HomeMy WebLinkAbout20253570 Resolution
Approve Contract Amendment #6 to Intergovernmental Agreement for Case
Management Agency (CMA) Services 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 Contract Amendment #6 to the
Intergovernmental Agreement for Case Management Agency (CMA) Services 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, and the
Colorado Department of Health Care Policy and Financing, commencing upon full
execution of signatures, and ending June 30, 2026, with further terms and conditions
being as stated in said amendment, and
Whereas, after review, the Board deems it advisable to approve said amendment, a copy
of which is attached hereto and incorporated herein by reference.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that Contract Amendment #6 to the Intergovernmental Agreement for Case
Management Agency (CMA) Services 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, and the Colorado Department of Health Care Policy and
Financing, be, and hereby is, approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said amendment.
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 29th day of December, A.D., 2025:
Perry L. Buck, Chair: Aye �.•••-�
Scott K. James, Pro-Tem: Excused fie. \ 14 •
Jason S. Maxey: Aye ♦ i1
Lynette Peppier: Aye •
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Kevin D. Ross: Excused "�� "
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Approved as to Form: , ® , e
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
cc: }-H S D 2025-3570
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BOARD OF COUNTY COMMISSIONERS
PASS-AROUND REVIEW
PASS-AROUND TITLE: State of Colorado Department of Health Care Policy and Financing Case
Management Agency Contract Amendment#6
DEPARTMENT: Human Services DATE: December 23, 2025
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: On January 17, 2024, the Department entered into an
Intergovernmental Agreement with the Colorado Department of Health Care Policy and Financing
(HCPF) to serve as a Case Management Agency (CMA), known to the Board as Document#2024-
0121. Under this agreement, the Department's Home and Community Supports Division (HCSD),
acting as the CMA, receives annual funding from HCPF to provide long-term care services in Weld
County to assist individuals in remaining in their homes and communities as an alternative to entering
institutional settings, such as nursing homes_ These services include information and assistance,
initial intake, screening, referral, assessment of need, determination of functional eligibility, care
planning, case management, reassessment, and case closure for older adults and individuals of all
ages with disabilities.
Since contract execution the following has occurred:
• Amendment#1 was approved on June 12, 2024, known to the Board as Document#2024-
1535.
• Amendment#2 was approved on December 18, 2024, known to the Board as Document
#2024-3344.
• Amendment #3 was approved on February 26, 2025, known to the Board as Document#2025-
0557.
• Amendment #4 was approved on May 21, 2025, known to the Board as Document#2025-
1396.
• Amendment#5 was approved on June 2, 2025, know to the Board as Document#2025-1488.
HCPF has now issued Amendment #6 (C24-188034A6), which updates Exhibit B, Statement of Work;
Exhibit C, Rates; Exhibit D, Terminology; and Exhibit E, Contractor's Administrative Requirements.
What options exist for the Board?
• Approval of the CMA Contract Amendment#6 for SFY 2025-2026.
• Deny approval of the CMA Contract Amendment #6 for SFY 2025-2026.
Consequences: WCDHS will not have updated contract exhibits.
Impacts: WCDHS will not have an updated contract to continue receiving funding that
provides services to older adults and individuals with disabilities in Weld County.
Costs (Current Fiscal Year/ Ongoing or Subsequent Fiscal Years):
• Total funding = No additional funding
• Funded through: Colorado Department of Health Care Policy and Finance.
Pass-Around Memorandum; December 23, 2025 — CMS ID 10190 2025-3570
I 7131 ki12-WCt-1
Recommendation:
• Approval of the Case Management Agency Contract Amendment#6 and authorize the Chair to
sign electronically.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck
Scott K. James
Jason S. Maxey Y
14
Lynette Peppier --if
Kevin D. Ross r
Pass-Around Memorandum; December 23, 2025—CMS ID 10190
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STATE OF COLORADO CONTRACT MODIFICATION
CONTRACT AMENDMENT #6
State Agency Contract Performance Beginning Date
Department of Health Care Policy and Financing March 1, 2024
Contractor Current Contract Expiration Date
Weld County Department of Human Services June 30, 2026
Original Contract Number Current Contract Maximum Amount
C24-188034 Medicaid Programs
Amendment Contract Number No Maximum for any SFY
C24-188034A6
State General Fund Programs
State Fiscal Year 2025-26 $21,812,013.00
Estimated Contractor Shared $1,605,032.93
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Each person signing this Amendment represents and warrants that they are duly authorized to execute this
Amendment and to bind the Party authorizing the person's signature.
CONTRACTOR STATE OF COLORADO
Weld County Department of Human Services Jared S. Potts, Governor
Perry L. Buck, Chair Department of Health Care Policy and Financing
Kim Bimestefer Executive DiIector
bocusigned by:
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12/30/2025 I 09:21 PST
Date: 12/30/2025 110:58 MST
Date:
STATE CONTROLLER
Robert Jaros, CPA, MBA,JD
Department of Health Care Policy and Financing
Jerrod Cotosman, Controller
—DocuSigned by:
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Amendment Effective Date: 12/30/2025 11:40 MST
A. In accordance with §24-30-202, C.R.S., this Amendment is not valid until signed and dated
above by the State Controller or an authorized delegate.
Amendment Contract Number: C24-188034A6 Page 1 of 1
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1. PARTIES
This Amendment(the"Amendment") to the Original Contract shown on the Signature and Cover
Page for this Amendment(the"Contract")is entered into by and between Contractor and the State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract.
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date shown
on the Signature and Cover Page for this Amendment. The State shall not be bound by any
provision of this Amendment before that Amendment Effective Date, and shall have no
obligation to pay Contractor for any Work performed or expense incurred under this Amendment
either before or after of the Amendment term shown in §3.B of this Amendment.
B. Amendment Term
The Parties' respective performances under this Amendment and the changes to the Contract
contained herein shall commence on the Amendment Effective Date shown on the Signature and
Cover Page for this Amendment.
4. PURPOSE
This Amendment updates Exhibit B, Statement of Work, Exhibit C, Rates, Exhibit D,
Terminology, and Exhibit E, Contractor's Administrative Requirements.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page is
hereby deleted and replaced with the Current Contract Expiration Date shown on the Signature
and Cover Page for this Amendment.
B. The Contract Maximum Amount table on the Contract's Signature and Cover Page is hereby
deleted and replaced with the Current Contract Maximum Amount table shown on the
Signature and Cover Page for this Amendment.
C. Exhibit B-5, Statement of Work is hereby deleted in its entirety and replaced with Exhibit B-6
Statement of Work as follows. All references to Exhibit B, Exhibit B-1, Exhibit B-2, Exhibit B-
3, Exhibit 4, and Exhibit B-5 shall now refer to Exhibit B-6.
D. Exhibit C- 5, Rates is hereby deleted in its entirety and replaced with Exhibit C-6, Rates as
follows. All references to Exhibit C, Exhibit C-1, Exhibit C-2, Exhibit C-3, Exhibit C-4 and
Exhibit C-5 shall now refer to Exhibit C-6.
E. Exhibit D-4, Terminology is hereby deleted in its entirety and replaced with Exhibit D-5,
Terminology as follows. All references to Exhibit D, Exhibit D-1, Exhibit D-2, and Exhibit-3,
and Exhibit D-4 shall refer to Exhibit D-5.
Amendment Contract Number: C24-188034A6 Page 1 of 2
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
F. Exhibit E-5. Contractor's Administrative Requirements is hereby deleted in its entirety and
replaced with Exhibit E-6 Contractor's Adminstrative Requirements as follows. All references
to Exhibit E, Exhibit E-1, Exhibit E-2, Exhibit E-3, Exhibit-4, and Exhibit E-5 shall now refer
to Exhibit E-6.
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments or other modifications to the Contract, if any, remain in full force and effect except
as specifically modified in this Amendment. Except for the Special Provisions contained in the
Contract, in the event of any conflict, inconsistency, variance, or contradiction between the
provisions of this Amendment and any of the provisions of the Contract or any prior modification
to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and
control. The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment specifically
modifies those Special Provisions.
Amendment Contract Number: C24-188034A6 Page 2 of 2
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
EXHIBIT B-6, STATEMENT OF WORK
1. CASE MANAGEMENT OBLIGATIONS
1.1. Contractor's Obligations
1.1.1. Contractor shall provide case management activities outlined in this Contract for the
following Home and Community Based Services(HCBS)waivers,non-HCBS programs,and
State General Fund programs:
1.1.1.1. Community First Choice(CFC)
1.1.1.2. Family Support Services Program(FSSP)
1.1.1.3. HCBS Children with Complex Health Needs(HCBS-CwCHN)
1.1.1.4. HCBS Children's Extensive Supports Waiver(HCBS-CES)
1.1.1.5. HCBS Children's Habilitation Residential Program Waiver(HCBS-CHRP)
1.1.1.6. HCBS Children's Home and Community Based Services Waiver(CHCBS)
1.1.1.7. HCBS Community Mental Health Supports Waiver(HCBS-CMHS)
1.1.1.8. HCBS Complimentary and Integrative Health Waiver(HCBS-CIH)
1.1.1.9. HCBS Developmental Disabilities Waiver(HCBS-DD)
1.1.1.10. HCBS Elderly, Blind and Disabled Waiver(HCBS-EBD)
1.1.1.11. HCBS Brain Injury Waiver(HCBS-BI)
1.1.1.12. HCBS Supported Living Services Waiver(HCBS-SLS)
1.1.1.13. Hospital Back-Up Program (HBU)
1.1.1.14. Intermediate Care Facilities-Intellectual and Developmental Disabilities (ICF-IDD)
1.1.1.15. Nursing Facilities (NF)
1.1.1.16. Omnibus Reconciliation Act of 1987 Specialized Services Program(OBRA-SS)
1.1.1.17. Program for All-Inclusive Care for the Elderly(PACE)
1.1.1.18. State Supported Living Services Program(State SLS)
1.1.2. Contractor shall abide by and perform its duties and obligations in conformity with relevant
federal law, all pertinent federal regulations, State law, rules and regulations of the
Department of Health Care Policy and Financing which include, but are not limited to:
1.1.2.1. Colorado Revised Statutes, Title 25.5,Article 6, Sections 104 through and including 107.
1.1.2.2. Colorado Revised Statute, Title 25.5,Article 10 et seq.
1.1.2.3. Colorado Department of Health Care Policy and Financing written communications.
1.1.2.4. Colorado Department of Public Health and Environment at 6 C.C.R. 1011-1 et seq.
1.1.2.5. Colorado Department of Human Services 12 C.C.R. 2509-8 7.700 et seq.
1.1.2.6. All State Medicaid regulations promulgated by the Department. These regulations
include, but are not limited to:
1.1.2.6.1. FSSP 10 CCR 2505-10, Sections 8.7561 et seq.
Exhibit B-6,Statement of Work Page 1 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.2.6.2. Long-Term Care 10 CCR 2505-10, Sections 8.400 through 8.409 et seq.
1.1.2.6.3. Colorado Case Management Agency Requirements 10 CCR 2505-10, Section 8.7200
et seq.
1.1.2.6.4. Community First Choice, 10 CCR 2505-10, Section 8.7600 et seq.
1.1.2.6.5. HCBS-BI 10 CCR 2505-10, Section 8.7101.E et seq.
1.1.2.6.6. HCBS-CwCHN 10 CCR 2505-10 Section 8.7101.D et seq.
1.1.2.6.7. HCBS-CES, 10 C.C.R. 2505-10 Section 8.7101.B et seq.
1.1.2.6.8. HCBS- CHCBS 10 CCR 2505-10, Sections 8.7101.A et seq.
1.1.2.6.9. HCBS-CHRP, 10 C.C.R. 2505-10 Section 8.7101.0 et seq.
1.1.2.6.10. HCBS-CIH 10 CCR 2505-10, Section 8.7101.H et seq.
1.1.2.6.11. HCBS-CMHS 10 CCR 2505-10, Section 8.7101.F et seq.
1.1.2.6.12. HCBS-DD, 10 C.C.R. 2505-10 Sections 8.7101.1 et seq.
1.1.2.6.13. HCBS-EBD 10 CCR 2505-10, Sections 8.7101.G et seq.
1.1.2.6.14. HCBS-SLS, 10 C.C.R. 2505-10 Sections 8.7101.1 et seq.
1.1.2.6.15. PACE Section 25.5-5-412, Section 6a-b., C.R.S et seq.
1.1.2.6.16. Case Management Services, Determination of Developmental Disability, Laboratory
and X-Ray, 10 CCR 2505-10 Section 8.607.2 through 8.6660.5.E.
1.1.2.6.17. Support Levels and Algorithms 10 CCR 2505-10 Section 8.7202.AA et seq
1.1.2.6.18. State SLS Program, 10 CCR 2505-10, Section 8.7560 et seq.
1.1.2.6.19. Recipient Appeals, 10 CCR 2505-10, Section 8.057 et seq.
1.1.2.6.20. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards (Uniform Guidance), 2 CFR Chapter I, Chapter II, Part 200 et al.
1.1.3. 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.
1.1.4. Contractor shall ensure applicant, Member, and individual rights are protected in accordance
with Title XIX of the Social Security Act, other applicable federal and state laws, and
Department regulations.
1.1.5. Contractor shall comply with written Operational Memos,policies,procedures, and guidance
issued by the Department.
1.1.6. The general Business Functions of Contractor shall include, but is not limited to, all the
following:
1.1.6.1. Contractor shall maintain a physical, publicly accessible, and Americans with Disability
Act (ADA) compliant office within the Defined Service Area and appropriate staffing
pattern to serve the Defined Service Area.
