HomeMy WebLinkAbout20092403.tiffRESOLUTION
RE: APPROVE ANCILLARY SERVICES AGREEMENT FOR COLORADO CHILDREN'S
BASIC HEALTH CARE PLAN 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 an Ancillary Services Agreement for the
Colorado Children's Basic Health Care Plan between the County of Weld, State of Colorado, by
and through the Board of County Commissioners of Weld County, on behalf of the Weld County
Department of Public Health and Environment, and the Colorado Department of Public Health and
Environment, commencing upon full execution, and ending June 30, 2013, with further terms and
conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, 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 Ancillary Services Agreement for the Colorado Children's Basic Health
Care Plan between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and the Colorado Department of Public Health and Environment be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 9th day of September, A.D., 2009.
ATTEST:
Weld County Clerk to t
BY: dalk:L,
Deputy Clerk to the Boa
APPRO ED AS TO FORM:
y Forney
Date of signature. 03/02
BOARD OF COUNTY COMMISSIONERS
WELD COU LORADO
William F. Garcia, Chair
Dougl. Rader acher, Pro-Tem
Sealy P. Conway
ara Kirkmeyer
David E. Long
2009-2403
HL0036
01/30/07
COLORADO
Memorandum
TO: William F. Garcia, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health au�l
Environment NCIA
DATE: July 22, 2009
SUBJECT: Ancillary Services Agreement for the
Children's Basic Health Plan
Enclosed for Board review and approval is an agreement between the Department of Health Care
Policy and Financing and the Board of County Commissioners of Weld County on behalf of the
Weld County Department of Public Health and Environment.
The agreement allows for WCDPHE to receive periodic payment for the provision of Covered
Services to enrollees under the Colorado Children's Basic Health Plan in accordance with the
terms of this Agreement and 25.5-8-101, C.R.S., as set forth in the Evidence of Coverage and the
CHP+ Provider Manual.
Reimbursement for all Covered Services provided by the Weld County Department of Public
Health & Environment is made by the Department of Health Care Policy and Financing or the
CHP+ Program Administrative Services Organization (ASO) on a fee -for -service basis in
accordance with the CHP+ Fee Schedule established by the State and specified in the CHP+
Provider Manual.
The agreement shall commence upon signature of this Agreement by the State Controller or
delegate and will extend through June 30, 2013. I recommend the approval of this agreement.
Enclosure
2009-2403
Colorado Department of Health
Care Policy
and Financing:
3l\O—t-IiO
Contract Routing Number:
Phase I Waiver#125
ANCILLARY SERVICES AGREEMENT
THIS AGREEMENT, Made this 15th of September, 2009 , by and between the State of Colorado for the
use and benefit of the Department of Health Care Policy and Financing, hereinafter referred to as "the
Department", or "the State" 1570 Grant Street, Denver, CO 80203-1818, and Board of County
Commissioners of Weld County d.b.a. on behalf of the Weld County Department of Public Health
and Environment, 1555 N 17th Ave Greeley, CO 80631 , hereinafter referred to as "the Contractor
WHEREAS, authority exists in the Law and Funds have been budgeted, appropriated and otherwise made
available and a sufficient uncommitted balance thereof remains available for encumbering and subsequent
payment of this Agreement in Fund Number N.A., Appropriation Code N.A. ;
WHEREAS, required approval, clearance and coordination has been accomplished from and with appropriate
agencies;
WHEREAS, the Department is the agency responsible for administration of the Children's Basic Health Plan,
hereinafter referred to as "the Program", pursuant to the provision of Article 8, Title 25.5, Colorado Revised
Statutes, as amended, and Title XXI of the Social Security Act; and
WHEREAS, the Contractor is capable of providing Covered Services, and desires to do so in accordance with
the terms of this Agreement and 25.5-8-101, C.R.S.;
NOW, THEREFORE, in consideration of the mutual covenants herein contained and the periodic payment to
the Contractor of the required premiums and subject to the terms, conditions, provisions, and limitations
contained in this Agreement, the Department and the Contractor agree as follows:
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1. DEFINITIONS
For the purpose of this Agreement, the following definitions shall apply:
Ancillary Service: A Covered Service which supports the diagnosis and/or treatment of a Member, which is
ordered by a Primary Care Provider or Specialty Care Provider, and which is delivered to the Member by
another Participating Provider on an outpatient or home care basis. Examples of Ancillary Services are
certain pharmaceuticals, medical supplies, laboratory tests, diagnostic or therapeutic radiology procedures,
durable medical equipment and developmental evaluations as described in the Evidence of Coverage.
Adverse Determination: A determination by the Department or its designee that an admission, availability of
care, continued stay or other Covered Service has been reviewed and, based upon the information provided,
does not meet the requirement for Medical Necessity, appropriateness, health care setting, level of care or
effectiveness, and payment by the Department for the requested service is, therefore, denied, reduced or
terminated.
Case Management: Case Management services consist of a set of services and activities through which
appropriate and cost-effective Covered Services are identified, planned, coordinated, obtained, monitored,
and continuously evaluated. Case Management services may vary in scope and frequency, depending on the
Enrollee's intensity of need.
Child Health Plan Plus (CHP+): The marketing name for the Program. The Children's Basic Health Plan
will be known to the public as CHP+.
CHP+ Provider Manual: The policy and procedure manual prepared by the Department that specifies the
policies and procedures to be followed by Participating Providers in carrying out the terms and conditions of
this Agreement. The CHP+ Provider Manual may be modified periodically by the Department, with at least
thirty (30) days prior written notice by the Department to the Contractor.
Colorado Medicaid: The Colorado Medical Assistance Program administered pursuant to Article 4, Title
25.5, Colorado Revised Statutes, as amended, and Title XIX of the Social Security Act.
