shall allow CE to conduct a reasonable
inspection of the facilities, systems, books, records, agreements, policies and procedures relating
to the use or disclosure of Protected Information pursuant to this Addendum for the purpose of
determining whether Associate has complied with this Addendum; provided, however, that: (i)
Associate and CE shall mutually agree in advance upon the scope,timing and location of such an
inspection; (ii) CE shall protect the confidentiality of all confidential and proprietary information
of Associate to which CE has access during the course of such inspection; and (iii) CE shall
execute a nondisclosure agreement, upon terms mutually agreed upon by the parties, if requested
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by Associate. The fact that CE inspects, or fails to inspect, or has the right to inspect,
Associate's facilities, systems, books, records, agreements, policies and procedures does not
relieve Associate of its responsibility to comply with this Addendum, nor does CE's (i) failure to
detect or (ii) detection, but failure to notify Associate or require Associate's remediation of any
unsatisfactory practices, constitute acceptance of such practice or a waiver of CE's enforcement
rights under the Contract.
p. Safeguards During Transmission. Associate shall be responsible for using
appropriate safeguards to maintain and ensure the confidentiality, privacy and security of
Protected Information transmitted to CE pursuant to the Contract, in accordance with the
standards and requirements of the Privacy Rule, until such Protected Information is received by
CE, and in accordance with any specifications set forth in Attachment A.
q. Restrictions and Confidential Communications. Within ten (10) business days of
notice by CE of a restriction upon uses or disclosures or request for confidential communications
pursuant to 45 C.F.R. Section 164.522, Associate will restrict the use or disclosure of an
individual's Protected Information, provided Associate has agreed to such a restriction.
Associate will not respond directly to an individual's requests to restrict the use or disclosure of
Protected Information or to send all communication of Protected Information to an alternate
address. Associate will refer such requests to the CE so that the CE can coordinate and prepare a
timely response to the requesting individual and provide direction to Associate.
3. Obligations of CE.
a. Safeguards During Transmission. CE shall be responsible for using appropriate
safeguards to maintain and ensure the confidentiality, privacy and security of PHI transmitted to
Associate pursuant to this Contract, in accordance with the standards and requirements of the
Privacy Rule, until such PHI is received by Associate, and in accordance with any specifications
set forth in Attachment A.
b. Notice of Changes. CE shall provide Associate with a copy of its notice of privacy
practices produced in accordance with 45 C.F.R. Section 164.520, as well as any subsequent
changes or limitation(s) to such notice, to the extent such changes or limitation(s) may effect
Associate's use or disclosure of Protected Information. CE shall provide Associate with any
changes in, or revocation of, permission to use or disclose Protected Information, to the extent it
may affect Associate's permitted use or disclosure of PHI, CE shall notify Associate of any
restriction on the use or disclosure of Protected Information that CE has agreed to in accordance
with 45 C.F.R. Section 164.522. CE may effectuate any and all such notices of non-private
information via posting on CE's web site. Associate shall review CE's designated web site for
notice of changes to CE's HIPAA privacy policies and practices on the last day of each calendar
quarter.
4. Termination.
a. Material Breach. In addition to any other provisions in the Contract regarding breach,
a breach by Associate of any provision of this Addendum, as determined by CE, shall constitute
a material breach of this Contract and shall provide grounds for immediate termination of this
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Contract by CE pursuant to the provisions of the Contract covering termination for cause, if any.
If the Contract contains no express provisions regarding termination for cause, the following
terms and conditions shall apply:
(I) Default. If Associate refuses or fails to timely perform any of the
provisions of this Contract, CE may notify Associate in writing of the non-performance, and if
not promptly corrected within the time specified, CE may terminate this Contract. Associate
shall continue performance of this Contract to the extent it is not terminated and shall be liable
for excess costs incurred in procuring similar goods or services elsewhere.
(2) Associate's Duties. Notwithstanding termination of this Contract, and
subject to any directions from CE, Associate shall take timely, reasonable and necessary action
to protect and preserve property in the possession of Associate in which CE has an interest.
(3) Compensation. Payment for completed supplies delivered and accepted
by CE shall be at the Contract price. In the event of a material breach under paragraph 4(a), CE
may withhold amounts due Associate as CE deems necessary to protect CE against loss from
third party claims of improper use or disclosure and to reimburse CE for the excess costs
incurred in procuring similar goods and services elsewhere.