1.1.6.1.1. Non-standard business hours and method of contact information for urgent situations
must be posted on Contractor's website in an easily accessible location and must
remain up-to-date and align with Contractor's after-hours policy.
Exhibit B-6,Statement of Work Page 2 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.6.1.2. Contractor shall ensure adequate staffing through virtual or in-person services
throughout the Defined Service Area in addition to a physical office space,providing
access to its office for staff,Members,families,services providers, and others to best
meet the needs of individuals based on individual preferences.
1.1.6.1.3. Contractor shall have the ability for case managers to travel, regional coverage, and
provide all required Work for the counties in which the agency operates.
1.1.6.1.4. Regular business office hours of operation shall follow an 8-hour schedule Monday
through Friday except for federal, state, or local holidays and unplanned closures due
to inclement weather or other emergencies.Regular business office hours and holiday
closures must be provided to all Members upon enrollment and at least annually,
posted publicly at each office location, and posted on Contractor's website.
Contractor shall have a procedure for notifying Members and the public of unplanned
closures or changes to regular business hours due to inclement weather or other
emergencies,which includes emergency contact information.
1.1.6.1.5. Contractor shall have internal procedures for accommodating individuals, Members,
and families who need assistance or consultation outside regular business office
hours.
1.1.6.2. Contractor shall have an after-hours policy and procedure to respond to urgent situations
outside of regular business hours as defined herein.
1.1.6.2.1. Contractor's after-hours policy and procedure shall include a response to all telephone
calls, voicemails, and emails from Members and families on average within two
Business Days of receipt by Contractor.
1.1.6.2.2. Procedures must provide Contractor after-hours contacts, e.g., voicemail, pager, or
answering service numbers and alternative contacts and resources, and information,
e.g., advocacy groups, community resources, etc., available to Members in urgent
situations including,but not limited to,hospital discharges,risk of homelessness, and
unexpected termination of residential services.
1.1.6.2.3. Procedures must clearly document how Contractor will ensure a commensurate
response to urgent situations including,but not limited to, hospital discharges,risk of
homelessness, and unexpected termination of residential services.
1.1.6.2.4. Contractor shall notify individuals, Members, families, providers, and community
partners of the procedures and make it readily available through a variety of methods,
including Contractor's website.
1.1.6.2.5. Non-standard business hours and method of contact information for urgent situations
must be posted on Contractor's website in an easily accessible location and must
remain up-to-date and align with Contractor's after-hours policy.
1.1.6.2.6. Contractor shall overcome any geographic barriers within the Defined Service Area,
including distance from the agency office to provide timely assessment and case
management services to individuals, Members and families, as required by Contract,
Federal or State statutes and regulations. This may include staff who reside
throughout the Defined Service Area to best meet the needs of individuals and
Members.
Exhibit B-6,Statement of Work Page 3 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.6.2.7. Contractor shall protect Members' rights as they relate to the responsibilities of Case
Management Agencies as described in this Contract.
1.1.6.2.8. Contractor shall provide access to a telephone system and trained staff to ensure
timely response to messages and telephone calls received after hours.
1.1.6.2.9. Contractor shall provide access to telecommunication devices and/or interpreters for
the hearing and vocally impaired and foreign language interpreters as needed to fulfil
all Work. Contractor shall conduct an assessment of the communication needs of the
Members they serve and ensure their interpretation and telecommunication services
sufficiently meet the Member's need in a timely fashion.
1.1.6.2.10. Contractor shall follow communication standards set by the Department which
includes,but is not limited to,Memo Series,technical assistance documents,Provider
Bulletins, training documents, and email correspondence.
1.1.6.2.11. Contractor shall ensure all information entered into the Department's systems is
accurate and entered within the timelines established within the Contract.
1.1.6.2.11.1. Systems include, but are not limited to, the Colorado interChange Medicaid
Management Information System (MMIS) and its subsystems: Bridge HCBS
Prior Authorization Request (PAR) subsystem and the Care and Case
Management (CCM) System.
1.1.6.2.12. Contractor shall support the Department's National Core Indicators(NCI) efforts.
1.1.6.2.13. Contractor shall enroll and act as a Medicaid Targeted Case Management (TCM)
provider for all HCBS waivers and CFC to include, but not limited to, providing
ongoing case management and monitoring activities for the Defined Service Area.
1.1.6.2.14. Contractor shall follow 10 C.C.R. 2505-10, Section 8.7202.M et seq. when
transferring a Member from one county to another county or from one Defined
Service Area to another Defined Service Area.
1.1.6.2.15. Contractor shall develop, implement, and maintain written policies and procedures to
ensure that all intake, referral, enrollment, and Person-Centered Service Planning
activities are conducted independently of any Provider Agency influence, including but
not limited to coaching, coercion, or undue influence. The policy and procedure will also
include but not limited to training and oversight for case managers specific to these
safeguards. These policies and procedures shall safeguard that the Case Management
Agency's (CMA) determinations of functional, programmatic, waiver, and services
eligibility are free from provider conflict of interest and consistent with 10 CCR 2505-10
§§ 8.7000-8.7200 et seq. and 42 C.F.R. § 441.301(c)(1)(vi).
1.1.6.2.16. Contractor shall inform all applicants and,as applicable,their guardians that the CMA
is solely responsible for determining functional, program, waiver, and services
eligibility, including but not limited to:
1.1.6.2.16.1. Level of Care Screen
1.1.6.2.16.2. Service Authorization
1.1.6.2.16.3. Direct Care Service Calculator
1.1.6.2.16.4. Support Level Assessment (SIS/ISLA)
Exhibit B-6,Statement of Work Page 4 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.6.2.16.5. HCBS-DD waver enrollment request (formally EER/Youth Transition/DI
request)
1.1.6.2.16.6. Support Level Review Request
1.1.6.2.16.7. Supported Living Services (SLS) Exceptions Request
1.1.6.2.16.8. Children's Extensive Services (CES) waiver application
1.1.6.2.17. Contractor shall notify all Provider Agencies, identified as part of a Member's team,
that eligibility and support determinations are the sole responsibility of the CMA.Any
direct or indirect engagement by a Provider Agency intended to shape these
determinations shall be considered a potential conflict of interest and reported to the
Colorado Department of Health Care Policy and Financing (HCPF) or the Colorado
Department of Public Health and Environment (CDPHE) pursuant to 10 CCR 2505-
10 § 8.7202.M and 6 CCR 1011-1 Ch. 2.
1.1.6.2.18. DELIVERABLE: Policies and procedures to ensure that all intake, referral,
enrollment, and Person-Centered Service Planning activities are conducted
independently of any Provider Agency influence, including but not limited to
coaching, coercion, or undue influence
1.1.6.2.19. DUE: July 1, 2026
1.1.6.2.20. Contractor may be granted a Conflict Free Case Management Authorization
(CFCMA)by the Department to provide LTSS Case Management within the Defined
Service Area when one is necessary to maintain services in rural and frontier service
areas.
1.1.6.2.20.1. Contractor shall obtain and maintain approval for the CFCMA throughout the
Contract Period to meet program requirements for a Case Management Agency.
1.1.6.2.20.2. The Department reserves the right to revoke Contractor's CFCMA at any time.
1.1.6.2.20.3. Contractor shall submit an annual report to the Department that includes, but is
not limited to, the following information:
1.1.6.2.20.3.1. Written processes in place to ensure remediation of conflict and separation of
entities.
1.1.6.2.20.3.2. Documentation of Member choice and informed consent of the conflict of the
agency being selected.
1.1.6.2.20.3.3. A summary of the individuals participating in direct services and case
management at the agency with the CFCMA.
1.1.6.2.20.3.4. Policies and procedures outlining how Contractor will validate that there are
no other willing and qualified providers in their Defined Service Area with
capacity to provide services for all eligible Members in the service area.
1.1.6.2.20.3.5. How Contractor is supporting the recruitment of providers in their area to
remediate conflict.
1.1.6.2.21. If Contractor is denied a CFCMA for any reason, or one is revoked, Contractor must
have documented written plans for transitioning individuals and Members. Contractor
shall continue to provide services until a transition may be successfully implemented.
Exhibit B-6,Statement of Work Page 5 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.6.2.21.1. DELIVERABLE: Annual report and written processes and procedures on
implementing rural exception and only willing and qualified provider
requirements for CMAs that have been granted a CFCMA.
1.1.6.2.21.2. DUE: June 15th of each year or prior to contract renewal for CMAs with an
approved rural exception
1.2. Collaboration with other Care Coordination Entities and Case Management Agencies
1.2.1. Contractor shall comply with written communication from the Department, provided by the
Department, between Contractor and community partners and service providers that outline
how Contractor will work together with these partners to coordinate care and better serve
individuals and Members. Contractor shall establish written memorandum of understanding
with local care coordination entities that outline roles and responsibilities, avoidance of
duplication of effort, and communication expectations. Contractor is responsible for
streamlining the Member experience to ensure full range of Medicaid services are being
offered and accessed based on the Member's needs. As applicable, a memorandum of
understanding shall address partnerships with:
1.2.1.1. Regional Accountable Entities (RAE)
1.2.1.1.1. The RAE is responsible for coordinating for physical health services and providing
and arranging for behavioral health services, including, but not limited to mental
health services or other non-waiver behavioral services and supports available
through Medicaid. The RAE promotes the population's health and functioning,
coordinates care across disparate providers, interfaces with LTSS providers, and
collaborates social, educational,justice, recreational, and housing agencies to foster
healthy communities and address complex needs that span multiple agencies and
jurisdictions. The RAE manages a network of primary care physical health providers
and behavioral health providers to ensure access to appropriate care for Medicaid
Members.
1.2.1.1.1.1. Contractor shall ensure collaboration with RAEs occurs for all shared Members
that need care coordination services for physical and behavioral health services.
Contractor shall identify which community agencies are responsible for
facilitation, follow-up, and solution focused on next steps for each Member
collaboration.
1.2.1.1.1.2. Contractor shall collaborate with the appropriate RAE when a Member needs
assistance in accessing or coordinating the Member's physical, behavioral, or
mental health needs. This shall include but is not limited to Members who have
complex medical or behavioral support needs, change of conditions or
involvement with Child Welfare or Adult Protection.
1.2.1.1.1.3. Coordinating with the RAE for shared Members who admit to a hospital, to
include, but not limited to, communicating reasons for admission, Member's
hospital status, and plans for discharge.
1.2.1.1.1.4. Collaborating with the RAE for shared Members discharging from the hospital to
ensure all support needs are reflected in the Support Plan and the Member is
connected to the necessary services to support a successful discharge.
Exhibit B-6,Statement of Work Page 6 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.2.1.1.1.5. Enter into a data sharing arrangement for the sharing of all necessary information
for the RAE to assist Members in accessing and coordinating physical and
behavioral health needs.
1.2.1.1.1.6. Contractor shall create a complex and creative solutions process with the RAE(s)
and designated staff to address needs spanning multiple Medicaid systems for all
shared Members. This shall include, but not be limited to, a regularly scheduled
joint coordination meeting at a cadence that best meets the Member's needs to
ensure holistic case management and care coordination. This process shall be
made available upon request.
1.2.1.1.1.7. Contractor shall honor Member's preferences for case management and care
coordination,when applicable,while ensuring collaboration with the RAE occurs.
1.2.2. Contractor shall work with the Department to identify a Key Performance Indicator(KPI)to
measure the effectiveness of coordination between Contractor and RAE. Medicaid Eligibility
Sites.
1.2.2.1. County department of human/social services (counties) and Medical Assistance (MA)
Sites are designated sites allowed by statute or certified by the Department of Health Care
Policy and Financing (Department) to process the State-authorized Medical Assistance
application for the programs that are administered by the Department and determine
eligibility for said programs. The role of county departments, specified in CRS 25.5-1-
118, is specific to the responsibility for the local administration of Medical Assistance.
Additionally, the Department is authorized to establish MA sites by statute(CRS 25.5-4-
205 et seq). Counties and MA Sites use the Colorado Benefits Management System
(CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Health First
Colorado (Colorado's Medicaid Program) programs.
1.2.2.2. Contractor shall ensure collaboration with all county and Medical Assistance sites
pertaining to application, renewal, case changes, or re-application status for Members in
Contractor's designated service area.
1.2.2.3. Contractor shall collaborate with the appropriate counties and/or Medical Assistance sites
to ensure proper follow-up and communication to support Members in obtaining and
maintaining their benefits.
1.2.3. Community Centered Boards
1.2.3.1. Community Centered Boards(CCB)are the agencies responsible for leveraging local and
regional resources to meet unmet needs for individuals with Intellectual and
Developmental Disabilities (IDD) and their families.
1.2.3.2. Contractor shall collaborate with CCBs, this may include, but is not limited to:
1.2.3.2.1. Receiving referrals or sharing information necessary for the CCB and/or CMA to
assist individuals and Members in accessing LTSS programs targeted for individuals
with intellectual and/or developmental delays or disabilities.
1.2.3.2.2. Coordinating care for non-waiver services for individuals and Members with
intellectual and developmental delays or disabilities where applicable or appropriate.
1.3. Qualification and Training Requirements
Exhibit B-6,Statement of Work Page 7 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.3.1. Contractor's personnel,including,but not limited to,Case Manager(s)and Case Management
Supervisor(s) shall meet all qualification requirements listed in 10 C.C.R. 2505-10, Sections
8.7203.A to 8.7204 et seq.