Reimbursement Adjustment: A bookkeeping adjustment made to a Participating Provider's financial records
that accounts for any difference between a Participating Provider's billed charge and the Maximum Service
Reimbursement set forth herein
Copavment: The amount required to be paid by the Enrollee directly to the Participating Provider at the time
of each professional or emergency room visit or to a dispensing pharmacy, as specified by the Department or
its designee on the Enrollee's identification card.
Covered Services: The services and benefits described and limited in the Evidence of Coverage document.
Services are Covered Services only if they are performed, arranged and authorized in accordance with the
terms, limitations, and exclusions set forth in the Evidence of Coverage and the CHP+ Provider Manual.
Emergency/Urgent Care Services: Emergency care is the sudden and, at the time, unexpected onset of a
health condition that requires immediate medical attention, where failure to provide medical attention would
result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would
place the person's health in serious jeopardy.
Urgent care means situations that are not life threatening but require prompt medical attention to prevent
serious deterioration in a member's health.
Enrollee: Any individual who is entitled to the benefits of the Program, classified in the State's management
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information system as an active enrollee, and not a member of a health plan provided by an insurance carrier
under contract with the Department.
Evidence of Coverage (Benefit Booklet): The document that governs the terms of the health care services
provided to Enrollees in the Program. The Evidence of Coverage sets forth the benefits, limitations,
exclusions and policies and procedures of the Program. The Evidence of Coverage may be periodically
modified by the Department, with at least fifteen (15) days prior written notice to the Contractor.
Experimental and/or Investigational Services: A service is experimental or investigational for an Enrollee's
condition if any of the following statements apply to it as of the time the service is or will be provided to the
Enrollee. The service:
1. Cannot be legally marketed in the United States without the approval of the Food and Drug
Administration (FDA) and such approval has not been granted; or
2. Is the subject of a current new drug or new device application of file with the FDA; or
3. Is provided as a Phase I or Phase II clinical trial, as the experimental or research arm of a Phase III
clinical trial or in any other manner that is intended to evaluate the safety, toxicity or efficacy of the
service; or
4. Is provided pursuant to a written protocol or other document that lists an evaluation of the service's
safety, toxicity or efficacy as among its objectives; or
5. Is subject to the approval or review of an Institutional Review Board (IRB) or other body that
approves or reviews research concerning the safety, toxicity or efficacy of services; or
6. Is provided pursuant to informed consent documents that describe the service as experimental or
investigational or in other terms that indicate that the service is being evaluated for its safety, toxicity
or efficacy; or
7. The prevailing opinion among experts as expressed in the published authoritative medical or scientific
literature is that (1) use of the service should be substantially confined to research settings, or (2)
further research is necessary to determine the safety, toxicity or efficacy of the service.
In making determinations whether a service is experimental or investigational, the following sources of
information will be relied upon exclusively:
1. The Enrollee's medical records;
2. The written protocol(s) or other document(s) pursuant to which the service has been or will be
provided;
3. Any consent document(s) the Enrollee or the Enrollee's representative has executed or will be asked
to execute to receive the service;
4. The files and records of the IRB or similar body that approves or reviews research at the institution
where the service has been or will be provided, and other information concerning the authority or
actions of the IRB or similar body;
5. The published authoritative medical or scientific literature regarding the service as applied to the
Enrollee's illness or injury; and
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6. Regulations, records, applications and other documents or actions issued by, filed with, or taken by the
FDA, the Office of Technology Assessment, or other agencies within the United States Department of
Health and Human services, or any state agency performing similar functions.
If two or more services are part of the same treatment plan or diagnosis, all of the services in that treatment
plan or diagnosis are excluded if one of the services is experimental or investigational.
Hospital Services: All inpatient, outpatient and emergency department services typically provided by a
general hospital which are defined hereunder as Covered Services. Except during a Medical Emergency, or
upon authorized referral, the Department shall be responsible only for the reimbursement of Hospital
Services provided by a Participating Provider.
Maximum Service Reimbursement: As specified in Section IV of this Agreement, the maximum amount of
reimbursement allowed for any Covered Service.
Medical Emergency: The sudden, and at the time, unexpected onset of a health condition that a prudent
layperson would assume requires immediate medical attention, where failure to provide medical attention
would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or
would place the person's health in serious jeopardy.
Medically Necessary or Medical Necessity: A Covered Service shall be deemed Medically Necessary if, in a
manner consistent with accepted standards of medical practice, it is:
1. Consistent with the symptom, diagnosis and treatment of an Enrollee's medical condition;
2. Widely accepted by the practitioner's peer group as efficacious and reasonably safe based upon
scientific evidence;
3. Not Experimental or Investigational;
4. Not solely for cosmetic purposes;
5. Not solely for the convenience of the Enrollee, subscriber, physician or other provider;
6. The most appropriate level of care that can be safely provided to the Enrollee, and;
7. Failure to provide the Covered Service would adversely affect the Enrollee's health.
When applied to inpatient care, Medically Necessary further means that Covered Services cannot be safely
provided in an ambulatory setting.
Network Provider: A licensed, certified or registered health care professional or facility that has entered into
a written agreement with the Department to provide certain Covered Services to Enrollees as required under
this contract. Network Providers become Participating Providers by virtue of this Agreement.
Non -Covered Services: Any service provided by the Contractor which is not defined as a Covered Service
herein, including but not limited to any service or benefit of the Program for which an Adverse Determination
has been made by the Department or its designee.
Participating Provider: Any licensed, certified or registered health care professional or facility that has
entered into a written agreement with the Department to provide Covered Services to Enrollees.
Primary Care Provider: A family medicine, pediatric or general practice health care provider who is a
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Participating Provider and who is responsible for managing and directing Covered Services provided to
Enrollees.
Primary Care Services: The same as Covered Services, as defined in this Definitions section.
Specialty Care Provider: A licensed, certified or registered health care provider who is a Participating
Provider, who practices in a specialty care area of medicine (not family medicine, pediatric, general practice
or internist), and who is responsible for providing health care services to an Enrollee upon the referral of the
Enrollee by the Enrollee's Primary Care Provider or another Participating Provider.