(4) Erroneous Termination for Default. If after such termination it is
determined, for any reason, that Associate was not in default, or that Associate's action/inaction
was excusable, such termination shall be treated as a termination for the public interest, and the
rights and obligations of the parties shall be the same as if this Contract had been terminated for
the public interest, as described in this Contract.
b. Reasonable Steps to Cure Breach. If CE knows of a pattern of activity or practice of
Associate that constitutes a material breach or violation of the Associate's obligations under the
provisions of this Addendum or another arrangement and does not terminate this Contract
pursuant to Section 4(a), then CE shall take reasonable steps to cure such breach or end such
violation, as applicable. If CE's efforts to cure such breach or end such violation are
unsuccessful, CE shall either (i) terminate the Contract, if feasible or (ii) if termination of this
Contract is not feasible, CE shall report Associate's breach or violation to the Secretary of the
Department of Health and Human Services.
c. Judicial or Administrative Proceedings. Either party may terminate the Contract,
effective immediately, if(i) the other party is named as a defendant in a criminal proceeding for
a violation of IIIPAA, the HIPAA Regulations or other security or privacy laws or (ii) a finding
or stipulation that the other party has violated any standard or requirement of HIPAA, the
HIPAA Regulations or other security or privacy laws is made in any administrative or civil
proceeding in which the party has been joined.
d. Effect of Termination.
(1) Except as provided in paragraph (2) of this subsection, upon termination
of this Contract, for any reason, Associate shall return or destroy all Protected Information that
Associate or its agents or subcontractors still maintain in any form, and shall retain no copies of
such Protected Information that Associate or its agents or subcontractors still maintain in any
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form, and shall retain no copies of such Protected information. If Associate elects to destroy the
PHI, Associate shall certify in writing to CE that such PHI has been destroyed.
(2) If Associate believes that returning or destroying the Protected
Information is not feasible, Associate shall promptly provide CE notice of the conditions making
return or destruction infeasible. Upon mutual agreement of CE and Associate that return or
destruction of Protected Information is infeasible, Associate shall continue to extend the
protections of Sections 2(a), 2(b), 2(c), 2(d) and 2(e) of this Addendum to such information, and
shall limit further use of such PHI to those purposes that make the return or destruction of such
PHI infeasible.
5. Injunctive Relief CE shall have the right to injunctive and other equitable and legal
relief against Associate or any of its agents or subcontractors in the event of any use or
disclosure of Protected Information in violation of this Contract or applicable law.
6. No Waiver of Immunity. No term or condition of this Contract shall be construed or
interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection,
or other provisions of the Colorado Governmental Immunity Act, CRS 24-10-100 et seq. or the
Federal Tort Claims Act, 28 U.S.C. 2671 el seq. as applicable, as now in effect or hereafter
amended.
7. Limitation of Liability. Any limitation of Associate's liability in the Contract shall be
inapplicable to the terms and conditions of this Addendum.
8. Disclaimer. CE makes no warranty or representation that compliance by Associate with
this Contract, HIPAA or HIPAA Regulations will be adequate or satisfactory for Associate's
own purposes. Associate is solely responsible for all decisions made by Associate regarding the
safeguarding of PHI.
9. Certification. To the extent that CE determines an examination is necessary in order to
comply with CE's legal obligation s pursuant to HIPAA relating to certification of its security
practices, CE or its authorized agents or contractors may, at CE's expense, examine Associate's
facilities, systems, procedures and records as may be necessary for such agents or contractors to
certify to CE the extent to which Associate's security safeguards comply with HIPAA, the
HIPAA Regulations or this Addendum.
10. Amendment.
a. Amendment to Comply with Law. The parties acknowledge that state and federal
laws relating to data security and privacy are rapidly evolving and that amendment of this
Addendum may re required to provide for procedures to ensure compliance with such
developments. The Parties specifically agree to take such action as is necessary to implement the
standards and requirements of HIPAA, the Privacy Rule, the Final HIPAA Security Regulations
at 68 Fed. Reg. 8334 (Feb 20, 2003), 45 C.F.R. § 164.314 and other applicable laws relating to
the security or privacy of PHI. The parties understand and agree that CE must receive
satisfactory written assurance from Associate that Associate will adequately safeguard all
Protected Information. Upon the request of either party, the other party agrees to promptly enter
into negotiations concerning the terms of an amendment to this Addendum embodying written
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assurances consistent with the standards and requirements of HIPAA, the Privacy Rule or other
applicable laws. CE may terminate this Contract upon thirty(30) days written notice in the event
(i) Associate does not promptly enter into negotiations to amend this Contract when requested by
CE pursuant to this Section or (ii) Associate does not enter into an amendment to this Contract
providing assurances regarding the safeguarding of PHI that CE, in its sole discretion, deems
sufficient to satisfy the standards and requirements of HIPAA and the Privacy Rule.
b. Amendment of Attachment A. Attachment A may be modified or amended by
mutual agreement of the parties in writing from time to time without formal amendment of this
Addendum.