1.3.2. Contractor shall ensure all case managers meet the qualification requirements established in
10 C.C.R. 2505-10, Section 8.7203.A et seq.
1.3.3. Contractor shall ensure all staff assigned to perform the Work in this Contract pass
competency-based training requirements as defined by the Department including, but not
limited to disability/cultural competency,person centeredness, soft skills, as well as program
specific knowledge and skills.
1.3.4. Contractor shall ensure that all case management staff receive training within 120 Calendar
Days after the staff member's hire date and prior to being assigned independent case
management duties. All other case management staff must receive retraining as required by
the Department, a Department-approved vendor, or Contractor.
1.3.5. Training modalities may include the Departments Learning Management System (LMS),
web-based training, virtual instructor-led training, in-person training sessions and training
materials available on the Department website. Contractor shall utilize training materials
provided by the Department.
1.3.6. Required Case Management Training includes, but is not limited to:
1.3.6.1. Applicable Federal and State laws and regulations for LTSS programs
1.3.6.2. Community First Choice
1.3.6.3. Critical Incident Reporting
1.3.6.4. Determination of Developmental Disability or Delay
1.3.6.5. Disability and Cultural Competency
1.3.6.6. Intake and Referral
1.3.6.7. Level of Care Screen(ULTC 100.2)
1.3.6.8. Long-Term Services and Supports Eligibility
1.3.6.9. Mandatory Reporting
1.3.6.10. Notices and Appeals
1.3.6.11. Nursing Facility Admissions
1.3.6.12. Rapid Reintegration
1.3.6.13. Participant Directed Training
1.3.6.14. Person-Centered Support Planning and Person-Centered Support Plan
1.3.6.15. Pre-Admission Screening and Resident Review(PASRR)
1.3.6.16. State General Fund Program Ongoing Case Management
1.3.6.17. State General Fund Program Requirements and Services
1.3.6.18. System Documentation
1.3.6.19. Waiver Requirements and Services
Exhibit B-6,Statement of Work Page 8 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.3.6.19.1. DELIVERABLE: Case Management Training
1.3.6.19.2. DUE: Semi-Annually, trainings held between July Pt and December 31st are due
January 15th, and trainings held between January 15t through June 1st are due June
15th
1.3.7. Contractor shall maintain supporting documentation demonstrating case managers attended
the required trainings and make the information available to the Department upon request.
Supporting documentation must include the name and description of the training,the date the
training was held, case managers in attendance, and trainer sign-off showing the case
manager completed the training.
1.3.8. There will be no exemptions to the above list of required trainings as all case managers shall
have a basic knowledge of all case management activities regardless of ongoing duties.
1.3.9. Contractor shall participate in Department and vendor trainings,which will be tracked by the
Department. Participation can be at the time of the presented training or, if applicable,
following the training using the materials available from the Department's website or LMS.
1.3.10. For Case Managers who have a documented minimum of one-year immediate prior work
experience at a different Colorado CMA, Contractor may assign independent case
management activities once Contractor has verified that the Case Manager's training
requirements were previously met.
1.3.11. Contractor may elect to perform additional training not outlined in the Contract, but
applicable to the Scope of Work, which may include mental health first aid, crisis
intervention, and trauma informed care. Contractor may utilize the Department's Case
Management Training Template to identify trainings attended that are not required by the
Department.
1.3.12. Case Management staff are required to retake training to address and remediatc performance
concerns as directed by the Department.
1.3.13. Contractor shall provide the date all case management staff,including new and existing staff,
were hired and the dates of received training in the areas identified in Section 1.2.3,using the
reporting template provided by the Department for review, approval, and payment.
1.3.14. Case Managers shall receive oversight reviews of their performance including their
competency with completing the Level of Care Screen. Contractor shall shadow case
management staff completing the Level of Care Screen on an annual basis and prior to the
end of each Contract Fiscal year to establish case manager's competency administering the
Level of Care Screen. Documentation on case manager performance will be maintained by
Contractor and provided to the Department upon request. Supervisors,lead workers,or a case
manager with at least three years of case management experience may perform the
shadowing.
1.4. Complaints
1.4.1. Contractor shall develop and maintain a formal complaints procedure, notify Members
annually of the procedures, and make the procedure publicly available to include posting the
procedure to Contractor's website. Procedures must include requirements for member
notification in accordance with 10 CCR 2505-10 8.7201.D.
1.4.2. Contractor shall receive, document, and track any complaint received by Contractor as it
relates to the services provided through this Contract to include, but not limited to, general
Exhibit B-6,Statement of Work Page 9 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
business functions, administration, State General Funded Programs, and case management
functions outlined in this Contract. Complaints received outside of the scope of this Contract
shall not be included. Documentation shall consist of a complaint log that includes the date
of complaint, name of the complainant, the nature of the complaint and the date and
description of the resolution.
1.4.3. Contractor shall submit all complaints to the Community Advisory Committee for review,
feedback, and input on resolving complaints.
1.4.4. Contractor shall analyze complaints for trends quarterly and shall submit all complaint-
oriented trends observed since the Effective Date of this Contract and the remedial actions
taken to address them to the Department.
1.4.5. Trend analysis shall include an examination of information including, but not limited to:
1.4.5.1. A comparison of complaint types and number of complaints over a period of time.
1.4.5.2. Number of type of complaint against Contractor,time,location,individual involved, staff
involved, and/or any additional relevant information.
1.4.5.3. An examination of potential reasons for the increase or decrease in complaints by total
number, subcontractor, individual, or staff.
1.4.5.4. An examination of preventative measures that can be implemented to reduce the number
or frequency of future complaints.
1.4.5.5. Implementation of a plan of action or any future actions to take place.
1.4.5.6. An analysis of whether the plan of action and changes made were effective or if additional
changes need to occur.
1.4.5.7. As part of the complaint process Contractor shall include, but is not limited to, all of the
following:
1.4.5.7.1. Document complaints received.
1.4.5.7.2. Address substantiated complaints.
1.4.5.7.3. Respond to complaints received and document actions taken to resolve and/or
mitigate complaints.
1.4.5.7.4. Conduct a quarterly trend analysis of all complaints received for the full period of the
Contract.
1.4.5.8. Contractor shall maintain all supporting documentation related to the collection and
follow-up to complaints and make it available to the Department upon request.
1.4.5.9. If Contractor received no complaints during the quarter, Contractor may submit the
Complaint Trends Analysis to the Department identifying no complaints were reported
during the quarter.
1.4.5.10. If Contractor received less than five complaints during the quarter and cannot establish a
complaint trend, Contractor may submit the Complaint Trends Analysis to the
Department with the complaint log that includes the date of complaint, name of the
complainant, the nature of the complaint and the date and description of the resolution.
1.4.5.11. Contractor shall submit the Complaint Trends Analysis to the Department for review and
approval.
Exhibit B-6,Statement of Work Page 10 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.4.5.11.1. DELIVERABLE: Complaint Trend Analysis
1.4.5.11.2. DUE: Quarterly,by October 15th, January 15th, April 15th and June 15th of each year.
1.5. Continuous Quality Improvement Plan
1.5.1. Contractor shall create and implement a Continuous Quality Improvement Plan for the
contract period. The Continuous Quality Improvement Plan shall include, but not be limited
to a description of the following:
1.5.1.1. How Contractor oversees the work performed by Case Managers as outlined in the
contract to ensure all tasks are being performed according to the requirements.
1.5.1.2. How Contractor reviews work to determine whether the work is being completed in a
correct and high-quality manner.
1.5.1.3. How Contractor identifies and addresses Case Management performance issues.
1.5.1.4. How Contractor notifies the Department of identified performance issues.
1.5.1.5. How Contractor will address at a minimum the following areas: operations, quality
controls, staffing, training, and community engagement. Required tasks will be outlined
in Department template that will be provided to Contractor yearly.
1.5.1.6. Contractor shall participate in the Department hosted Quality Community of Practice.
1.5.2. Contractor shall submit the Continuous Quality Improvement Plan to the Department for
review, approval, and payment. The Department will establish a regularly scheduled cadence
with Contractor to review and discuss the CQI Plan, data, and agency specific quality
dashboard. Contractor shall review the plan and metrics with the Department annually.
1.5.2.1. DELIVERABLE: Continuous Quality Improvement Plan
1.5.2.2. DUE: Within 90 Business Days after the Effective Date
1.5.3. Contractor shall review its Continuous Quality Improvement Plan on an annual basis and
update the plan as appropriate to account for any changes. Contractor shall submit the
Continuous Quality Improvement Plan Update or document that the plan was reviewed, and
changes were not required.
1.5.3.1. DELIVERABLE: Continuous Quality Improvement Plan Update
1.5.3.2. DUE: Annually, by October 1st
1.6. Appeals
1.6.1. Contractor shall represent the Department and defend any adverse action in accordance with
10 CCR 2505-10 8.7202.R et seq., and 10 CCR 2505-10 Section 8.057 et. seq. in all HCBS,
CFC, PACE, Hospital Back-Up Facilities, and Nursing Facility appeals initiated during this
Contract. This section does not apply to State General Fund Programs. Contractor shall
coordinate with the Department for any adverse actions necessitating Department attendance
at a hearing.
1.6.1.1. Contractor shall identify and disclose to the Department immediately, and no later than
45 Calendar Days prior to a scheduled appeal hearing, any conflict of interest that would
interfere with Contractor's ability to represent the Department in any appeal.
Exhibit B-6,Statement of Work Page 11 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.6.2. Contractor shall represent its actions at Administrative Law Judge hearings when the
individual or Member appeals a denial or adverse action affecting individual's or Member's
program eligibility or receipt of services.
1.6.3. Contractor shall process appeals in accordance with schedules published by the State of
Colorado Office of Administrative Courts and rules promulgated by the Department.
1.6.4. Contractor shall develop an Appeals Packet which contains all relevant documentation to
support Contractor's denial or adverse action.
1.6.5. Contractor shall develop an Appeals Packet no later than 20 Business Days prior to the date
of a scheduled hearing.
1.6.6. Contractor shall submit exceptions when applicable and include all relevant information.
1.6.7. Contractor shall cooperate with the Office of the State Attorney General for any case in which
it is involved.
1.6.8. Contractor shall document all appeals where Contractor attends any hearing in an
Administrative Law Court.
1.6.9. Contractor shall make the Appeal Packets available to the Department upon request.
1.6.10. Contractor shall enter all Appeal Packets Created Dates and Court Decision Dates into the
CCM system within 10 Business Days of packets being created and court hearings attended.
1.6.10.1. Contractor shall receive reimbursement for all Appeals based on data entry into the CCM.
1.7. Critical Incidents
1.7.1. Critical Incident Reporting
1.7.1.1. Contractor shall be responsible for entering Critical Incident Reports (CIR) in the CCM
as soon as possible, but no later than 24 hours(one business day) following notification.
1.7.1.2. Contractor shall ensure all suspected incidents of abuse, neglect, and exploitation are
immediately reported consistent with current statute; Section 19-3-301 through 19-3-318
C.R.S. Colorado Children's Code, Section 18-8-115 C.R.S. (Colorado Criminal Code -
Duty to Report a Crime), 18-6.5-108 C.R.S.(Colorado Criminal Code-Wrongs to At-Risk
Adults), and Section 26-3.1-102, C.R.S. (Social Services Code-Protective Services).
1.7.1.3. Contractor shall document all CIR follow-up information in accordance with Department
direction in the CCM and maintain detailed documentation.
1.7.2. Critical Incident Follow-Up Completion and Entry
1.7.2.1. Contractor shall ensure all CIRs follow-up is completed and entered into the CCM within
the timelines established by the Department and/or the Department's Quality
Improvement Organization.
1.7.2.2. Timelines for follow-up are determined by the Department and depend on the type and
severity of the CIR. The following are general timelines assigned to remediation and CIR
follow up:
1.7.2.2.1. High Priority Follow Up- CIRs which require immediate attention and must be
addressed to ensure the immediate health and safety of a waiver or CFC participant
must be remediated within and responded to in the CCM within 24-48 hours.
Exhibit B-6,Statement of Work Page 12 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.7.2.2.2. Medium Priority Follow Up — CIRs which require additional information or follow
up to ensure appropriate actions are taken and there is no immediate risk to the health
and safety of the waiver or CFC participant must be completed in the CCM within
three to four Business Days.
1.7.2.2.3. Low Priority Follow Up—CIRs that have been remediated by CMAs, have addressed
immediate and long-term needs, have implemented services or supports to ensure
health and safety, and those that have protocols in place to prevent a recurrence of a
similar CIR but may require an edit to the CIR or additional information entered into
the CCM. The follow-up for CIRs in this category must be completed and entered
within five Business Days.
1.7.2.3. PERFORMANCE STANDARD: 90% of all CIRs assigned follow-up are completed
and entered into the CCM within the timelines established by the Department and/or the
Department's Quality Improvement Organization each quarter.
1.8. Critical Incident Report Administrative Review
1.8.1. Contractor shall conduct a Critical Incident Report Administrative Review upon direction
from the Department.
1.8.2. Critical Incident Report administrative reviews shall be initiated by the Department and will
require Contractor to upload documentation to the CCM as assigned. Contractor may be
required to document that the reported incident of alleged Mistreatment, Abuse, Neglect, or
Exploitation(MANE)was reported to law enforcement, per mandated reporting laws, and to
adult/child protection services to be screened for additional investigation by the Colorado
Department of Human Services as appropriate. The Department may also request that
Contractor file a report with the Colorado Department of Public Health and Environment as
necessary. Critical Incident Report administrative review may also require documentation of
whether additional services might be needed as a result of the incident or gathering of
additional documentation at the request of the Department.