State: The sovereign state of Colorado, its administrative agencies, departments and agent(s), used for
administration of the Program.
II. OBLIGATIONS OF THE CONTRACTOR
A. Applicable Laws: The Contractor shall abide by all applicable federal and state laws and regulations
and rules, as amended, in the performance of work required under this Agreement.
B. Incorporated Documents: The most current CHP+ Provider Manual and Evidence of Coverage are
hereby incorporated into this Agreement. The Contractor hereby certifies that it has read,
understands, and agrees to abide by all provisions of the CHP+ Provider Manual and Evidence of
Coverage prepared by the Department, both of which are on the CHP+ provider web site at
http://www.chpplusproviders.com/. From time to time, the Contractor will be notified in writing by
the Department of changes to the CHP+ Provider Manual and Evidence of Coverage. Contractor shall
adhere to the policies, procedures and requirements set forth in the most recent version of the CHP+
Provider Manual and the Evidence of Coverage.
C. Covered Services: The Contractor agrees to provide all Medically Necessary Covered Services to
Enrollees as defined in the Evidence of Coverage.
D. Non -Covered Services: In the event the Contractor recommends that an Enrollee receive Non -Covered
Services from the Contractor, as defined herein, the Contractor shall inform the Enrollee prior to the
provision of such services that:
1. the services recommended are Non -Covered Services;
2. the Department will not pay for or be liable for such services; and
3. The Enrollee shall be financially liable to the Contractor for such services.
If the Contractor substantially fails to inform the Enrollee that such recommended services are not
covered, then the Contractor shall be financially responsible for such services and may not collect
payment for such services from the Enrollee or the Department.
E. Referrals:
1. Except in a Medical Emergency, the Contractor agrees to obtain prior authorization from the
Department or its designee for all services requiring referrals. Authorizations are based on
information available at the time requested and do not preclude subsequent denial due to
changes in coverage or eligibility not known to the Department or its designee at time
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authorization is granted.
2. The Contractor agrees to refer Enrollees only to Participating Providers for Covered Services,
and to furnish such providers with complete information regarding treatment, procedures, and
diagnostic tests performed prior to such referrals, all in accordance with the policies set forth in
the CHP+ Provider Manual.
3. In the event services required by an Enrollee are not available from Participating Providers,
other providers may be utilized with the prior approval of the Department or its designee, as
described in the CHP+ Provider Manual. If the Contractor refers an Enrollee to a
non -Participating Provider for non -emergency Covered Services without appropriate
authorization, the Contractor shall be financially responsible for such services and shall not
collect payment for such services from the Enrollee or the Department.
F. Inpatient and Outpatient Admissions: Any inpatient or outpatient admission, other than for a Medical
Emergency, shall be approved in advance by the Department or its designee(s). It is the responsibility
of the Participating Provider ordering the admission to obtain prior authorization from the Department
or its designee(s). In the event of an admission due to a Medical Emergency, Contractor shall notify
the Department or its designee(s) of the admission within seventy-two (72) hours, or the next business
day. All inpatient admissions shall be subject to such further utilization management procedures set
forth in the CHP+ Provider Manual.
G. Eligibility: It is hereby agreed that the Contractor shall be responsible for verifying that the patient is
an Enrollee prior to providing any Covered Service required hereunder. The Department or its
designee(s) will confirm the status of Enrollees upon request by the Contractor.
H. Records and Reports: Contractor shall maintain and provide, without charge, such medical, financial,
and administrative records and information to the Department as may be necessary for compliance by
the Department with state and federal law, as well as for administration of the Program. The
Department shall have access, at reasonable times upon demand and upon reasonable prior notice, to
the electronic data and files, books, records and papers of Contractor relating to the health care
services provided to Enrollees, and to the cost thereof. Upon receipt of such records from the
Contractor, the Department and/or its designee(s) shall ensure that all such records are maintained in
strict accordance with all applicable laws and regulations concerning the confidentiality of patient and
provider records and information.
I. Health Insurance Portability & Accountability Act of 1996 ("HIPAA"): Pursuant to federal law and
regulations governing the privacy of certain health information, the Contractor, to the extent
applicable, shall comply with the Health Insurance Portability and Accountability Act of 1996, 42
U.S.C. § 1320d — 1320d-8 ("HIPAA") and its implementing regulations promulgated by the U.S.
Department of Health and Human Services, 45 C.F.R. Parts 160 and 164 (the "Privacy Rule") and
other applicable laws, as amended.
J. Provider -Patient Relationship:
The Contractor shall use best efforts to ensure that Network Providers develop satisfactory
patient -physician relationships with Enrollees. If the Contractor is unable to do so, then Contractor
shall provide written notification to the Enrollee, with a copy submitted to the Department or its
designee(s), giving a specific description of the problem and what efforts have been made to resolve
the problem. The Department will then use its best efforts to refer such Enrollee to another Provider as
promptly as possible, in consultation with the Contractor. Contractor shall ensure the continued
delivery of Covered Services until such time as Enrollee has been re -assigned by the Department or its
designee.
K. Provision of Services and Professional Requirements:
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1. The Contractor shall accept as patients, without regard to health status or health care needs, all
enrollees referred to the Contractor in accordance with the policies and procedures set forth in
the CHP+ Provider Manual. The Contractor agrees to (a) not differentiate or discriminate in the
treatment of Enrollees or in the quantity or quality of services delivered to Enrollees on the basis
of race, sex, age, religion, health status, or source of payment, and (b) to observe, protect, and
promote the rights of Enrollees as patients. All Covered Services provided hereunder by the
Contractor shall meet the accepted standards of professional practices prevailing in the
community at the time such services are rendered.