11. Assistance in Litigation or Administrative Proceedings. Associate shall make itself, and
any subcontractors, employees or agents assisting Associate in the performance of its obligations
under the Contract, available to CE, at no cost to CE, up to a maximum of thirty (30) hours, to
testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being
commenced against CE, its directors, officers or employees based upon a claimed violation of
HIPAA, the Privacy Rule or other laws relating to security and privacy or PHI, except where
Associate or its subcontractor, employee or agent is a named adverse party.
12. No Third Party Beneficiaries. Nothing express or implied in this Contract is intended to
confer, nor shall anything herein confer, upon any person other than CE, Associate and their
respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.
13. Interpretation and Order of Precedence. The provisions of this Addendum shall prevail
over any provisions in the Contract that may conflict or appear inconsistent with any provision in
this Addendum. Together, the Contract and This Addendum shall be interpreted as broadly as
necessary to implement and comply with HIPAA and the Privacy Rule. The parties agree that
any ambiguity in this Contract shall be resolved in favor of a meaning that complies and is
consistent with HIPAA and the Privacy Rule. This Contract supersedes and replaces any
previous separately executed fHPAA addendum between the parties.
14. Survival of Certain Contract Terms. Notwithstanding anything herein to the contrary,
Associate's obligation sunder Section 4(d) ("Effect of Termination") and Section 12 ("No Third
Party Beneficiaries") shall survive termination of this Contract and shall be enforceable by CE as
provided herein in the event of such failure to perform or comply by the Associate. This
Addendum shall remain in effect during the term of the Contract including any extensions.
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15. Representatives and Notice.
a. Representatives. For the purpose of the Contract, the individuals identified elsewhere
in this Contract shall be the representatives of the respective parties. If no representatives are
identified in the Contract, the individuals listed below are hereby designated as the parties'
respective representatives for purposes of this Contract. Either party may from time to time
designate in writing new or substitute representatives.
b. Notices. All required notices shall be in writing and shall be hand delivered or given
by certified or registered mail to the representatives at the addresses set forth below.
State/Covered Entity Representative:
Name: W. Sean Bryan
Title: Contract and Performance Management Unit Supervisor
Department: Department of Health Care Policy and Financing
Address: 1570 Grant Street, Denver, CO 80439
Contractor/Business Associate Representative:
Name: Eva Jewell
Title: SEP Administrator
Company: Weld County Department of Human Services by and through the
Weld County Board of Commissioners
Address: PO Box 1805
Greeley, Colorado 80632
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ATTACHMENT A
This Attachment sets forth additional terms to the HIPAA Business Associate
Addendum, which is part of the Contract, between the State of Colorado, Department of Health
Care Policy and Financing, and Weld County Department of Human Services by and through the
Weld County Board of Commissioners, contract number 3011-1322 ("Contract") and is
effective as of July 1, 2010 (the "Attachment Effective Date"). This Attachment may be
amended from time to time as provided in Section 10(b) of the Addendum.
1. Additional Permitted Uses. In addition to those purposes set forth in Section 2(a) of the
Addendum, Associate may use Protected Information as follows:
No additional permitted uses.
2. Additional Permitted Disclosures. In addition to those purposes set forth in Section 2(b)
of the Addendum, Associate may disclose Protected Information as follows:
No additional permitted disclosures.
3. Subcontractor(s). The parties acknowledge that the following subcontractors or agents of
Associate shall receive Protected Information in the course of assisting Associate in the
performance of its obligations under this Contract:
None.
4. Receipt. Associate's receipt of Protected Information pursuant to this Contract shall be
deemed to occur as follows and Associate's obligations under the Addendum shall
commence with respect to such PHI upon such receipt:
Upon receipt of PHI from the Department.