1.8.3. Contractor shall be reimbursed for all critical incident reports through a Per Member Per
Month (PMPM) payment for all Members enrolled in an HCBS waiver or CFC.
Reimbursement will be based on all Members that are active in the CCM with Contractor and
have an approved PAR in the Bridge.
1.9. Human Rights Committee (HRC)
1.9.1. Contractor shall establish an HRC. The HRC is composed, to the extent possible, of two
professional persons trained in the application of behavior development techniques and three
representatives comprised of one or more of the following: persons receiving Long-Term
Care services, parents, Guardians, or Legally Authorized Representatives of persons
receiving or whom have received Long-Term Care services,or persons with lived experience
having long-term care needs,or persons caring for a loved one with long-term care needs.An
employee or board member of a Provider Agency within Contractor's designated service area
shall not serve as a member of the HRC.
1.9.2. Contractor shall establish and facilitate a Human Rights Committee (HRC) pursuant to 10
C.C.R. 2505-10 Section 8.7202.Q et seq. Contractor shall maintain qualifications for each
member of the HRC and make it available to the Department upon request.
Exhibit B-6,Statement of Work Page 13 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.9.3. Contractor shall submit a list of HRC members and documentation of qualifications of all
new members annually.
1.9.3.1. DELIVERABLE: HRC Member List
1.9.3.2. DUE: Annually, by August 15th
1.9.4. Contractor shall notify the Department of any changes to the HRC members within 10
Business Days of the date of change.
1.9.4.1. DELIVERABLE: HRC Member Updates
1.9.4.2. DUE: Within 10 Business Days of the date of change to the HRC members
1.9.5. Contractor shall establish at least one HRC as a third-party mechanism to safeguard the rights
of persons enrolled in HCBS-CES, HCBS-CHRP, HCBS-SLS, HCBS-DD, State SLS,
OBRA-SS, and FSSP. The HRC is an advisory and review body to the administration of
Contractor.
1.9.6. Contractor shall develop policies and procedures which include, but are not limited to, HRC
responsibilities for the committee's organization, use of Department required universal
documents, the review process, mitigation of potential conflicts of interest, and provisions
for recording dissenting opinions of committee members in the committee's
recommendations.
1.9.7. Contractor shall orient members regarding the duties and responsibilities of the Human
Rights Committee and make this information available to the Department upon request.
1.9.8. Contractor shall provide the HRC with the necessary staff support to facilitate its functions.
1.9.9. Contractor shall keep proper documentation and record of all HRC recommendations and
ensure that all documentation is a part of the members record in the CCM.
1.9.10. Contractor shall maintain HRC meeting minutes, attendance logs, and supporting
documentation related to an HRC meeting and make it available to the Department within 10
Business Days upon request.
1.9.11. Contractor shall notify the Department in writing of any changes to the HRC membership
within 10 Business Days.
1.9.12. Contractor shall document all reviews within the CCM within 10 Business Days of the date
of the HRC review.
1.9.13. Contractor shall be reimbursed for all HRC activities through a PMPM payment for all
Members enrolled in HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS.
Reimbursement will be based on Members that are active in the CCM with Contractor and
have an approved PAR in the Bridge.
1.9.14. Contractor shall invoice the Department for all State SLS, OBRA-SS, and FSSP Members
reviewed by the Human Rights Committee using the template created by the Department.
1.9.14.1. DELIVERABLE: Human Rights Committee Invoice for State SLS, OBRA-SS, FSSP
1.9.14.2. DUE: Monthly, by the 15th
2. PRE-ENROLLMENT ACTIVITIES
2.1. LTSS LOC Referral, Intake, and Screening
Exhibit B-6,Statement of Work Page 14 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
2.1.1. Contractor shall perform all long-term services and supports Level of Care referral, intake,
and screening functions/activities for enrollment into the following waivers and programs:
2.1.1.1. Community First Choice(CFC)
2.1.1.2. Family Support Services Program(FSSP)
2.1.1.3. HCBS—Children with Complex Health Needs (HCBS-CwCHN)
2.1.1.4. Consumer-Directed Attendant Support Services (CDASS)
2.1.1.5. HCBS—Children's Extensive Supports Waiver(HCBS-CES)
2.1.1.6. HCBS—Children's Habilitation Residential Program Waiver(HCBS-CHRP)
2.1.1.7. HCBS—Children's Home and Community Based Services Waiver(CHCBS)
2.1.1.8. HCBS—Community Mental Health Supports Waiver(HCBS-CMHS)
2.1.1.9. HCBS—Complimentary and Integrative health(HCBS-CIH)
2.1.1.10. HCBS—Developmental Disabilities Waiver(HCBS-DD)
2.1.1.11. HCBS—Elderly, Blind, and Disabled Waiver(HCBS-EBD)
2.1.1.12. HCBS—Brain Injury Waiver(HCBS-BI)
2.1.1.13. HCBS—Supported Living Services Waiver(HCBS-SLS)
2.1.1.14. Hospital Back-Up Program (HBU)
2.1.1.15. In Home Supports and Services (IHSS)
2.1.1.16. Intermediate Care Facilities for Individuals with Intellectual and Developmental
Disabilities (ICF/IID)
2.1.1.17. Nursing Facilities (NF)
2.1.1.18. Omnibus Reconciliation Act of 1987 Specialized Services Program(OBRA-SS)
2.1.1.19. Program for All-Inclusive Care for the Elderly(PACE)
2.1.1.20. State Supported Living Services Program(State SLS)
2.2. Contractor shall perform all Long Term Supports and Services Level of Care (LTSS LOC)
referral,intake,and screening functions/activities in accordance with §25.5-6-104,C.R.S. and 10
CCR 2505-10, Sections 8.7202.B., 8.7202.E, and 8.401 et seq., shall include, but not limited to,
the following:
2.2.1.1. Timelines shall be applied based on the location of the applicant at the time Contractor
receives the referral for a LOC Screen:
2.2.1.1.1. Hospital, Two Business Days,
2.2.1.1.2. Skilled Nursing Facility, Five Business Days, or
2.2.1.1.3. Community, 10 Business Days
2.2.1.2. CMAs shall not require an LTSS LOC Referral Form to intake a referral requesting a
LOC Screen.
2.2.1.3. Conduct and document the Colorado Intake Screen Tool(CIST),LOC Screen,and Rapid
Reintegration within required timelines set forth by the Department.
Exhibit B-6,Statement of Work Page 15 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.2.1.3.1.1. Conduct and document the CIST in the CCM within two Business Days referral
requesting a LOC Screen for LTSS services, except for applicants entering the
Hospital Back-Up program.
2.2.1.3.2. Timeline to conduct and document the CIST does not extend the LOC Assessment
timelines set forth by the Department.
2.2.1.3.3. Ensure documentation includes the individual's need for LTSS and/or the individual's
request for a LOC Screen even if the CIST indicates the individual may not be
functionally eligible for LTSS.
2.2.1.3.3.1. Referral form/documentation requesting a LOC Screen is uploaded in the CCM.
2.2.1.3.4. Document all efforts to contact an applicant to conduct the CIST, LOC Screen, and
any referrals made to non-LTSS services in the CCM.
2.2.1.4. Have a written policy and procedure for expediting the LTSS LOC referral or another
referral for LOC Screen in the event that an applicant is in an emergency situation.
2.2.1.5. Conduct and document a LOC Screen without delay if an applicant has requested a Delay
Determination or Developmental Disability Determination required for HCBS-DD,
HCBS-SLS, HCBS-CES, and HCBS-CHRP waivers.
2.2.1.5.1. Individuals may opt to delay the LOC Screen while seeking a Delay Determination
or Developmental Disability Determination. In such cases, Contractor shall document
this in the individual's record within the Care and Case Management(CCM) system.
2.2.1.5.2. Upon receiving a LTSS LOC referral, CMAs shall attempt to verify whether a LTC
Medicaid Application has been submitted, but shall not delay or postpone a LOC
Screen if the interview conducted to complete the CIST or subsequent contacts
indicate that an applicant had not yet submitted a LTC Medicaid Application by the
time the assessment is scheduled.
2.2.1.5.3. The CMA shall refer the applicant to the appropriate resources needed to submit their
LTC Medicaid Application, if submission has not been completed throughout the
intake referral process and subsequent to completing the assessment.
2.2.1.5.4. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
2.2.1.6. Individuals shall be notified at the time of the decision of their application for publicly
funded LTSS that they have the right to appeal the actions of Contractor according to 10
CCR 2505-10 section 8.057 and 8.7202.R et seq. The notification shall include the right
to request a fair hearing before an Administrative Law Judge.
2.2.1.6.1. PERFORMANCE STANDARD: 100% of LTSS LOC Referrals and all intake
referrals submitted to Contractor are entered or uploaded into the CCM within two
Business Days of the LTSS LOC Referral or intake referral receipt date.
2.3. Intellectual and/or Developmental Disability and Developmental Delay Determinations
2.3.1. Contractor shall determine whether an applicant meets the definition of an Individual with an
Intellectual and/or Developmental Disability and Developmental Delay as defined under 10
CCR 2505-10, section 8. 7100.A, in accordance with 10 C.C.R. 2505-10 section 8.607.2 et
seq.
Exhibit B-6,Statement of Work Page 16 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.3.2. Contractor may expedite psychological or adaptive behavior testing for Intellectual and/or
Developmental Disability and Developmental Delay Determinations when there are delays
due to issues identifying a provider or scheduling testing with a provider in order complete
the PASRR Level II assessments for individuals residing in skilled nursing facilities.
Requests for testing funding must be submitted on the template prescribed by the Department.
2.3.3. Contractor may request funding for testing necessary to complete Intellectual and/or
Developmental Disability and Developmental Delay Determination to move forward with
intake and referral activities. This includes cases where an applicant cannot access testing
due to financial burden and other funding is not available if they have submitted a long-term
care Medicaid application and the financial eligibility has not been determined. Requests for
funding must be submitted to the Department for approval prior to funding being approved.
2.3.3.1. DELIVERABLE: Prior Approval for Testing Funding and Invoice
2.3.3.2. DUE: Monthly,by the 15th
2.3.4. Contractor shall maintain all supporting documentation related to the testing for DD
Determination and make it available to the Department upon request.
2.3.5. Contractor shall complete the individual's determination record and assessment record in the
CCM with all applicable dates and information within 10 Business Days after a determination
is complete.
2.3.5.1. Contractor shall receive reimbursement for all determinations based on data entry into
the CCM.
2.3.6. Contractor shall maintain the individual's determination, documents, and upload them to the
CCM.
2.3.7. Contractor shall ensure that all determinations are complete, in accordance with Department
regulations, and the individual has been determined to have a disability or delay prior to
enrollment into HCBS-DD, HCBS-SLS, HCBS-CHRP (unless eligible through Serious
Emotional Disturbance criteria), HCBS-CES, State SLS, FSSP, and OBRA-SS.
2.3.8. Individuals shall be notified at the time of the decision of the determination that they have
the right to appeal actions of Contractor to 10 CCR 2505-10 sections 8.057 et seq., 8.7202.R
et seq. The notification shall include the right to request a fair hearing before an
Administrative Law Judge.
2.4. Waiting List Management
2.4.1. Contractor shall maintain a program specific waiting list within the CCM for all eligible
individuals for whom funding is not available. Waiting lists may be applicable for HCBS-
DD, State SLS, OBRA-SS and FSSP dependent on available funding. Contractor shall not
maintain a waiting list for any of the other programs included within this Contract.
2.4.2. Contractor shall determine HCBS-DD waiting list eligibility by conducting an assessment
that clearly defines detailed and Member-specific information that specifies how the
individual meets the HCBS-DD waiver requirement for needing access to services and
supports twenty-four (24) hours a day pursuant to 10 CCR 2505-10 8.7202.G et seq. and
8.7101.J et seq.
2.4.2.1. Contractor's description of daily living needs of an individual who requires access to
twenty-four (24) hour a day services and support in the LOC waiting list assessment
should indicate services and support needs that are only available in the HCBS-DD
Exhibit B-6,Statement of Work Page 17 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
waiver to determine why access to services and supports twenty-four hours a day are
necessary for the individual.
2.4.3. The name of a person eligible for the program shall be placed on the waiting list by Contractor
making the eligibility determination.
2.4.4. When an eligible person is placed on the waiting list for Waiver services, a written notice of
action including information regarding individual rights and appeals shall be sent to the
person or the person's legal guardian in accordance with the provisions of 10 C.C.R. 2505-
10 8.7202.J et seq.
2.4.5. When funding has been made available for an individual Contractor will remove the person
from the"As Soon as Available" (ASAA) waiting list within 10 Business Days.
2.4.6. The placement date used to establish a person's order on an HCBS waiver waiting list shall
be:
2.4.6.1. The date on which the person was initially determined to have a developmental disability
by Contractor; or
2.4.6.2. The 14th birth date if a child is determined to have a developmental disability by
Contractor prior to the age of 14.
2.4.7. When an individual is eligible for a program and funding is not available, Contractor shall:
2.4.7.1. Verify demographic information.
2.4.7.2. Compile and correct data.
2.4.8. Contractor shall complete data entry of Waiting List record into the CCM within 10 Business
Days of any addition or change to the Waiting List.
2.4.9. Contractor shall conduct and document, in the CCM, an annual follow-up with individuals
18 and older for all HCBS waivers with a Waiting List timeline of ASAA, Safety Net (SN),
or "see date" to update changes in demographic information and ensure the individual is
appropriately identified on waiting lists for the program and services the individual is eligible
to receive.