2. The Contractor shall maintain all such licenses, certifications and/or registrations necessary in
the State of Colorado to deliver Ancillary Services required hereunder. The Contractor agrees
to notify the Department or its designee in writing immediately in the event that any adverse
action is taken with respect to such licensure, certification and/or registration. The Contractor
shall provide copies of such license(s), certification(s), and/or registration(s) upon execution of
this agreement, and upon subsequent request of the Department or its designee.
3. The Contractor, and or any of the Specialty Care Providers within the Contractor's practice,
shall be certified and/or credentialed by a hospital, which is a Participating Provider, to perform
any Covered Services.
L. Allied Professionals: The Contractor shall, to the extent feasible, utilize such additional allied health
and other qualified personnel as are available and appropriate for effective and efficient delivery of
Covered Services in accordance with the terms of this Agreement
M. Insurance: The Contractor shall obtain and maintain such policies of commercial general liability,
professional liability and other insurance as are necessary to adequately cover the Contractor and its
agents and/or employees against any claim for damages, arising from personal injuries or death
occasioned directly or indirectly in connection with the performance of Covered Services, the use of
any property and facilities provided by the Contractor, and activities performed by the Contractor, its
agents and/or employees in connection with this Agreement. Such insurance coverage shall include
professional/medical malpractice insurance, and the Contractor, and/or all other physicians in the
Contractor's practice, shall be independently insured for malpractice, in an amount equal to a minimum
of $0.5 million per incident and $1.5 million in aggregate per year. The levels of such insurance
coverage shall be in compliance with the requirements of Colorado Statutes and Department of Public
Health and Environment rules. The general liability insurance shall maintain a limit of no less than one
million per occurrence. Proof of such insurance shall be furnished by the Contractor to the Department
or its designee(s) upon execution of this Agreement. The Contractor shall give the Department or its
designee(s) at least thirty (30) days prior written notice of the cancellation of such policies
N. Program Materials: Contractor agrees that the Department or its designee(s) may use its name,
address, and phone number in a provider directory and other Program materials.
O. Coordination of Benefits and Subrogation:
I. Contractor shall establish procedures for identification of Enrollees with all other insurance
coverage that may be coordinated with benefits available to Enrollees in the Program.
Contractor shall notify the Department or its designee(s) whenever Contractor has reason to
believe an Enrollee may be entitled to coverage under any other health benefit plan, including
Colorado Medicaid, and shall assist the Department or its designee(s) in obtaining information
for the coordination of benefits when an Enrollee holds such other coverage.
2. The Contractor shall accept reimbursement from Colorado Medicaid for patient care for any
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Enrollee whom the Contractor provided Covered Services hereunder during the contract year
that becomes eligible for Colorado Medicaid. The Contractor shall obtain provider
identification from Colorado Medicaid if necessary to receive payment in such cases.
3. Contractor agrees to identify and notify the Department or its designee(s) of any facts that might
give rise to subrogation or third party liability cases, and to execute and provide documents that
may reasonably be required or appropriate for the purpose of pursuing reimbursement or
payment from other payers.
4. Amounts actually recovered by the Department through subrogation shall be distributed as
specified in the CHP+ Provider Manual.
P. Quality Improvement, Peer Review, Credentialing, and Patient Grievance:
1. The Contractor hereby acknowledges that a basic objective of the Program is to control the cost
and promote the quality of medical care provided to Enrollees, and that to accomplish such
purpose it will be necessary for the Department, its designee(s), Participating Providers,
directors, employees and agents, to review Contractor's records pertaining to the treatment of
Enrollees, to review the quality of care provided by Contractor, and to investigate and resolve
Enrollee complaints.
2. The Contractor shall comply with policies and procedures promulgated and/or implemented by
the Department for quality improvement, peer review, credentialing and patient grievance
processes.
Ill. OBLIGATIONS OF THE DEPARTMENT
A. Enrollee Identification: The Department or its designee(s) shall provide each Enrollee with an
identification card and shall require each Enrollee to select a Primary Care Provider. Upon written or
telephone request, the Department or its designee(s) will advise Contractor of the eligibility of an
Enrollee and the name of the Enrollee's Primary Care Provider.
B. Provider -Patient Relationship:The Contractor shall use best efforts to ensure that Network Providers
develop satisfactory patient -physician relationships with Enrollees. If the Contractor is unable to do
so, then Contractor shall provide written notification to the Enrollee, with a copy submitted to the
Department or its designee(s), giving a specific description of the problem and what efforts have been
made to resolve the problem. The Department will then use its best efforts to refer such Enrollee to
another Provider as promptly as possible, in consultation with the Contractor. Contractor shall ensure
the continued delivery of Covered Services until such time as Enrollee has been re -assigned by the
Department or its designee.
C. Program Changes:The Department shall provide Contractor with thirty (30) days prior written notice
of any material changes in the Evidence of Coverage or CHP+ Provider Manual.
D. Payment:For all Covered Services provided by Contractor hereunder, the Department or the CHP+
Program Administrative Services Organization (ASO) contractor shall pay the Contractor in
accordance with the reimbursement terms set forth in Section IV of this Agreement.
E. Confidentiality of Records: Any data or information pertaining to the diagnosis, treatment, or health of
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any Enrollee or applicant obtained by the Department or its designee shall be held in confidence as
required under all applicable laws and regulations, and shall not be disclosed to any third person except
in connection with quality improvement and peer review activities, or unless an appropriate release has
been obtained, or as described in the Evidence of Coverage.
F. Provider List: The Department or its designee shall periodically provide Contractor with a current list
of Participating Providers.
G. Provider/Enrollee Communications: The Department shall not prohibit the Contractor from (i)
expressing disagreement with a medical decision, medical policy or medical practice of the
Department or its designee; (ii) making a good faith report to a state or federal authority regarding any
practice or act of the Department or its designee which jeopardizes the health or welfare of Enrollees;
or (iii) discussing with third parties, including Enrollees, the existence and type of financial incentive
and compensation that the Contractor receives from the Department. The Department further warrants
that it shall not terminate this Agreement solely if (a) Contractor takes any of the above actions; (b) the
Contractor expresses disagreement with a decision by the Department or its designee to deny or limit
benefits; (c) the Contractor assists a Enrollee to seek reconsideration of the Department's or its
designee's decision; or (d)) the Contractor discusses with a current, former or prospective patient any
aspect of the patient's medical condition, any proposed treatment or treatment alternative, whether or
not covered by the Program, or (e) Contractor's personal knowledge of the health needs of such
Enrollee.