5. Additional Restrictions on Use of Data. CE is a Business Associate of certain other
Covered Entities and, pursuant to such obligations of CE, Associate shall comply with
the following restrictions on the use and disclosure of Protected Information:
No additional restrictions on Use of Data.
6. Additional Terms.
No additional terms.
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Contract Routing No. 3011-1322
EXHIBIT A
STATEMENT OF WORK
1. GENERAL DESCRIPTION
Per C.R.S. 25.5-6-104 (2)(k), the Contractor shall serve as a single access or entry point
within a local area where a current or potential long-term care client can obtain long-term
care information, screening, assessment of need, and referral to appropriate long-term
care program and case management services.for all Coloradoans within their designated
district seeking access to, or information about long term care.
2. DEFINITIONS
A. "Benefits Utilization System(BUS)" means the online data system maintained by
the Department for recording case management activities associated with Long
Term Care (LTC) services.
B. "Case Management Agency (CMA)" means the organization obligated to fulfill
the responsibilities and requirements of this Contract.
C. "Case Manager" means an individual who meets the qualifications to perform
case management activities.
D. "Licensed Medical Professional" means the Primary Care Physician (PCP) or
licensed medical staff(LPN or RN).
E. "Prior Authorization Request (PAR)" means a request authorized by the
Department or CMA prior to obtaining certain services, supplies, equipment or
other waiver benefit items.
F. "Program" means a publicly funded program including, but is not limited to
Consumer Directed Attendant Support Services (CDASS), Children's Home and
Community Based Services (Children's HCBS), Home and Community-Based
Services for Persons with Brain Injury (HCBS-BI), Home and Community-Based
Services for the Elderly, Blind and Disabled (HCBS-EBD), Home and
Community-Based Services for Persons with Mental Illness (HCBS-MI), Home
and Community-Based Services for Persons Living with Acquired Immune
Deficiency Syndrome (HCBS-PLWA), Pediatric Hospice Waiver, Long-Term
Home Health Services (LTHH), Program of All-Inclusive Care for the Elderly
(PACE), Medicaid nursing facility care and case management services funded
through 42 U.S.C. Section 3001, et. seq., as amended.
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G. "Resource Development" means the analysis and implementation of additional
resources or services that extend the capabilities of community-based long-term
care systems to better serve long-term care clients and those likely to need
community-based long-term care in the future.
H. "Service Plan" means the document developed by the Case Manager with the
client and/or legal guardian and, if appropriate, collaterals, to document client
choice, establish, and identify the services and supports the client needs to
successfully live in the community. The Service Plan shall reflect the full scope of
the client's needs and include services from all funding sources including third
party and natural supports. The Service Plan shall document the amount,
frequency and duration of each service, the type of provider to furnish each
service, and the expected outcome of each service.
1. "Single Entry Point (SEP)" means an agency within a local area where a current
or potential long-term care client can obtain community-based long-term
information, screening, assessment of need and referral to appropriate programs
and case management services.
J. "Single Entry Point District" means a single county, or two or more counties,
designated as a geographic region in which one agency serves as the Single Entry
Point.
K. "Uniform Long Term Care (ULTC)" Instrument means the Functional Needs
Assessment and professional medical information used to determine Functional
Eligibility for LTC services.
L. "Utilization Review (UR)" means a system for prospective, concurrent, and
retrospective review of the necessity and appropriateness in the allocation of
supports and services to ensure the proper and efficient administration of
Medicaid LTC benefits.
3. BACKGROUND
In 1990, the Legislative Long Term Health Care Task Force developed a legislative
proposal, passed in the 1990 session, that required the Department to study the
development of a SEP system for accessing long term care services (Senate Bill-9). This
study, entitled "Improving Client Access to Long Term Care in Colorado," provided the
framework for the legislation passed during the following session in 1991 (House Bill-
1287), which implemented the SEP system for long term care in Colorado. The purpose of
this legislation is to improve access to long term care services and to facilitate utilization of
appropriate services by long term care clients. The system is to function for both private
and publicly funded clients in need of long term care services.
Per C.R.S. 25.5-6-104 (1) (a) and (b):
"1) (a) The general assembly hereby finds, determines, and declares that there is an
increasing strain on long-term care services in the state; that the number of persons in need
Page 2 of 9
of long-term care continues to grow; that community-based resources are not integrated
into a centralized system for referrals, assessment of needs, development of care plans, and
case management; and that persons in need of long-term care services have difficulty
accessing and using the current system, which is fragmented and which results in
inappropriate placements.