2.4.10. Contractor shall enter annual follow-up within the CCM within 10 Business Days of the
contact.
2.4.10.1. Contractor shall receive reimbursement for annual waiting list contacts based on data
entry into the CCM.
2.4.10.2. PERFORMANCE STANDARD: 100% of HCBS individuals 18 and older with an
ASAA, SN, or "see date" timeline on the Waiting List are contacted annually and
documented within the CCM within 10 Business Days.
2.5. Program Enrollment from the Waiting List
2.5.1. HCBS-DD Enrollment from the Waiting List
2.5.1.1. When an enrollment becomes available from the HCBS-DD Waiting List,the Department
will notify Contractor of the individual who will be offered an enrollment by the order of
selection date.
2.5.1.2. Contractor shall notify the individual of the enrollment offer within five Business Days.
Contractor shall make three attempts to contact the individual within a 30-calendar day
Exhibit B-6,Statement of Work Page 18 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
period. Contractor shall document in the CCM all attempts to contact the individual for
the enrollment offer. If the individual does not respond to the offer of enrollment,
Contractor shall change the individuals waiting list timeline to"Safety Net".
2.5.1.3. Individuals shall be notified at the time of the enrollment offer that they have the right to
appeal the actions of Contractor to 10 CCR 2505-10 sections 8.7202.R et seq. and 8.057
et seq. The notification shall include the right to request a fair hearing before an
Administrative Law Judge.
2.5.2. HCBS-DD Waiting List Enrollment Capacity Building
2.5.2.1. As appropriated and earmarked by the General Assembly, Contractor may receive
capacity building funding to support the enrollment of individuals into the HCBS-DD
waiver from the waiting list.
2.5.2.2. Contractor shall receive written notification of any capacity building funding for
individuals enrolling into the HCBS-DD waiver from the waiting list.
2.5.2.3. If funding is allocated, Contractor shall report how the capacity building funding was
used to support the enrollment of the authorized Member(s) into the HCBS-DD waiver
on a template developed by the Department. Funding must be used to support Member
enrollment in the following categories:
2.5.2.3.1. Staffing costs
2.5.2.3.1.1. Recruiting and hiring
2.5.2.3.1.2. Professional development
2.5.2.3.1.3. Equipment and supplies
2.5.2.3.1.4. Information technology
2.5.2.3.2. Program costs
2.5.2.3.2.1. Advertising
2.5.2.3.2.2. Equipment and supplies
2.5.2.4. DELIVERABLE: Capacity Building Funding Expenses
2.5.2.5. DUE: Quarterly, if funding is allocated, by October 31 st, January 31st, April 30th, and
June 15th or the Fiscal Year end close date determined by the Department
2.5.3. FSSP Enrollment from the Waiting List
2.5.3.1. In cooperation with the local Family Support Council, Contractor shall develop
procedures for determining how and which individuals on the Waiting List will be
enrolled into FSSP. These procedures must comply with Department regulations on
waiting list and prioritization of funding.
2.5.3.2. Contractor shall select individuals from the waiting list to enroll into FSSP in accordance
with 10 CCR 2505-10 8.7561et seq.
2.5.4. State SLS Enrollment from the Waiting List
2.5.4.1. Contractor shall develop procedures for determining how and which individuals on the
waiting list will be enrolled into the State SLS program in accordance with 10 C.C.R.
Exhibit B-6,Statement of Work Page 19 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2505-10 Section 8.7560. These procedures shall be made available to the Department
upon request and used to select individuals from the waiting list to enroll into State SLS.
2.5.5. OBRA-SS Enrollment from the Waiting List
2.5.5.1. Contractor shall determine when funding is not available within Contractor's existing
State General Fund program allocation and notify the Department that additional funding
is being requested to enroll the individual into OBRA-SS within 10 Business Days of
funding needs being identified.
2.5.5.2. Contractor shall place the individual on the waiting list until funding becomes available
or Contractor may partially fund services when limited funding is available within
existing allocations.
2.5.5.3. Contractor shall develop procedures for determining how and when individuals will be
placed on the waiting list and make the procedures available to the Department upon
request.
2.5.6. Waiting List Records Maintenance
2.5.6.1. Contractor shall remove individuals from the Waiting List after an enrollment is
authorized to the individual and the individual or guardian accepts or refuses the
authorization for enrollment within 10 Business Days after the individual or guardian's
response or the last communication attempt.
2.5.6.2. If an individual or guardian declines an enrollment, Contractor shall enter the reason for
declining an enrollment into the CCM Waiting List record within 10 Business Days of
the enrollment being declined.
2.5.6.3. Contractor shall provide information and referrals to individuals, families and/or
guardians at the time of the annual follow-up.
2.5.6.4. Contractor shall continue to refer individuals on the Waiting List to other community
resources that may be available and inform individuals of their choice of providers,
waivers, CFC, and services.
2.5.6.5. Contractor shall provide assistance completing Medicaid financial applications or other
public assistance program applications at the time assistance is requested by the
individual, family, or guardian.
2.5.6.6. Individuals shall be notified at the time of the enrollment authorization that they have the
right to appeal actions of Contractor as described in 10 CCR 2505-10 section 8.057 et
seq., 8.7202.R et seq. The notification shall include the right to request a fair hearing
before an Administrative Law Judge.
2.6. Compilation and Correction of Waiting List Data
2.6.1. Contractor shall correct 100% of Waiting List data errors discovered by the Department
within 10 Business Days of notification from the Department of an error.
2.6.1.1. PERFORMANCE STANDARD: 100% of Waiting List data corrected within 10
Business Days of notification.
2.7. Authorization and Reporting of HCBS-DD Enrollments
2.7.1. Contractor shall obtain prior authorization from the Department for all enrollments into the
HCBS-DD waiver.
Exhibit B-6,Statement of Work Page 20 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.7.2. In accordance with 10 CCR 2505 Section 8.7101.J, Contractor shall inform the Department
of all vacancies in the HCBS-DD waiver. Vacancies shall be submitted to the Department
monthly on the date and template prescribed by the Department.
2.7.3. Individuals shall be notified at the time of the enrollment authorization that they have the
right to appeal the actions of Contractor to 10 CCR 2505-10 section 8.7202.R and 8.057 et
seq. The notification shall include the right to request a fair hearing before an Administrative
Law Judge.
2.7.3.1. DELIVERABLE: HCBS-DD Vacancy Reporting
2.7.3.2. DUE: Monthly,by the 15th on the template prescribed by the Department
2.7.4. Contractor shall report all enrollment dates or changes to enrollment status for the HCBS-
DD waiver to the Department monthly on the date and template prescribed by the
Department.
2.7.4.1. DELIVERABLE: HCBS-DD Enrollment Date and Enrollment Change Reporting
2.7.4.2. DUE: Monthly, by the 15th on the template prescribed by the Department
3. ASSESSMENT AND ANNUAL REASSESSMENT
3.1. Contractor shall perform the Level of Care (LOC) Screen (ULTC 100.2) for each individual as
directed by the Department and in accordance with regulations.
3.2. Contractor shall provide staff that meet the case manager qualifications set forth in state statutes
and regulations to perform all LOC Screens.
3.3. Contractor shall utilize and conduct the Department prescribed tools for the Initial LOC Screen
for all new applicants to HCBS, CFC, PACE, Nursing Facilities, Hospital Back-Up, and ICF-
IDD.
3.4. Initial LOC Screens include the following Assessment Event types: Initial, HCBS-DD Waitlist,
Deinstitutionalization (DI), and Reverse Deinstitutionalization. LOC Screen Reassessments
include the following Assessment Event type:Continued Stay Review.LOC Screen Unscheduled
Reviews include the following Assessment Event type: Unscheduled Review.
3.4.1. An Unscheduled Review Event Type shall be utilized when a LOC Screen is completed due
to a significant change in the Member functioning and support needs including documented
medical conditions,post hospitalization,or significant change in activities of daily living.
3.5. Contractor shall perform all Initial and Annual Reassessment Level of Care Screens for the
operation of a CMA in accordance with §25.5-6-104, C.R.S., 10 CCR 2505-10, Section 8.401,
and 10 CCR 2505-10, Sections 8.7202.E et seq. and 8.7202.F et seq.
3.6. The Initial LOC Screen shall include and ensure,but not limited to, the following:
3.6.1. Contractor shall attempt to verify that a LTC Medicaid Application has been submitted after
receiving a LTSS LOC referral but should not delay a LOC Screen if the interview conducted
to complete the intake indicates that an applicant has not submitted a LTC Medicaid
Application.
3.6.1.1. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid application
verification.
Exhibit B-6,Statement of Work Page 21 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
3.6.2. Contractor shall consider an Initial LOC Screen to be complete when the following has been
done: an in-person assessment is completed, the PMIP has been obtained and verified to be
accurate by the Case Manager to certify LOC, the attestation form, if applicable, has been
obtained and verified to be accurate by the Case Manager to determine target criteria, and the
assessment has been entered in the CCM .
3.7. The Annual LOC Screen Reassessment shall include and ensure,but not limited to,the following:
3.7.1. A review of financial eligibility information.
3.7.1.1. Contractor shall take action regarding Member Medicaid eligibility within one Business
Day of receipt from the eligibility site.
3.7.1.2. Contractor shall notify all providers of the discontinuation of services no later than 11
Calendar Days prior to the certification end date that services shall not be authorized past
the certification end date.
3.7.1.2.1. In the event Contractor fails to discontinue HCBS waiver and/or CFC services for a
Member found ineligible for a HCBS and/or CFC,Contractor shall be responsible for
reimbursing any providers for services rendered.
3.7.1.3. A review of the LOC Screen information.
3.7.1.4. A review of all supportive information related to the LOC for the Member to include, but
not limited to, documentation and interviews.
3.7.1.5. A review of relevant medical, educational, social, or other assessment records or
information when applicable.
3.7.1.6. A review of all community living information and options as an alternative to nursing
facility/institutionalized care.
3.8. The Initial LOC Screen and Annual LOC Screen Reassessment shall include and ensure, but not
limited to, the following:
3.8.1. Contractor shall ensure all LOC Screens are conducted in person with the individual, at
minimum, and in the place where the individual or Member resides.
3.8.2. A review of HCBS waiver Target Criteria for individual participation.
3.8.3. Determine individual Level of Care Eligibility for enrollment in HCBS, CFC, PACE, HBU,
Nursing Facility admission, or ICF-IDD admission. Analyzing the information obtained to
determine the most appropriate responses to the LOC Screen questions.
3.8.3.1. Contractor shall verify that a Member meets institutional Level of Care by receiving a
PMIP signed by a treating licensed medical professional and dated no earlier than six
months from the certification start date and no later than 90 Calendar Days from the
evaluation date of an Initial Level of Care Screen; and within 90 Calendar Days of the
certification start date and before the certification end date for a Reassessment for all
individuals and Members currently receiving services through Hospital Back-Up Unit
(HBU),Nursing Facility(NF),Intermediate Care Facility for Individuals with Intellectual
and Developmental Disabilities (ICF-IDD), and Program for All-Inclusive Care for the
Elderly(PACE).
3.8.3.1.1. PERFORMANCE STANDARD: Contractor shall ensure a Professional Medical
Information Page (PMIP) is signed within 90 Calendar Days of the certification start
Exhibit B-6,Statement of Work Page 22 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
date and before the certification end date for a LOC Screen Reassessment for all
applicants and individuals currently receiving services through the Hospital Back-Up
Unit (HBU), Nursing Facility (NF), Intermediate Care Facility for Individuals with
Intellectual and Developmental Disabilities (ICF-IDD), and Program for All-
Inclusive Care for the Elderly(PACE).
3.8.4. Communicating Level of Care Eligibility status to the appropriate eligibility site.
3.8.5. A LOC Certification notice shall be provided to referring agencies such as PACE
organizations, Nursing Facilities, or Hospitals upon obtaining written consent provided by
the individual that meets HIPAA standards.
3.8.6. Providing Notice of Action to applicants and Members of all appealable actions related to
their eligibility in a LTSS program.
3.8.6.1. Members shall be notified at the time of the denial of ineligibility decision that they have
the right to appeal the actions of Contractor to 10 CCR 2505-10 Section 8.057 et seq. and
8.7202.R The notification shall include the right to request a fair hearing before an
Administrative Law Judge.
3.8.6.2. Representing the Department in all appeals relevant to a LTSS program eligibility.
3.8.7. Documenting and maintaining LOC Screens, including all relevant information,utilizing the
CCM within the timeframes established in 10 CCR 2505-10, Sections 8.7202.E and 8.7202.F
et seq.
3.9. Failure by Contractor to complete the Annual LOC Reassessment shall cause a break in payment
authorization for waiver and/or CFC services for the individual or Member.
3.9.1. Contractor shall ensure that this break in payment authorization shall not affect the continued
delivery of waiver and/or CFC services to the individual or Member. Service costs incurred
during a break in payment authorization are non-allowable costs.
3.9.2. Contractor shall bear the sole financial responsibility for all costs incurred during this break
in payment authorization and shall be responsible for reimbursing any providers for services
rendered during the gap in eligibility.
3.9.3. Contractor shall schedule an in-person Initial LOC Screen in accordance with 10 CCR 2505-
10 Section 8.7202.E and shall adhere to the following processes and timelines based on type:
3.9.3.1. Hospital to HCBS or CFC
3.9.3.1.1. Contractor conducts and documents the LOC Screen and generates the electronic
LOC Eligibility Determination in the Care and Case Management (CCM) system
within two Business Days of receiving a referral.