IV. MAXIMUM SERVICE REIMBURSEMENT
A. Payment for Covered Services:
1. Reimbursement for all Covered Services provided by the Contractor hereunder shall be made
by the Department or the CHP+ Program Administrative Services Organization (ASO)
contractor on a fee -for -service basis in accordance with the CHP+ Fee Schedule established by
the State and specified in the CHP+ Provider Manual.
2. Maximum Service Reimbursement shall always be the lesser of the billed charges or the
Maximum Service Reimbursement allowed under this Section, minus the Copayment, when
applicable.
3. The CHP+ Fee Schedule is based on the Centers for Medicare and Medicaid Service's (CMS)
Resource Based Relative Value Scale (RBRVS) as adjusted for Colorado. CHP+ uses two
separate conversion factors to calculate reimbursement a) Medical/Surgical/Laboratory b)
Anesthesia. Most labs, durable medical equipment, and injectable drugs are paid on a flat fee
basis. The Department may modify these rates during the term of this Agreement in accordance
with changes in RBRVS by Medicare. In instances where the RBRVS method does not set unit
values, CHP+ uses a modified Medicare fee schedule.
4. Whenever reimbursement equals the Maximum Service Reimbursement minus applicable
Copayments, Contractor shall make a Reimbursement Adjustment. The amount of the
Reimbursement Adjustment shall not be the responsibility of the Enrollee or the Department.
5. Financial obligations of the State of Colorado payable after the current fiscal year are
contingent upon funds for that purpose being appropriated, budgeted, and otherwise made
available.
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B. Third Party Payors: In the event that payment, in whole or part, for Covered Services provided by the
Contractor hereunder may be made by an insurance carrier or other third party identified as a "primary
payor" under Title 10, C.R.S., the Contractor shall first bill such primary payors for services rendered.
All Covered Services that are not reimbursable by such primary payors shall be reimbursed by the
Department or its designee(s) in accordance with Section IV.A of this Agreement.
C. Disputed Claims:
1. Upon the initiation of any action by the Department or its designee(s) regarding the payment of
claims for Covered Services provided by the Contractor hereunder, the Department or its
designee shall issue written notice to the Contractor as specified in the CHP+ Provider Manual.
If Contractor disagrees with the action taken or the amount paid by the Department or its
designee(s) on any claim submitted under this Agreement, Contractor must notify the
Department or its designee(s) in writing of such dispute within ninety (90) days after the claim
is paid or denied.
2. The Contractor hereby waives any right to dispute the amount of payment or any other action
taken by the Department or its designee(s) on a claim for Covered Services provided by the
Contractor hereunder unless notification is received within the time specified in paragraph 1
above. In such event, Contractor shall be prohibited from collecting any payment from the
Enrollee.
D. Repayment: In the event that the Contractor receives payment for medical services in an amount in
excess of that authorized under this Agreement, whether as a result of Contractor's error, the
Department's (or its designee's) error, or otherwise, Contractor shall repay the amount of
overpayment to the Department upon discovering or being notified in writing by the Department of
the overpayment within forty-five (45) days.
E. Limitation of State Financial Liability / Suspension of Enrollment and Services: Payment pursuant to
this Agreement shall be made as earned, in whole or part, from available State and federal funds, in an
amount not to exceed the amount of funds available for each fiscal year this contract is in effect for the
purchase of all medical services for the Program. The funds that are available for each fiscal year may
be used to pay multiple contractors for the services that are described in this Agreement. The liability
of the State, at any time, for such payments shall be limited to the unexpended amount remaining of
such funds.
Pursuant to section 25.5-8-108, C.R.S., if the State determines that eligibility guidelines must be
adjusted or additional enrollment in the Program must be suspended and/or terminated due to
insufficient funds, eligibility guidelines may be adjusted or additional enrollment suspended or
terminated for the entire Program. If the State determines that the delivery of Covered Services to
enrollees in the Program must be adjusted, suspended and/or terminated due to insufficient funds, the
delivery of Covered Services may be suspended or terminated for the entire Program.
The State shall provide at least sixty (60) days prior written notice to the Contractor before eligibility
guidelines are adjusted or enrollment in the Program and/or the delivery of Covered Services to
enrollees in the Program is suspended or terminated. Additional enrollment in the Program and/or the
delivery of Covered Services by the Contractor to enrollees in the Program shall cease or be limited or
adjusted consistent with the directions in such written notice by the State.
V. GENERAL PROVISIONS
FY 2008 - 2013 Ancillary Services Agreement
Waiver updated 5/2008
Page 10 of IS
A. Order of Precedence: The provisions of this Agreement shall govern the relationship of the
Department and the Contractor. In the event of conflicts or inconsistencies between this Agreement
and its exhibits or attachments, such conflicts or inconsistencies shall be resolved by reference to the
document in the following order of priority:
1. Colorado Special Provisions, pages 18 through 20.
2. Agreement, pages 1 to 17.
B. Performance Period:This Agreement shall be effective upon approval by the State Controller or
designee or on the 15th of September, 2009, whichever is later. The Agreement performance
contemplated herein shall commence as soon as practicable after the effective date of this Agreement
and shall be undertaken and performed in the sequence and manner set forth in the scope of work and
extended through June 30, 2013. The Contractor understands and agrees that the Department shall not
be liable for payment of work or services or for cost or expenses incurred by this Contractor prior to
the proper execution and the State Controller approval of this Agreement.