(b) The general assembly further finds, determines, and declares that the state is in need of
a long-term care system that organizes each long-term care client's entry, assessment of
need, and service delivery into a single unified system; and that such system must include,
at a minimum, a locally established single entry point administered by a designated entity,
a single client assessment instrument and administrative process,targeted case management
in order to maximize existing federal, state, and local funding, case management, and an
accountability mechanism designed to assure that budget allocations are being effectively
managed."
4. CONTRACTOR'S OBLIGATIONS
A. The Contractor shall perform the functions of a Single Entry Point Agency as defined
by Sections 25.5-6-104 through 25.5-6-106, C.R.S. (2007) and the regulations
applicable to the Department and the Single Entry Point system at 10 C.C.R. 2505-10,
Sections 8.390 et seq. These functions shall be provided for participants in various
long term care Programs including, but not limited to: , Consumer Directed Attendant
Support Services (CDASS), Children's Home and Community Based Services
(Children's HCBS), Home and Community-Based Services for Persons with Brain
Injury (HCBS-BI), Home and Community-Based Services for the Elderly, Blind and
Disabled (HCBS-EBD), Home and Community-Based Services for Persons with
Mental Illness (HCBS-MI), Home and Community-Based Services for Persons
Living with Acquired Immune Deficiency Syndrome (HCBS-PLWA), Pediatric
Hospice Waiver, Long-Term Home Health Services (LTHI-I), Program of All-
Inclusive Care for the Elderly (PACE), Medicaid nursing facility care and case
management services funded through 42 U.S.C. Section 3001, et. seq., as amended.
B. The Contractor shall perform its obligations in conformity with the provisions of Title
XIX of the Social Security Act and other applicable federal and state laws and
regulations.
C. The Contractor shall perform the Case Management functions for eligible persons as
defined in the state statutes and regulations, including but not limited to
intake/screening/referral, assessment of client need using the Department-prescribed
form, determination of functional eligibility, development and implementation of a
Service Plan, on-going Case Management, monitoring of clients, reassessment and
case closure.
D. The Contractor shall perform all necessary administrative functions for the operation
of a Single Entry Point agency as defined in the state statutes and regulations
including, but not limited to the following:
Page 3 of 9
1. Establishing a community advisory committee for the purpose of
providing public input and guidance for SEP Agency operation. The
committee shall meet at least twice a year or more often as necessary.
2. Establishing a Resource Development committee to facilitate the
development of local resources to meet the long-term care needs of
individuals who reside within the Single Entry Point District. At least
annually, committee updates shall be provided to the Department. Active,
on-going participation by key management or administrative staff in area
provider or interest group meetings to discuss resource development issues
are an acceptable substitute as long as complete documentation of the
discussions and progress made in developing relevant solutions is
forwarded to the Department at least annually.
3. Providing staff who meet the qualifications set forth in the state statutes
and regulations to perform necessary administrative, supervisory, case
management and UR functions.
4. Administering a personnel system for recruiting, hiring, evaluating and
terminating employees.
5. Performing accounting tasks in compliance with all rules and regulations
for accounting practices.
6. Maintaining client records in accordance with Program requirements,
including documentation of all case activities, monitoring of service
delivery and service effectiveness. The Contractor shall utilize the BUS
for the purpose of client information management. All relevant client
activities shall be documented in the prescribed system within the
timeframes established by the Department.
7. Protecting client's rights as they relate to the responsibilities of SEP
agencies as described in this contract.
8. Determining the client's Post Eligibility Treatment of Income (PETI)
according to instructions set forth by the Department.
9. Overcoming any geographic barriers within the district, including distance
from the agency office to provide timely assessment and case management
services to clients.
10. Providing access to its facilities for clients, service providers and others
during regular business office hours. Regular business office hours of
operation shall be posted and made available to the public and
accommodations made available for clients who need assistance or
consultation outside regular business office hours.
11. Providing access to a telephone system and trained staff to ensure timely
response to messages and telephone calls received after hours.
Page 4 of 9
12. Providing access to telecommunication devices and/or interpreters for the
hearing and vocally impaired and access to foreign language interpreters
as necessary.
13. Distributing an annual survey of a random sample of clients using a
Department-prescribed form to determine the level of satisfaction with
case management services provided to the client. Survey guidelines and
client names for the random sample shall be provided by the Department.