3.9.3.1.2. LOC Eligibility Determination start date for Assisted Care Facility may be the date
of referral on the LTSS LOC referral form received by Contractor.
3.9.3.1.3. Referral to LOC Eligibility Determination not to exceed two Business Days.
3.9.3.2. Hospital to Skilled Nursing Facility
3.9.3.2.1. Contractor conducts and documents the LOC Screen and PASRR Level I Screen and
generates the electronic LOC Eligibility Determination in the CCM within two
Business Days of receiving a referral.
Exhibit B-6,Statement of Work Page 23 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
3.9.3.2.2. Contractor completes and documents the Nursing Facility Length of Stay form to
indicate the length of stay necessary to meet the applicant's needs.
3.9.3.2.3. LOC Eligibility Determination start date may be the date the LTSS LOC Referral
Form is received by Contractor.
3.9.3.2.4. Referral to LOC Eligibility Determination not to exceed two Business Days.
3.9.3.2.5. Hospital timelines apply to any applicant in a hospital wanting to enroll in PACE and
HBU.
3.9.3.3. Skilled Nursing Facility to HCBS or CFC
3.9.3.3.1. Contractor conducts and documents the LOC Screen and generates the electronic
LOC Eligibility Determination in the CCM within five Business Days of receiving a
referral.
3.9.3.3.2. Referral to LOC Eligibility Determination not to exceed five Business Days.
3.9.3.4. Skilled Nursing Facility Payer Source Change
3.9.3.4.1. Contractor conducts and documents the LOC Screen and generates the electronic
LOC Eligibility Determination in the CCM within five Business Days of receiving a
referral.
3.9.3.4.2. Referral to LOC Eligibility Determination not to exceed 5 Business Days.
3.9.3.5. HCBS or CFC to Skilled Nursing Facility
3.9.3.5.1. Contractor conducts and documents the LOC Screen and PASRR Level I Screen and
generates the electronic LOC Eligibility Determination in the CCM within 10
Business Days of receiving a referral.
3.9.3.5.2. Contractor completes the Nursing Facility Length of Stay form to indicate the length
of stay necessary to meet the applicant's needs.
3.9.3.5.3. LOC Eligibility Determination start date may be the Referral Form signature date.
3.9.3.5.4. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.9.3.6. Community to HCBS or CFC
3.9.3.6.1. Contractor conducts and completes the LOC Screen and generates the electronic LOC
Eligibility Determination in the CCM within 10 Business Days of receiving a referral.
3.9.3.6.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
Referral Form signature date.
3.9.3.6.3. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.9.3.7. Contractor shall conduct an Annual LOC Screen Reassessment no earlier than 90
Calendar Days prior to and no later than 30 Calendar Days prior to the current LOC
Screen certification end date.
3.9.3.7.1. PERFORMANCE STANDARD: 100% of Initial LOC Screens and Annual LOC
Screen Reassessments are conducted within required timelines at 10 CCR 2505-10,
Sections 8.7202.E et seq.and 8.7202.F et seq. and are entered into the CCM following
the timelines at 10 CCR 2505-10 Section 8.7202.E et seq.
Exhibit B-6,Statement of Work Page 24 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
3.9.3.8. Contractor shall receive reimbursement for all initial and reassessment LOC Screens
based on data entry into the CCM.
3.10. At-Risk Diversion
3.10.1. Contractor shall:
3.10.1.1. Outreach the identified At-Risk Diversion individuals in conjunction with timelines
determined by the Department to ensure basic health and safety needs in the community
are being met to avoid nursing facility placement.
3.10.1.2. Initial Outreach shall include Member's first occurrence on the at-risk determination list
as indicated by the Department.
3.10.1.3. Ongoing Outreach shall include Member's subsequent occurrence on the at-risk
determination list as indicated by the Department.
3.10.1.3.1. At-Risk Diversion activities shall include, but are not limited to:
3.10.1.3.1.1. Assessing the effectiveness of current support and services to determine if there
is a need for additional resources, supports, and/or services.
3.10.1.3.1.2. Support in assessing if the individual has become eligible for any other resources
including community resources and other Medicaid resources.
3.10.1.3.1.3. Documenting all At-Risk Diversion activities in detail in the CCM within 10
Business Days of the activity.
3.10.1.3.1.4. Maintaining all supporting documentation and make it available to the
Department upon request.
3.10.1.3.1.4.1. DELIVERABLE: At-Risk Diversion Invoice
3.10.1.3.1.4.2. DUE: Monthly, by the 15th
3.11. Rapid Reintegration
3.11.1. Contractor shall initiate the Rapid Reintegration if applicable, during the LOC Screen for
Nursing Facility.
3.11.1.1. Contractor shall provide Members information about community-based services using
the Member preference guide available on the CCM and website.
3.11.1.2. Contractor shall complete the Rapid Reintegration within the CCM if the Member
expresses a desire to return to the community.
3.11.1.3. Contractor shall ensure the Rapid Reintegration includes the Rapid Reintegration barrier
questions and either the Rapid Reintegration Plan or Rapid Referral as determined by the
CCM.
3.11.1.4. Contractor shall ensure that any referrals deemed necessary during the Rapid
Reintegration process are completed within two Business Days of the LOC Screen.
3.11.1.5. Contractor shall complete the post Rapid Reintegration satisfaction survey at the next
scheduled contact with the Member or within 90 Calendar Days of the transition,
whichever is earlier. The Rapid Reintegration survey shall be completed with any
Member transitioning from a Nursing Facility to the community that received a Rapid
Reintegration Plan or Rapid Referral.
Exhibit B-6,Statement of Work Page 25 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
3.11.1.5.1. DELIVERABLE: Rapid Reintegration Diversion Invoice
3.11.1.5.2. DUE: Monthly, by the 15th
3.12. Interim Support Level Assessment
3.12.1. Contractor shall establish one point of contact for Interim Support Level Assessment(ISLA)
related processes and communications.
3.12.2. Contractor shall conduct an ISLA for initial HCBS-DD and HCBS-SLS enrollments when
criteria set forth at 10 C.C.R. 2505-10 Section 8.7202.AA et seq. are met, the Member has
never had a Supports Intensity Scale (SIS) Assessment, and the Member is seeking Day
Habilitation,Prevocational,Supported Employment Services and/or Residential Habilitation.
Contractor shall not be reimbursed for an ISLA prior to the individual being determined
eligible for a waiver through the Level of Care Screen and confirmation of financial
eligibility.
3.12.3. Contractor shall conduct all initial ISLAs within 30 Calendar Days of the Member meeting
both functional and financial eligibility.
3.12.4. Contractor shall upload the ISLA into the CCM within 10 Business Days of the assessment
date.
3.12.5. Contractor shall complete the Department-prescribed ISLA invoice, and submit it to the
Department within 30 Calendar Days of the assessment date.
3.12.6. Contractor shall complete the ISLA and enter the Department-specified outcomes from the
ISLA into the Bridge prior to completion of the Pre Prior Authorization(PPA)and before the
PAR Start Date.
3.12.6.1. DELIVERABLE: Completed Interim Support Level Assessment Invoice
3.12.6.2. DUE: Within 30 Calendar Days of the Assessment Date
3.13. HCBS-CES Applications
3.13.1. Contractor shall complete initial and CSR applications for persons applying for the HCBS-
CES waiver as set forth by the Department's prescribed guidelines.
3.13.2. Initial HCBS-CES applications shall be submitted to the designated entity for review no more
than 30 Calendar Days after the initial LOC is completed or no more than 30 Calendar Days
after the Applicant/family has chosen enrollment onto the HCBS-CES waiver.
3.13.3. CSR HCBS-CES applications shall be submitted to the designated entity in accordance with
timelines as set forth by the Department in order to prevent any break in services.
3.13.4. Contractor shall maintain all HCBS-CES applications and supporting documentation and
make it available to the Department upon request.
3.14. HCBS-CHRP Support Need Level Assessment
3.14.1. Contractor shall conduct a Support Need Level Assessment for all HCBS-CHRP enrollments
and re-assessments as set forth by the Department's prescribed guidelines.
3.14.2. Contractor shall conduct an initial Support Need Level Assessment within 45 Calendar Days
from the date of the Initial Level of Care Screen. Contractor shall conduct all reassessments
as necessary when individual's needs change.
Exhibit B-6,Statement of Work Page 26 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
3.14.3. Contractor shall submit a list of all completed HCBS-CHRP Support Need Level
Assessments on a template prescribed by the Department.
3.14.3.1. DELIVERABLE: Completed HCBS-CHRP Support Need Level Assessment List
3.14.3.2. DUE: Monthly, by the 15th
3.14.4. Contractor shall maintain all Support Need Level Assessments and supporting documentation
and make it available to the Department upon request.
3.14.4.1. PERFORMANCE STANDAND: Support Need Level Assessment
3.14.4.2. DUE: Within 10 Business Days of the Department's request
4. STATE GENERAL FUND PROGRAM OBLIGATIONS
4.1. Service and Support Requirements
4.1.1. Contractor shall administer the three State General Fund Programs: State SLS, OBRA-SS,
and FSSP and purchase services and supports for persons determined to be eligible under this
Contract. If Contractor has been determined to be the only willing and qualified provider by
the Department for the Defined Service Area, Contractor must administer the State Programs
and purchase and/or provide services and supports for persons determined to be eligible under
this Contract. Contractor shall not be responsible for guaranteeing services to eligible persons
under this Contract if there are no Providers available to provide services and supports.
Contractor must ensure separation of case management responsibilities and the provision of
services for both State SLS and OBRA-SS.
4.1.2. Contractor shall ensure that written notifications are provided to individuals and Members
informing them of their rights and the potential influence Contractor has on the Support
Planning process, such as exercising free choice of providers.
4.1.3. Contractor shall provide the individual, Members, and/or guardian with written information
about how to file a provider agency complaint as well as how to make a complaint against
Contractor.
4.1.4. Contractor shall have procedures for a dispute resolution process, as described in 10 C.C.R.
2505-10, Section 8.7202.S et seq., when an action to terminate, change, reduce or deny
services is initiated by the provider service agency.
4.2. State General Fund Service Expenditure Reporting
4.2.1. Contractor shall report all State SLS,FSSP,and OBRA-SS direct service expenditures on the
template provided by the Department. All services must be reported and reimbursed within
the fiscal year the service is provided.
4.2.1.1. DELIVERABLE: State General Fund Program Service Expenditure Reports
4.2.1.2. DUE: Monthly, by the 15th of each month or Fiscal Year end close date determined by
the Department for the month of June.
4.2.2. Adjustments to direct service expenditures must be added to the next direct service
expenditure report submitted by Contractor at the time of discovery. If the adjustment is
identified after the close of the fiscal year the service is rendered, Contractor must report the
adjustment to the Department within 10 Business Days of discovery and a check must be sent
to the Department with the amount of the overpayment in addition to details about the
overpayment to include Member name, program, services, and dollar amount.
Exhibit B-6,Statement of Work Page 27 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
4.2.3. Contractor shall verify all services are supported with required documentation as required in
10 C.C.R. 2505-10 Sections 8.7560 et seq., 8.7561 et seq., and 8.7202.V et seq.
4.3. State Supported Living Services (State SLS)
4.3.1. General Requirements
4.3.1.1. Contractor shall operate the State SLS program pursuant to 10 C.C.R. 2505-10 Section
8.7560et seq.
4.3.1.2. Contractor shall not add surcharges to the purchase of covered services for State SLS.
4.3.1.3. Contractor shall provide a list of qualified providers for all services to Members and
families, during the State SLS Individual Support Plan process, and to other interested
parties upon request.
4.3.1.4. Contractor shall provide or coordinate with local service providers to provide community
services to individuals enrolled in State SLS who meet the intellectual and developmental
disabilities criteria and the eligibility requirements for the specific program required in
10 C.C.R. 2505-10 Section 8.7560 et seq.
4.3.1.5. The Department will notify Contractor of the target number of individuals that shall be
served through State SLS prior to the start of each State Fiscal Year (SFY). Contractor
may choose to enroll more individuals in State SLS than authorized, ensuring all
individuals can be served within the funding allocated.Target caseload is calculated using
the unique number of Members that receive direct services during the contract period.
4.3.2. State SLS Eligibility
4.3.2.1. Contractor shall determine eligibility for the State SLS program pursuant to 10 C.R.S.
2505-10 Section 8.7560.B et seq.
4.3.2.2. Contractor shall provide options counseling for State SLS after it is demonstrated that the
Member has applied for HCBS waiver services and explored long-term care services
offered under the State Plan, including CFC, and has demonstrated that available
Medicaid services cannot meet the Member's needs.
4.3.2.3. Contractor shall document any State SLS service needs for Member's enrolled in HCBS
and/or CFC.
4.3.2.4. Eligibility for the State SLS program does not guarantee the availability of services and
supports.
4.3.3. State SLS Individual Support Plans
4.3.3.1. Pursuant to 10 C.R.S.2505-10 Section 8.7560.D et seq. all State SLS Members must have
a State SLS ISP.
4.3.3.2. Contractor shall develop a State SLS Individual Support Plan(State SLS ISP) within 10
Business Days after an initial Individual Support Plan(ISP)meeting for those individuals
not established with Contractor and with a Developmental Disability determination at
time of referral. Contractor shall have up to 10 Business Days to complete additional
meetings and/or assessments that allow for the creation of the State SLS ISP during this
time. Contractor shall ensure the State SLS ISP is signed by all required parties prior to
implementation.