C. Holdover Provision: In the event the Department desires to continue the services and a replacement
Agreement has not been fully executed by the end date of this Agreement, the Department, upon
written notice to the Contractor, may unilaterally extend this Agreement for a period of up to two (2)
months. The Agreement shall be extended under the same terms and conditions as the original
Agreement, including, but not limited to prices, rates and service delivery requirements. However, this
extension shall terminate at the end of the two month period or when the replacement Agreement is
signed by the State Controller or an authorized delegate.
D. Federal Funding:This contract is subject to and contingent upon the continuing availability of federal
funds for the purposes hereof.
E. Termination for Convenience:Either party may terminate this Agreement without cause with ninety
(90) days prior written notice to the other party. Once notice has been given, the Contractor shall not
take any Enrollees as new patients, but shall continue to treat Enrollees who are current patients for
ninety (90) days.
F. Termination for Default/Cause: lf, through any cause, the Contractor shall fail to fulfill, in a timely and
proper manner, its obligations under this Agreement, or if the Contractor shall violate any of the
covenants, agreements, or stipulations of this Agreement, the Department shall thereupon have the
right to terminate this Agreement for cause by giving written notice to the Contractor of its intent to
terminate and at least ten (I 0) days opportunity to cure the default or show cause why termination is
otherwise not appropriate. In the event of termination, all finished or unfinished documents, data,
studies, surveys, drawings, maps, models, photographs, and reports or other material prepared by the
Contractor under this Agreement shall, at the option of the Department, become its property, and the
Contractor shall be entitled to receive just and equitable compensation for any services and supplies
delivered and accepted. The Contractor shall be obligated to return any payment advanced under the
provisions of this Agreement.
Notwithstanding the above, the Contractor shall not be relieved of liability to the Department for any
damages sustained by the Department by virtue of any breach of the Agreement by the Contractor,
and the Department may withhold any payment to the Contractor for the purposes of mitigating its
damages until such time as the exact amount of damages due to the Department from the Contractor is
determined.
If after such termination it is determined, for any reason, that the Contractor was not in default, or that
the Contractor's action/inaction was excusable, such termination shall be treated as a termination for
M1Y 100 - 1011 Ancillary Semen. Agreement
Waiver updated 5/100tl
Page II of Ia
convenience, and the rights and obligations of the parties shall be the same as if the Agreement had
been terminated for convenience, as described herein
G. Termination for Loss of Licensure or Insurance:The Department may terminate this Agreement
immediately upon the Contractor's loss or suspension of licensure, certification(s) and/or
registration(s) to provide Covered Services in the State of Colorado, or failure to maintain insurance in
accordance with this Agreement.
H. Legal Authority: The Contractor warrants that it possesses the legal authority to enter into this
Agreement and that it has taken all actions required by its procedures, by-laws, and/or applicable law
to exercise that authority, and to lawfully authorize its undersigned signatory to execute this
Agreement and to bind the Contractor to its terms. The person(s) executing this Agreement on behalf
of the Contractor warrant(s) that such person(s) have full authorization to execute this Agreement.
I. Representatives and Notice: For the purpose of this Agreement, the individuals identified below are
hereby designated representatives of the respective parties. Either party may from time to time
designate in writing new or substitute representatives:
For the State:
Alan S. Kislowitz, MSHA Child Health Plan Plus (CHP+), Health Plan Manager
Name Title
For the Contractor:
William F Garcia Chair Other
Name Title
Notices: All notices required to be given by the parties hereunder shall be hand delivered or given
by certified or registered mail to the individuals at the addresses set forth below. Either party may
from time to time designate in writing substitute addresses or persons to whom such notices shall
be sent.
For the State:
Name:
Department and
Division:
Address:
For the Contractor:
Name:
Title:
Address:
Alan S. Kislowitz, MSHA
Child Health Plan Plus (CHP+), Health Plan
Manager
1570 Grant Street
Denver, CO 80203-1818
William F Garcia Chair
Other
1555 N 17th Avenue Greeley, CO 80631
j. Force Majeure: Neither the Contractor nor the Department shall be liable to the other for any delay in,
or failure of performance of, any covenant or promise contained in this Agreement, nor shall any delay
or failure constitute default or give rise to any liability for damages if, and only to the extent that, such
delay or failure is caused by "force majeure." As used in this contract "force majeure" means acts of
God; acts of the public enemy; acts of the state and any governmental entity in its sovereign or
1 Y 21MIX-201] Avclhry Services Ay¢mrnl
W.rv.. updated 5120011
Ngu 12 of 18.
God; acts of the public enemy; acts of the state and any governmental entity in its sovereign or
contractual capacity; fires; floods; epidemics; quarantine restrictions; strikes or other labor disputes;
freight embargoes; or unusually severe weather.
k. Assignment and Successors: The Contractor agrees not to assign rights or delegate duties under this
contract or subcontract any part of the performance required under the contract without the express,
written consent of the Department which shall not be unreasonably withheld. Except as herein
otherwise provided, this agreement shall inure to the benefit of, and be binding upon, the parties
hereto and their respective successors and assigns. This provision shall not be construed to prohibit
assignments of the right to payment to the extent permitted by Section 4-9-318, CRS, provided that
written notice of assignment adequate to identify the rights assigned is received by the controller for
the agency, department, or institution executing this contract. Such assignment shall not be deemed
valid until receipt by such controller -- as distinguished from the State Controller -- and the Contractor
assumes the risk that such written notice of assignment is received by the controller for the agency,
department, or institution involved.