14. Facilitating the Medicaid application process for potentially eligible
individuals, responding to all referrals of potentially eligible clients within
Department-prescribed timeframes and providing appropriate and timely
access to services for all eligible long-term care clients.
15. Providing a thorough assessment of service needs and resources to assure
the most appropriate public and private resources are utilized to meet the
client's needs. The determination of appropriate resources shall not
supplant, but support self-care, family care and other informal community
based resources. The Contractor shall provide a thorough assessment and
determine functional eligibility using the ULTC Instrument for all clients
requesting publicly funded long-term care services.
16. Providing case management and UR functions and establishing a Service
Plan for recipients of publicly funded long-term care Programs. The
authorization and administration of services through a publicly funded
Program shall be in accordance with eligibility criteria as defined by
applicable state and federal statutes and regulations.
17. Reporting and providing follow-up action to critical incidents using the
Department-prescribed system.
18. Assuring that long-term care clients who receive case management
services receive the type and amount of skilled and non-skilled community
based long-term care services listed in the Service Plan. These services
shall not exceed the type and amount of services medically and/or
functionally required by each client.
19. Reviewing all PARs. The Contractor shall approve, deny or return a PAR
to the provider agency for additional information and notify the
Department of any significant increase or decrease in skilled services for a
client.
20. Following the standards set by the Department. These standards include
Dear Administrator Letters, Dear Agency Letters and written documents
from Department-approved training.
21. Processing information regarding client Medicaid eligibility within two
business days of receipt from the eligibility site.
Page 5 of 9
22. Performing all pertinent information processing within the applicable
timeframes specified in Department regulations.
23. Conducting an annual review using the Department prescribed tool(s) to
determine compliance with program and administrative requirements.
Guidelines for the review and the random sample of clients shall be
provided by the Department. Results shall be submitted to the Department
or the Department's designee within the prescribed timeframes.
24. Obtaining a waiver annually from the Department to provide direct
services based on criteria in applicable Department regulations. SEP
agencies granted a waiver to provide services must provide written
notification to the client and/or guardian of the potential influence the SEP
has on the Service Planning process. The SEP agency must also provide
the client and/or guardian with written information about how to file a
provider agency and/or SEP agency complaint. Upon client and/or
guardian request, the SEP agency must provide an option for the client
and/or guardian to request a different entity to develop the Service Plan.
The SEP must also provide an option for the Service Plan to be monitored
by a different SEP entity or individual.
25. Receiving, documenting and resolving complaints regarding the SEP
and/or service provider agencies. Documentation shall include the
complaint, the resolution of the complaint and the dates of contact.
Periodically analyze complaints for trends and institute corrective actions
as appropriate.
26. Verifying that each HCBS client has received at least one waiver service
within the timeframes specified in the applicable waiver and/or regulation.
If a client does not receive at least one waiver service within the
timeframes specified in the applicable waiver and/or regulation, the
Contractor shall appropriately notify the client that he/she is ineligible for
waiver services and that he/she has the right to appeal.
27. Reassessing a client using the ULTC Instrument annually, when there is a
significant change in the client's condition or more often as specific
waiver rules or circumstances require.
E. The Contractor shall follow 10 C.C.R. 2505-10, Section 8.393.31 when
transferring a client from one county to another county or from one Single Entry
Point District to another district.
F. The Contractor shall employ or contract with a Licensed Medical Professional to
be available to staff for consultation regarding medical and diagnostic concerns
and Long Term Home Health (LTHH) PARs for SEP clients.
G. The Contractor shall attend Administrative Law Judge hearings when the
Contractor agency has made a denial or adverse action against a client and the
Page 6 of 9
client appeals. The Contractor shall defend their decision as described in 10
C.C.R. 2505-10, Sections 8.057 et seq.
H. The Contractor shall submit Department required information electronically upon
the Department's request.
The Contractor shall assist in the transition of services in the event that the
contract shall be transferred to a different entity. Transitional assistance provided
by the Contractor shall include the transfer of all hard copy documents maintained
by the Contractor and shall be completed no later than ten (10) business days prior
to contract termination date.
5. THE DEPARTMENT'S OBLIGATIONS
A. The Department or a designee shall review the performance of the Contractor.
Performance monitoring may include a review of log notes, service plans,
assessments and other documentation relevant to the long term care services
provided the client. The Contractor shall be notified within 30 days of the
outcome of a review that may result in approval, provisional approval, denial or
termination of certification. The Department may appoint a designee to monitor
and/or make certification recommendations.