Exhibit B-6,Statement of Work Page 28 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
4.3.3.3. The State SLS ISP shall be developed through an in-person meeting that includes, at a
minimum, the individual seeking services and Contractor.
4.3.3.4. Contractor shall utilize the ISP within the CCM.
4.3.3.5. Contractor shall document and finalize all ISP information in the CCM within 10
Business Days of the date of the initial ISP meeting.
4.3.3.5.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the State
SLS ISPs are developed within 10 Business Days of the individual's referral to a State
General Fund program or after the initial ISP meeting.
4.3.3.6. The State SLS ISP shall be effective for no more than one year and reviewed by
Contractor at least every six months in an in-person monitoring contact.
4.3.3.7. If an individual seeks additional supports or alleges a change in need, Contractor shall
review and update the ISP prior to changing the authorized services and supports.
4.3.4. State SLS Ongoing Case Management
4.3.4.1. Contractor shall utilize appropriated funds to perform Case Management duties in
accordance with 10 C.C.R. 2505-10 Section 8.7560.E et seq.:
4.3.4.1.1. Intake and referral.
4.3.4.1.2. Determining program eligibility.
4.3.4.1.3. Supporting individuals with learning and accessing other community resources.
4.3.4.1.4. Developing a State SLS Individual Support Plan.
4.3.4.1.5. Maintaining the determination of eligibility for services and supports.
4.3.4.1.6. Providing service and support authorization and coordination.
4.3.4.1.7. Program transition coordination.
4.3.4.1.8. Case Management, policy, and regulation training.
4.3.4.1.9. Service records maintenance.
4.3.4.1.10. Utilization review.
4.3.4.2. Contractor shall document all ongoing case management activities in detail in the CCM
within 10 Business Days of the activity.
4.3.4.3. Contractor shall be reimbursed for ongoing case management activities based on
information entered into the CCM.
4.3.4.4. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
4.3.5. State SLS Monitoring
4.3.5.1. State SLS Monitoring shall be person centered and include at least one in person contact
with the Member and three additional monitoring contacts per year using the individual's
selected modality; in person or virtual and should be discussed and determined based on
Member preference and need.
4.3.5.1.1. The Member's selected modality must be documented within the case notes for each
monitoring contact within the CCM.
Exhibit B-6,Statement of Work Page 29 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.3.5.1.2. State SLS Monitoring activities shall include,but not be limited to:
4.3.5.1.2.1. Monitoring all services and supports delivered pursuant to the State SLS
Individual Support Plan.
4.3.5.1.2.2. Assessing the effectiveness of the State SLS supports and services.
4.3.5.1.2.3. Assessing if additional State SLS supports and services are needed.
4.3.5.1.2.4. Support in assessing if the individual has become eligible for any other resources
including community resources and other Medicaid resources.
4.3.5.1.2.5. Reviewing health and safety concerns.
4.3.5.1.2.6. Reviewing any Critical Incidents.
4.3.5.1.3. Contractor shall document all monitoring activities in detail in the CCM within 10
Business Days of the activity.
4.3.5.1.4. Contractor shall be reimbursed for monitoring activities based on information entered
into the CCM.
4.3.5.1.4.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at
the required quarterly interval.
4.3.6. State SLS Transfers
4.3.6.1. Contractor shall manage State SLS transfers in accordance with 10 C.R.S 2505-10
Section 8.7560.F et seq.
4.3.7. State SLS Direct Services
4.3.7.1. Contractor shall utilize appropriated funds to provide or subcontract with providers to
provide services to support individuals with an intellectual and developmental disability
living in the community in accordance with 10 C.C.R. 2505-10 Section 8.7560.H.
4.3.8. State SLS Records Maintenance
4.3.8.1. Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make it available to the Department upon request as required in 10
C.C.R. 2505-10 Section 8.7560.H et seq.
4.3.8.2. Receipts, invoices, and service logs must contain, at a minimum: Member name, service
description, provider name, first and/or last date of service, service rate, and amount due
or paid.
4.3.8.3. If Contractor does not maintain supporting documentation in the required format for all
services rendered, the Department may recover these funds pursuant to 10 C.C.R. 2505-
10 Section 8.076 et seq.
4.3.8.4. Through ongoing monitoring, Contractor shall ensure all services reimbursed by
Contractor are rendered by service providers in accordance with the State SLS Individual
Support Plan.
4.3.8.5. Contractor shall attempt to resolve any discrepancies with the service provider directly.
4.3.8.6. Contractor shall notify the Department of any instances of suspected fraud or waste, and
any supporting documentation at the time of discovery.
Exhibit B-6,Statement of Work Page 30 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.3.8.7. Contractor shall notify all service providers that all records and supporting documentation
related to services rendered through State SLS are subject to inspection and recovery by
the Department pursuant to 10 C.C.R. 2505-10 Section 8.076 et seq.
4.4. Omnibus Budget Reconciliation Act of 1987 Specialized Services (OBRA-SS)
4.4.1. Contractor shall provide or arrange for the provision of OBRA-SS to any individual where
the Pre-Admission Screening and Resident Review (PASRR) Level II Evaluation identified
the need for placement into a nursing facility and need for additional specialized services.
Contractor shall ensure the OBRA-SS being provided are listed on the individual's Notice of
Determination(NOD). Contractor shall ensure that OBRA-SS are related to the individual's
intellectual or developmental disability or related condition and individualized to the
resident's needs.
4.4.2. PASRR Level II Evaluation
4.4.2.1. Contractor will review the PASRR Level II Evaluations received from the Skilled
Nursing Facility or State appointed vendor prior to developing an OBRA-SS Individual
Support Plan or providing services.
4.4.3. Maintaining Eligibility and Enrollment
4.4.3.1. Contractor shall enroll individuals into OBRA-SS, if the individual resides in a nursing
facility, demonstrates a need, and agrees to receive services.
4.4.3.2. Upon approval of the nursing facility admission by the State Intellectual Disability
Authority and receipt of the Final Notice of Determination,Contractor shall send referrals
to providers for OBRA-SS within 10 Business Days from the date the PASRR Notice of
Determination is issued and/or received from the Skilled Nursing Facility or State
appointed vendor.
4.4.3.3. Contractor shall maintain Member records within the CCM. All changes to OBRA-SS
enrollments, shall be entered into the CCM within 10 Business Days of the change. The
Department may adjust the number of authorized enrollments based on fluctuating
enrollments. If the individual does not receive OBRA-SS within one calendar month
Contractor shall inactivate the individual's record in the CCM.
4.4.4. OBRA-SS Individual Support Plans
4.4.4.1. Contractor shall develop an OBRA-SS Individual Support Plan(ISP)within 10 Business
Days after an initial ISP meeting for those individuals not established with Contractor
and with a Developmental Disability determination at time of referral. Contractor shall
have up to 10 Business Days to complete additional meetings and/or assessments that
allow for the creation of the OBRA-SS ISP during this time. Contractor shall ensure the
OBRA-SS ISP is signed by all required parties prior to implementation.
4.4.4.2. The OBRA-SS ISP shall be developed through an in-person meeting that includes, at a
minimum, the individual seeking services and Contractor.
4.4.4.3. Contractor shall utilize the ISP template within the CCM.
4.4.4.4. Contractor shall document and finalize all ISP information in the CCM within 10
Business Days of the date of the initial 1SP meeting.
Exhibit B-6,Statement of Work Page 31 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
4.4.4.4.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the OBRA-
SS Individual Support Plans are developed within 10 Business Days of the
individual's referral to a State General Fund program or after the initial ISP meeting.
4.4.4.5. The OBRA-SS ISP shall be effective for no more than one year and reviewed by
Contractor at least every six months in an in-person monitoring contact.
4.4.4.6. If a Member seeks additional supports or alleges a change in need,Contractor shall review
and update the ISP prior to changing the authorized services and supports.
4.4.4.7. Contractor shall maintain all OBRA-SS ISPs and supporting documentation and make
them available to the Department upon request.
4.4.5. OBRA-SS Ongoing Case Management
4.4.5.1. Contractor shall utilize appropriated funds to perform Case Management duties to
include:
4.4.5.1.1. Intake and referral.
4.4.5.1.2. Verifying a PASRR Level II Evaluation and Skilled Nursing Facility residency.
4.4.5.1.3. Developing an OBRA-SS Individual Support Plan.
4.4.5.1.4. Maintaining the determination of eligibility for services and supports.
4.4.5.1.5. Providing service and support authorization and coordination.
4.4.5.1.6. Ensuring there is not a duplication of authorized services with the services provided
in the nursing facility.
4.4.5.1.7. Program transition coordination.
4.4.5.1.8. Service records maintenance.
4.4.5.1.9. Case Management, policy, and regulation training.
4.4.5.1.10. Utilization review.
4.4.5.2. Contractor shall document all ongoing case management activities in detail in the CCM
within 10 Business Days of the activity.
4.4.5.3. Contractor shall be reimbursed for ongoing case management activities based on
information entered into the CCM
4.4.5.4. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
4.4.6. OBRA-SS Monitoring
4.4.6.1. Monitoring shall be person centered and include at least one in person contact with the
Member and three additional monitoring contacts per year using the individual's selected
modality; in person or virtual and should be discussed and determined based on Member
preference and need. The Member's selected modality must be documented within the
narrative for each monitoring contact within the CCM.
4.4.6.2. Monitoring activities shall include but not be limited to:
4.4.6.2.1. Monitoring all services and supports delivered pursuant to the OBRA-SS ISP.
4.4.6.2.2. Assessing the effectiveness of the supports and services.
Exhibit B-6,Statement of Work Page 32 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.4.6.2.3. Assessing if additional supports and services are needed.
4.4.6.2.4. Support in assessing if the individual has become eligible for any other resources
including community resources or other Medicaid resources.
4.4.6.2.5. Reviewing health and safety concerns.
4.4.6.2.6. Reviewing any Critical Incidents.
4.4.6.3. Contractor shall document all monitoring activities in detail in the CCM within 10
Business Days of the activity.
4.4.6.4. Contractor shall be reimbursed for monitoring activities based on information entered
into the CCM.
4.4.6.4.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the
required quarterly interval.
4.4.7. OBRA-SS Direct Services
4.4.7.1. Contractor shall not utilize OBRA-SS funds to purchase mental health related services.
Contractor shall seek provision of, or payment for, mental health services for those
individuals through the Medicaid-funded mental health system or other local sources of
funding.
4.4.7.2. Contractor shall not utilize or authorize OBRA-SS funds to provide or purchase services
and supports that are covered and provided by the nursing facility.
4.4.7.3. Contractor shall utilize appropriated funds to provide services or coordinate with a
provider to support individuals with intellectual and developmental disabilities living in
a nursing facility. Contractor shall not utilize funding for services that are provided by
the Nursing Facility through Medicaid reimbursement. Services eligible through OBRA-
SS include:
4.4.7.3.1. Assistive Technology
4.4.7.3.2. Behavioral Consultation
4.4.7.3.3. Behavioral Line Services
4.4.7.3.4. Behavioral Counseling
4.4.7.3.5. Behavioral Counseling Group
4.4.7.3.6. Behavioral Plan Assessment
4.4.7.3.7. Day Habilitation - Specialized Habilitation
4.4.7.3.8. Day Habilitation - Supported Community Connections
4.4.7.3.9. Dental—Basic
4.4.7.3.10. Dental—Major
4.4.7.3.11. Mileage
4.4.7.3.12. Other Public Conveyance
4.4.7.3.13. Prevocational Services
4.4.7.3.14. Recreational Facility Fees/Passes
Exhibit B-6,Statement of Work Page 33 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.4.7.3.15. Job Coaching—Individual
4.4.7.3.16. Job Coaching—Group
4.4.7.3.17. Job Development—Individual
4.4.7.3.18. Job Development—Group
4.4.7.3.19. Job Placement
4.4.7.3.20. Vision
4.4.7.4. Services must be provided in accordance with the service definitions found in 10 C.C.R.
2505-10 Section 8.7500 et seq.
4.4.8. OBRA-S$ Records Maintenance
4.4.8.1. Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make it available to the Department upon request as required in 10
C.C.R. 2505-10 Section 8.130.2 et seq.
4.4.8.1.1. Receipts or invoices must contain,at a minimum: Member name, service description,
provider name, first and/or last date of service, service rate, and amount due or paid.
4.4.8.2. If Contractor does not maintain supporting documentation in the required format for all
services rendered, the Department may recover these funds pursuant to 10 C.C.R. 2505-
10 Section 8.076 et seq.
4.4.8.3. Through ongoing monitoring, Contractor shall ensure all services reimbursed by
Contractor are rendered by service providers in accordance with the OBRA-SS Individual
Support Plan.
4.4.8.4. Contractor shall attempt to resolve any discrepancies with the service provider directly.
4.4.8.5. Contractor shall notify the Department of any instances of suspected fraud and any
supporting documentation at the time of discovery.
4.4.8.6. Contractor shall notify all service providers that all records and supporting documentation
related to services rendered through OBRA-SS are subject to inspection and recovery by
the Department pursuant to 10 C.C.R. 2505-10 Section 8.076 et seq.
4.4.9. Mental Health Services Prohibited
4.4.9.1. Contractor shall not utilize state funds to purchase mental health related services for
individuals with intellectual disabilities who are Medicaid eligible and who also have a
Medicaid covered mental health diagnosis.
4.4.9.2. Contractor shall seek provision of, or payment for, mental health services for those
individuals through the Medicaid funded mental health system or other local sources of
funding.