1. Third Party Beneficiaries: It is expressly understood and agreed that the enforcement of the terms and
conditions of this Agreement and all rights of action relating to such enforcement, shall be strictly
reserved to the State and the named Contractor. Nothing contained in this agreement shall give or
allow any claim or right of action whatsoever by any other third person. It is the express intention of
the State and the Contractor that any such person or entity, other than the State or the Contractor,
receiving services or benefits under this agreement shall be deemed an incidental beneficiary only.
m. Governmental Immunity: Notwithstanding any other provision of this Agreement to the contrary, no
term or condition of this Agreement 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, Section 24-10-101, et seq., CRS, as now or hereafter amended. The
parties understand and agree that liability for claims for injuries to persons or property arising out of
negligence of the State of Colorado, its departments, institutions, agencies, boards, officials and
employees is controlled and limited by the provisions of Section 24-10-101, et seq., CRS, as now or
hereafter amended and the risk management statutes, Section 24-30-1501, et seq., CRS, as now or
hereafter amended. Any liability of the Department created under any other provision of this
Agreement, whether or not incorporated herein by reference, shall be controlled by, limited to, and
otherwise modified so as to conform with, the above cited laws
n. Severability: To the extent that this Agreement may be executed and performance of the obligations of
the parties may be accomplished within the intent of the Agreement, the terms of this Agreement are
severable, and should any term or provision hereof be declared invalid or become inoperative for any
reason, such invalidity or failure shall not affect the validity of any other term or provision hereof.
o. Waiver: The waiver of any breach of a term, provision, or requirement of this Agreement shall not be
construed or deemed as waiver of any subsequent breach of such term, provision, or requirement, or of
any other term, provision, or requirement
p. Entire Understanding: This Agreement is intended as the complete integration of all understandings
between the parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent novation,
renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied
in a writing executed and approved pursuant to the State Fiscal Rules.
q. Survival of Certain Contract Terms:Notwithstanding anything herein to the contrary, the parties
understand and agree that all terms and conditions of this Agreement and the exhibits and attachments
hereto which may require continued performance, compliance, or effect beyond the termination date of
the Agreement shall survive such termination date and shall be enforceable by the State as provided
herein in the event of such failure to perform or comply by the Contractor.
FY 2008 - 2013 Ancillary Services Agreement
Waiver updated 52008
Page 13 of 18
r. Modification and Amendment: This Agreement is subject to such modifications as may be required by
changes in federal or state law, or their implementing regulations. Any such required modification
shall automatically be incorporated into and be part of this Agreement on the effective date of such
change as if fully set forth herein. Except as provided herein, no modification of this Agreement shall
be effective unless agreed to in writing by both parties in an amendment to this Agreement that is
properly executed and approved in accordance with applicable law.
s. Litigation Reporting: Unless otherwise provided, the Contractor shall promptly notify the State in the
event that the Contractor learns of any actual litigation in which it is a party defendant. The
Contractor, within ten (10) days after being served with a summons, complaint, or other pleading in a
case which involves services provided under this Agreement and which has been filed in any federal or
state court or administrative agency, shall deliver copies of such document to the representative
designated in this Agreement, or in absence of such designation, to the chief executive officer of the
department, agency, or institution executing this Agreement on behalf of the State.
t. Audit, Inspection of Records, and Monitoring: The Contractor shall permit the State, federal
government, or any other duly authorized agent of a governmental agency to audit, inspect, examine,
excerpt, copy and/or transcribe Contractor's records during the term of this Agreement and for a period
of three (3) years following termination of this Agreement or final payment hereunder, whichever is
later, to assure compliance with the terms hereof, or to evaluate the Contractor's performance
hereunder. The Contractor shall also permit these same described entities to monitor all activities
conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may
in its sole discretion deem necessary or appropriate, such monitoring may consist of internal
evaluation procedures, examination of program data, special analyses, on -site check, or any other
reasonable procedure.
u. 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 42 U.S.C. Sections 6101, et seq.
Age Discrimination in Employment Act of 1967 29 U.S.C. 621-634
Americans with Disabilities Act of 1990 (ADA) 42 U.S.C. 12101, et seq.
Equal Pay Act of 1963 29 U.S.C. 206(d)
Immigration Reform and Control Act of 1986 8 U.S.C. 1324b
Section 504 of the Rehabilitation Act of 1973 29 U.S.C. 794
Title VI of the Civil Rights Act of 1964 42 U.S.C. 2000d
Title VII of the Civil Rights Act of 1964 42 U.S.C. 2000e
Title IX of the Education Amendment of 1972 20 U.S.C. 1681, et seq.
FY 2008 - 2013 Ancillary Services Agreement
Waiver updated 5/2008
Page 14 of 18
Section 24-34-302, et seq., Colorado Revised Statutes 1997,as amended
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 Department relies.
1. The Contractor will not discriminate against any person on the basis of race, color, national origin,
age, sex, religion and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or
AIDS -related conditions, in performance of work under this contract.
2. 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) and (Colorado
Executive Order, 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.
v. Venue: The parties agree that venue for any action related to performance of this contract shall be in
the City and County of Denver, Colorado.
w. Debarment and Suspension:
1. If this is a covered transaction or the Agreement 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.
2. This certification is a material representation of fact upon which reliance was placed when the
Department 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 Department may terminate this Contract for default.
3. The Contractor shall provide immediate written notice to the Department if it has been
debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded by
any federal department or agency.
4. The terms "covered transaction," "debarment," "suspension," "ineligible," "lower tier covered
transaction," "covered transaction," "principal," and "voluntarily excluded," as used in this
paragraph have the meanings set out in 45 CFR Part 76.
5. The Contractor agrees that it will include this certification in all lower tier covered transactions
and subcontracts that exceed $100,000.
FY 2008 - 2013 Ancillary Services Agreement
Waiver updated 5/2008
Page 15 of 18
SPECIAL PROVISIONS
(The Special Provisions apply to all contracts except where noted in italics.)
I. CONTROLLER'S APPROVAL. §CRS 24-30-202 (1). This contract shall not be deemed valid until it has been approved
by the Colorado State Controller or designee.
2. FUND AVAILABILITY. §CRS 24-30-202 (5.5). Financial obligations of the State payable after the current fiscal year
are contingent upon funds for that purpose being appropriated, budgeted, and otherwise made available.
3. 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.