B. The Department, in accordance with the state statutes and regulations, shall
certify the Contractor. Certification shall be based upon, but not limited to,
results of on-site visits, evaluation results of the quality of service provided,
compliance with Program requirements, service timeliness, performance of
administrative functions, costs per client, communications with clients, client
monitoring, targeting populations served, community coordination and outreach
and financial accountability.
6. TRAINING, COMPLAINTS, APPEALS, CRITICAL INCIDENTS AND
ADMINISTRATIVE OVERSIGHT REQUIREMENTS
A. Training. The Contractor shall, at a minimum, train all case managers hired since
the effective date of this contract in the following areas prior to independent case
management assignment:
I. Long Term Care Eligibility;
2. Intake and Referral;
3. ULTC 100.2 Assessment;
4. Service Plan Development;
5. Notices and Appeals;
6. BUS Documentation; and
7. Home Health.
The Contractor shall provide to the Department by the end of each quarter an
electronic listing of all case management staff hired since the effective date of this
contract and an attendance roster for each training area identified using the
Page 7 of 9
reporting template attached to this contract as Exhibit D, Case Manager Training
Report Template.
All new case management staff shall receive at a minimum basic training and
instruction in all of these areas as a prerequisite to independent placement.
Documentation of the successful completion of this basic training and instruction
shall be included on the Case Manager Training Report Template provided as
Exhibit D to this Contract.
B. Complaint Process:
1. The Contractor shall document complaints received by the agency;
2. The Contractor shall take appropriate action to address substantiated
complaints;
3. The Contractor shall respond to complaints received and document
actions taken to resolve and/or mitigate complaints to the extent
possible; and
4. The Contractor shall conduct quarterly complaint process trend
analyses.
The Contractor shall submit to the Department by the end of each quarter, using
the reporting template attached to this contract as Exhibit E, Complaint
Trends/Remedial Action Report Template, a trend analysis and corrective action
report indicating any complaint-oriented trends observed since the effective date
of this contract and the remedial actions taken to address them.
C. Appeals:
1. In reference to appeals initiated and closed during the contract period,
the Contractor shall have represented the Department and worked
towards obtaining a favorable decision;
2. The Contractor shall process appeals in accordance with schedules
published by the State of Colorado Office of Administrative Courts
and rules promulgated by the Department;
3. The Contractor shall represent the Department in accordance with 10
C.C.R. 2505-10, Sections 8.057 etseq and 8.393 et seq; and
4. The Contractor shall submit all exceptions to the Office of Appeals
and include required information.
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. The Contractor shall respond to critical incidents received and
document actions taken to resolve and/or mitigate critical incidents to
the extent possible; and
Page 8 of 9
4. 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.
E. Administrative Review Tool:
The Contractor shall submit to the Department by the end of each quarter the
results of the application of the tool attached to this contract as Exhibit B, Case
Management Agency(CMA) Administrative Review Tool.
6. BILLING PROCEDURES AND RECONCILIATION
A.
1. At the end of State Fiscal year 2009-10 a Holdover Letter was issued that
extended the prior contract term 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 Letter 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 paragraph 7.A. of the contract.
B. 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 of the contract term. The
total of all monthly payments made shall not exceed the Maximum Amount stated
in the contract.
C. Contractor payments will be reconciled to the forecasted amounts used to
determine the contract Maximum Amount in accordance with 10 C.C.R. 2505-10,
Section 8.392.3.C., as soon as practicable following the contract period.
Page 9 of 9
Contract Routing No. 3011-1322
EXHIBIT B
tADMINISTRATIVE:MONITORING 700E t'
Agency.Name:
Reviewed By:
+a Review Date: .
- 'Assurance:Administrative AUNorRy
The Medicaid Agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance o
waiver functions by other state and local nonstateagencies(if appropriate)and contracted e tities.
'YoWNo/NIA. PTS
1.Case Managers meet the qualifications as outlined in State regulation
2.Case Managers have been screened (e.g.drug screening,background checks)and are appropriate for employment as defined by the agency
3.Agency administers a personnel system for recruiting.hiring.evaluating,and terminating employees °
4.If required by the contract,agency staffs a licensed medical professional
5.1f required by the contract,the agency follows standards as set fodh by the Department through DALs and written documents from Department
sanctioned lrainings °
6.Agency completed 015-mandated sample review of cases within required timeframes(Program Tool)
7.If required by the contract,agency has identified provider resource gaps and taken action to address q
B.If required by the contract,agency has an established resource development committee and has a summary of activities available
9.Agency has a method ofvenfying that clients have received at least one waiver service each month
10.Agency maintains client records in accordance with program requirements,including documentation of all case activities,the mondodng of service
delivery,and service effectiveness
11.The contractor uses the BUS for the purpose of client information management
12.Clients rights are protected as h pertains to the temns of the contract
13.Clients have access to the office during regular business office hours
14.Agency provides a telephone system and trained staff to.
a.Timely respond to messages
b.Provide access to telecommunication devices and/ar interpreters for the hearing and/or vocally impaired
C.Provide access to foreign language interpreters as needed
15.Case management functions are performed according to the contract or provider ageement
16.The agency assisted in the administration of the most recent annual client satisfaction survey
17.Contractor submits Department-required information electronically as scheduled or upon Department's request 0
It.If required by the contract:
a.Insurance is maintained in the coned amounts
b Workers compensation coverage is available as required by state statute
c.Employer's liability insurance as required by state statute
d.Commercial general liability with minimum limits as specified in the contract and with the state as an additional insured
e.Automobile liability insurance with minimum limits as specified in the contract with the State as an additional insured
C Insurance policies include language preventing the cancellation or nonrenewal without at least 45 days prior notice to the Department
g.Insurance policies include clauses stating that each tamer will waive all rights of recovery,under subrogation or otherwise,against the State of
Colorado,its agencies,institutions,organizations.officers,agents,employees,and volunteers
h.The issuing insurance companies have a satisfactory standing wRh the State
i.Certificates showing insurance coverage were submitted to the Department vfhin 7 business days of the effective date of the contract
19.In the event that the contractor subcontracts with other entities or organizations to perform duties outlined in the contract,that contractor has
0
secured express w+8ten consent of the Department
20.Contractor complied with the Reporting requirements as specified in the contract
21.Contractor complies with
HIPAA
22.If the Contractor received$500,000 or more of Federal Funds from all sources,the contractor has complied with the provisions of OMB Circular No.
a
23.1]
23.During the term of this contract,the Contractor did not engage in any rosiness or personal activities orpracticez or maintain any relationships which
conflict in any way with the Contractor fully performing his/her obligations under this contract
24.The Contractor refrained from any practices,activities or relationships which could reasonably be considered to be in conflict with the Contractors
ability to fury perform the obligations to the Department under the terms of this contrad
25 The Contractor(and subcontractors or subgrantees permitted under the terms of this contract)maintained a written code of standards governing the
performance of its employees engaged in the award and administration of contracts
26.If this is a covered transaction as defined by the State Controller or the conrad amount exceeds
dstl 10,000,the 0o rased Co d actor certi fiedltified toth best o its
knowledge and belief that it and its pincipals and subcontractors are not presently debarred,s p p °
or voluntadly excluded by any Federal Department or agency
1
of 46:$ 1.SS'or2'
Grading�Eachquesllon on is worts 278 pis.`Yes'or7WA'(when applicable)rs'wodh 3.77 8 p1s,'No'NwoM gpts.�
Pa,v-,nio
Page 1 of I
Contract Routing No. 3011-1322
EXHIBIT C
SINGLE ENTRY POINT AGENCY STATEMENT OF EXPENDITURES
SEP AGENCY: MONTH/YEAR: TODAY'S DATE:
g ';;r 4):NEXPENSES .':ice,; ,'NUMBER a�L-
Personal Services
Travel
Operating
Capital Outlay
Overhead
TOTAL EXPENDITURES $ -
SURPLUS BALANCE
TOTAL PAID HOURS(to quarter hour detail) Sample week: to
IN SAMPLE WEEK(Submit this section only for months which include sample week)
OURS " NUMBERS+K iPERGEN•,:q
HCBS-EBD #DIV/0
HCBS-PLWA #DIV/0!
HCBS.BI #DIV/0!
HCBS-MI #DIV/0!
LTHH #DIV/0!
CDASS(State Plan) #DIV/0!
MEDICAID GENERAL #DIV/0!
SUBTOTAL HOURS 0
PRIVATE PAY 0
TOTAL HOURS 0
rev 7-2010
Page 1 of 1
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