/Applicable Only to Intergovernmental Contracts) 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 §24-10-10I et seq., or the Federal Tort Claims Act, 28 U.S.C. 2671 et seq., as
applicable, as now or hereafter amended.
4. INDEPENDENT CONTRACTOR. 4 CCR 801-2. 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 or shall be deemed
to be an agent or employee of the state. Contractor shall pay when due all required employment taxes and income taxes and
local head taxes on any monies paid by the state pursuant to this contract. Contractor acknowledges that contractor and its
employees are not entitled to unemployment insurance benefits unless contractor or a third party provides such coverage
and that the state does not pay for or otherwise provide such coverage. Contractor shall have no authorization, express or
implied, to bind the state to any agreement, liability or understanding, except as expressly set forth herein. Contractor shall
provide and keep in force workers' compensation (and provide proof of such insurance when requested by the state) and
unemployment compensation insurance in the amounts required by law and shall be solely responsible for its acts and those
of its employees and agents.
5. NON-DISCRIMINATION. Contractor agrees to comply with the letter and the spirit of all applicable State and federal
laws respecting discrimination and unfair employment practices.
6. CHOICE OF LAW. The laws of the State of Colorado, and rules and regulations issued pursuant thereto, shall be applied
in the interpretation, execution, and enforcement of this contract. Any provision of this contract, whether or not
incorporated herein by reference, which provides for arbitration by any extra judicial body or person or which is otherwise
in conflict with said laws, rules, and regulations shall be considered null and void. Nothing contained in any provision
incorporated herein by reference which purports to negate this or any other special provision in whole or in part shall be
valid or enforceable or available in any action at law, whether by way of complaint, defense, or otherwise. Any provision
rendered null and void by the operation of this provision will not invalidate the remainder of this contract, to the extent that
this contract is capable of execution. At all times during the performance of this contract, Contractor shall strictly adhere to
all applicable federal and State laws, rules, and regulations that have been or may hereafter be established.
7. VENDOR OFFSET. CRS §§24-30-202 (1) and 24-30-202.4. )Not Applicable to Intergovernmental Contracts) The
State Controller may withhold payment of certain debts owed to State agencies under the State's vendor offset intercept
system 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
certified by the State Controller as owing to the State as a result of final agency determination or judicial action.
8. SOFTWARE PIRACY PROHIBITION. Governor's Executive Order D 002 00. No State or other public funds
payable under this contract shall be used for the acquisition, operation, or maintenance of computer software in violation of
federal copyright laws or applicable licensing restrictions. Contractor hereby certifies that, for the term of this contract and
any extensions, Contractor has 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 paragraph, the State may exercise any remedy available at law or
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. §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.
Revised May 13, 2008
Page 16 of 18 HCPF LAN version, June 4, 2008
SPECIAL PROVISIONS
(The Special Provisions apply to all contracts except where noted in italics.)
10. 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-IO2(5)(c), Contractor shall not knowingly employ or contract with an illegal alien to
perform work under this contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this contract Contractor
(a) shall not use E -Verify Program or Department program procedures to undertake pre -employment screening of job
applicants while this contract is being performed, (b) shall notify the subcontractor and the contracting State agency within
three days if Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien for work
under this contract, (c) shall terminate the subcontract if a subcontractor does not stop employing or contracting with the
illegal alien within three days of receiving the notice, and (d) shall comply with reasonable requests made in the course of
an investigation, undertaken pursuant to CRS §8-17.5-102(5), by the Colorado Department of Labor and Employment. If
Contractor participates in the Department program, Contractor shall deliver to the contracting State agency, institution of
higher education or political subdivision a written, notarized affirmation, affirming that Contractor has examined the legal
work status of such employee, and comply with all of the other requirements of the Department program. If Contractor
fails to comply with any requirement of this provision or CRS §8-17.5-101 et seq., the contracting State agency, institution
of higher education or political subdivision may terminate this contract for breach and, if so terminated, Contractor shall be
liable for damages.
11. PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen
(18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise
lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et
seq., and (c) has produced one form of identification required by CRS §24-76.5-103 prior to the effective date of this
contract.
Revised May 13, 2008
Page 17 of 18 HCPF LAN version, June 4, 2009
Contract Routing Number:
-31\c) 5
CONTRACT SIGNATURE PAGE
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
and accept personal responsibility for any and all damages the State may incur for any errors in
such representation.
By:
By:
Signature of Authorized Officer
William' a R. Genic. , Chair
Printed Name & Title of Authorized Officer
Board of County Commissioners of Weld
County d.b.a. behalf of the Weld County By:
Department of Public Health and Environment
Legal Name of Contracting Entity
STATE OF COLORADO:
BILL TTER, JR., GOVERNOR
For: Joan Henneberry, Executive Director
Department of Health Care Policy and Fin
LEGAL REVIEW
John W. Suthers, Attorney General
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
§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 Contactor for such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER:
David J. Mc l nott, CPA/
By _
Date
J
\/ HUO
Page It of It
HCPF Contract Signature Page
Revised 4/1/08
CH
Child Health Plan Plus CHPA 62
June 1, 2009
Dear Provider:
Welcome to the Child Health Plan Plus's (CHP+) State Managed Care Network (SMCN). We
have enclosed your contract with Colorado Department of Health Care Policy and Financing (the
Department), which has now been fully executed. This agreement is made and entered according
to the date signed by the Department as indicated on the contract signature page. Please keep
this copy for your files. An original copy of the contract remains at the Department and
Colorado Access keeps an additional copy for their administrative files.
To access the most current version of the SMCN Provider Manual, Provider Directory and fee
schedule, please visit www.chpplusproviders.com.
Thank you for your participation in CHP+. Together we can ensure quality health care for low-
income children and pregnant women in Colorado.
Sincerely,
State Managed Care Network Provider Contracting Department
800-511-5010 ext 5219
State Managed Care Network
PO Box 17580 Denver, CO 80217-0580
Hello