4.5. Family Support Services Program(FSSP)
4.5.1. Contractor shall administer and provide or purchase Family Support Services pursuant to
§25.5-10-305, C.R.S. and 10 C.C.R. 2505-10 Section 8.7561 et seq.
4.5.2. Eligibility, Needs Assessment, and Prioritization of Families.
4.5.2.1. Contractor shall determine individual eligibility for the FSSP pursuant to 10 C.R.S 2505-
10 Section 8.7561.C.
Exhibit B-6,Statement of Work Page 34 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.5.2.2. Contractor shall provide options counseling for FSSP after it is demonstrated that the
Member has applied for HCBS waiver services and has demonstrated that the waiver
cannot meet the Member's needs.
4.5.2.3. Contractor shall document any FSSP service needs for Member's enrolled in HCBS.
4.5.2.4. After FSSP eligibility has been determined, Contractor shall conduct an FSSP Needs
Assessment prior to authorizing services. Contractor shall develop a Needs Assessment
Tool that is, at a minimum, inclusive of all requirements outlined in 10 C.C.R 2505-10
Section 8.7561.F and have documented scoring criteria for the tool. The tool shall be
included in Contractor's policies and procedures.
4.5.2.4.1. DELIVERABLE: Needs Assessment Tool Template and Scoring Criteria
4.5.2.4.2. DUE: Annually, by August 15th
4.5.2.5. Any revisions to the needs assessment tool template and scoring criteria must be
submitted to the Department within 10 Business Days of the updated tool being
implemented.
4.5.2.6. Contractor shall assess all families, both on the waiting list as "As Soon as Available"
and currently receiving FSSP services, for level of need on an annual basis in accordance
with 10 CCR 2505 Section 8.7561.F et seq.
4.5.2.7. Contractor shall document all completed FSSP Needs Assessments within the CCM
within 10 Business Days of completion of the assessment.
4.5.2.7.1. Contractor shall be reimbursed for most in need assessments based on information
entered into the CCM.
4.5.2.8. Contractor shall maintain all Needs Assessment documentation and make it available to
the Department upon request.
4.5.2.9. The Department will notify Contractor of the target number of individuals that shall be
served through FSSP prior to the start of each State Fiscal Year (SFY). Contractor may
choose to enroll more individuals in FSSP than targeted, ensuring all individuals can be
served within the funding allocated. Target caseload is calculated using the unique
number of Members that receive direct services during the contract period.
4.5.3. Family Support Plans(FSP)
4.5.3.1. Contractor shall ensure that individuals and families enrolled in the FSSP have an
individualized Family Support Plan (FSP) which meets the requirements of an
Individualized Plan, as defined in Section 25.5-10-202 et seq. and 25.5-10-211 C.R.S
prior to receiving services.
4.5.3.2. The FSP shall be developed by, at a minimum, a family representative, and Contractor.
Contractor shall ensure the FSP is signed by all required parties prior to implementation.
4.5.3.3. The FSP shall be effective for no more than one year.
4.5.3.4. If the Member seeks additional supports or alleges a change in need, Contractor shall
review and update the FSP prior to changing the authorized services and supports.
4.5.3.5. Contractor shall upload a copy of the FSP information in the CCM within 10 Business
Days of the FSP effective date.
Exhibit B-6,Statement of Work Page 35 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.5.4. FSSP Ongoing Case Management
4.5.4.1. Pursuant to 10 C.R.S 2505-10 Section 8.7561.G Contractor shall provide case
management for the FSSP, to include coordination of services provided for individuals
with an IDD or Developmental Delay that consists of facilitating enrollment, assessing
needs, locating, coordinating, and monitoring needed FSSP funded services, and
monitoring the effective and efficient provision of services across multiple funding
sources.
4.5.4.2. Contractor shall not charge families to provide direct services and case management for
Family Support Services.
4.5.4.3. Contractor shall provide a list of qualified providers for appropriate services to applicants,
Member(s), and families, during the individualized planning process, and to other
interested parties upon request.
4.5.4.4. Contractor shall utilize appropriated funds to perform case management duties in
accordance with 10 CCR 2505 8.7561.G et seq. to include:
4.5.4.4.1. Development, application assistance, and annual re-evaluation of the Family Support
Plan (FSP) which shall be conducted at least once per year and include making
changes to the FSP as indicated.
4.5.4.4.2. Providing service authorization and support coordination to include but not limited to
assessing the effectiveness of FSSP supports and services.
4.5.4.4.3. Ensuring all services and supports are delivered in accordance with the FSP.
4.5.4.4.4. Coordinating with families to obtain required documentation for services.
4.5.4.4.5. Supporting the individual in assessing eligibility for other community and/or
Medicaid resources.
4.5.4.4.6. Program transition coordination.
4.5.4.4.7. Service records maintenance.
4.5.4.4.8. Case Management, policy, and regulation training.
4.5.4.4.9. Utilization review.
4.5.4.5. Contractor shall document all ongoing case management activities in detail in the CCM
within 10 Business Days of the activity.
4.5.4.5.1. Contractor shall be reimbursed for ongoing case management activities based on
information entered into the CCM.
4.5.4.5.2. The use of mass email communication, robotic and/or automatic voice messages
cannot be used to replace Contractor's required individualized case management
activities.
4.5.5. FSSP Direct Services
4.5.5.1. Contractor shall utilize appropriated FSSP funds to purchase services and/or reimburse
or advance funds to families for expenses that are incurred as a result of supporting the
family and/or individual with an intellectual or developmental disability or delay living
in the family home.
Exhibit B-6,Statement of Work Page 36 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.5.5.2. Contractor shall only authorize and advance or reimburse services that are needed as a
result of the individual's Intellectual and Developmental Disability or Developmental
Delay and shall not be approved if the need is a typical age-related need. The correlation
between need and disability must be documented in the FSP.
4.5.5.3. Contractor shall ensure that all services are provided in the most cost-effective manner,
meaning the least expensive manner to meet the need.
4.5.5.4. Contractor shall ensure that all services are authorized pursuant to the FSP.
4.5.5.5. Contractor shall utilize FSSP funds to provide funding to families for expenses referenced
in §25.5-10-305(a-j), C.R.S and 10 C.R.S. 2505-10 Section 8.7561.D Contractor shall not
authorize or provide any service that is not outlined in these regulations.
4.5.5.6. Contractor shall ensure the authorized services through FSSP are not duplicative of other
resources the family has access to, including HCBS, CFC,third party insurance, etc.
4.5.5.7. Contractor shall prioritize funding for the FSSP pursuant to 10 C.R.S 2505-10 Section
8.7561.F et seq.
4.5.6. Family Support Council
4.5.6.1. Contractor shall establish and maintain a Family Support Council (FSC) pursuant to
§25.5-10-304 et seq., C.R.S. and 10 C.C.R. 2505-10 Section 8.7561.B et seq.
4.5.6.2. Contractor shall ensure that the FSC is comprised primarily of individuals in services,
family members, and guardians of individuals enrolled in FSSP.
4.5.6.3. Contractor shall submit a list of FSC members annually.
4.5.6.3.1. DELIVERABLE: FSC Member List
4.5.6.3.2. DUE: Annually, by August 15th
4.5.6.4. Contractor shall notify the Department in writing of any changes to the FSC within 10
Business Days.
4.5.6.4.1. DELIVERABLE: FSC Member Updates
4.5.6.4.2. DUE: Within 10 Business Days of the date of change to the FSC members
4.5.6.5. Contractor shall provide orientation and training to all FSC members on the duties and
responsibilities of the FSC. The training and orientation shall be documented with a
record of the date of the training, who provided the training,training topic, and names of
attendees. Contractor shall make the training and orientation materials available to the
Department upon request.
4.5.6.6. Contractor shall ensure the FSC fulfills all duties outlined in 10 C.C.R. 2505-10 Section
8.7561.B et seq. Contractor shall document the meeting minutes and submit them to the
Department. Contractor shall maintain all supporting documentation related to an FSC
meeting and make it available to the Department upon request.
4.5.6.6.1. DELIVERABLE: FSC Meeting Minutes
4.5.6.6.2. DUE: Monthly, by the 15th of each month and by June 30th
4.5.7. FSSP Annual Report and Evaluation
Exhibit B-6,Statement of Work Page 37 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
4.5.7.1. In coordination with the FSC, Contractor shall be responsible for evaluating the
effectiveness of the FSSP on an annual basis. Contractor shall ensure the annual program
evaluation addresses all areas required in 10 CCR 2505-10 Section 8.7561.I et seq.
4.5.7.2. Contractor shall create and submit an FSSP Annual Report and Evaluation to the
Department. The FSSP Annual Report and Evaluation shall contain all requirements
outlined in 10 CCR 2505-10 Section 8.7561.K et seq. Council member signatures
approving the report must be submitted as a separate attachment to the deliverable.
4.5.7.3. Contractor must ensure the Annual Report and Evaluation does not contain Member PHI.
4.5.7.4. Contractor shall provide the Annual Report and Evaluation to the Department for review
and post the report on Contractor's website.
4.5.7.4.1. DELIVERABLE: FSSP Annual Report and Evaluation and Council Signature Page
4.5.7.4.2. DUE: Annually, by October 1st
4.5.8. FSSP Records Maintenance
4.5.8.1. Contractor shall maintain supporting documentation capable of substantiating all
expenditures and reimbursements made to providers, Members and/or families.
4.5.8.2. When Contractor purchases services or items directly for Members and/or families,
Contractor shall:
4.5.8.2.1. Maintain receipts or invoices from the service provider and documentation
demonstrating that the provider was paid by Contractor.
4.5.8.2.1.1. Receipts or invoices must contain, at a minimum: Member and/or family name,
provider name, first and/or last date of service, item(s) or service(s) purchased,
item(s) or service(s) cost and amount due or paid.
4.5.8.3. When Contractor reimburses Members and/or families for services or items, Contractor
shall:
4.5.8.3.1. Ensure the Member and/or family provides Contractor with receipts or invoices prior
to reimbursement.
4.5.8.3.2. Maintain receipts or invoices from the Member and/or family, and documentation
demonstrating that the individual and/or family was reimbursed by Contractor.
4.5.8.3.3. Ensure all receipts or invoices provided by the Members and/or family contain, at a
minimum: Member and/or family name, provider name, first and/or last date of
service, item(s) or service(s)purchased, items(s) or service(s) cost, and amount paid.
4.5.8.4. When Contractor provides funding to Members and/or families for the purchase of
services or items in advance, Contractor shall include, but is not limited to:
4.5.8.4.1. Establish policies and procedures outlining Contractor's processes for advancing
funds, ensuring supporting documentation is received by the Member and/or family,
and remedial action steps Contractor will take if supporting documentation is not
received. The policies and procedures shall identify timelines and shall be made
available to the Department upon request.
4.5.8.4.2. Notify the Member and/or family that they are required to submit invoices or receipts
to Contractor of all purchases made prior to the close of the State Fiscal Year.
Exhibit B-6,Statement of Work Page 38 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
4.5.8.4.3. Ensure the Member and/or family provides Contractor with receipts or invoices.
4.5.8.4.4. Maintain receipts or invoices from the Members and/or family, and documentation
demonstrating that the Members and/or family was provided with advanced funds by
Contractor.
4.5.8.4.5. Ensure all receipts or invoices provided by the Members and/or family contain, at a
minimum: Members and/or family name, provider name, first and/or last date of
service, item(s) or service(s)purchased, items(s) or service(s) cost, and amount paid.
4.5.8.4.6. Contractor shall ensure the documentation received by the Member and/or family
indicates that the amount was paid.
4.5.8.4.7. If a Member and/or family does not submit invoices or receipts, Contractor shall
document all attempts to obtain receipts or paid invoices and any remedial action
taken. Contractor shall make all supporting documentation available to the
Department upon request.
4.5.8.4.8. If Contractor cannot provide supporting documentation as described in this section,
the Department may recover any unsubstantiated expenditure from Contractor.
4.5.8.5. Contractor shall ensure supporting documentation is recorded for all FSSP dollars for
multiple family services to include a detailed description of the service provided and the
date(s) of service.
4.5.8.5.1. Contractor shall ensure all program expenses related to multiple family expenses can
be substantiated through time tracking, wage costs, benefit costs, or any other
supporting documentation to verify expenses related to proving the services.
5. DATA ENTRY,DATA MONITORING,AND OVERSIGHT
5.1. Individual/Member Records
5.1.1. Contractor shall:
5.1.1.1. Comply with all reporting and billing policies and procedures established by the
Department,document individual and Member records within the CCM and adhere to the
system requirements provided by the Department for these systems. Systems include,but
are not limited to, the Colorado interChange Medicaid Management Information System
(MMIS) and its subsystems: Bridge HCBS PAR subsystem and the Care and Case
Management (CCM) System. Contractor shall have access to Member eligibility, PAR,
and claims data through reporting provided through a COGNOS data query application.
5.1.1.2. Comply with all data entry guidelines for report-based Contract payments posted by the
Department.
5.1.1.3. Maintain individual and Member records within the CCM for the purposes of individual
and Member information management.
5.1.1.4. Maintain accurate and detailed documentation of all case management and State General
Fund Program activities required through the Contract.
5.1.1.5. Maintain accurate and detailed supporting documentation of all activities required
through this Contract to substantiate reimbursement and make all documentation
available to the Department upon request if not documented within the CCM.
Exhibit B-6,Statement of Work Page 39 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
5.1.1.6. Correct 100% of data errors discovered by the Department and confirm the accuracy of
the data entered into the CCM within 10 Business Days of notification from the
Department of an error.
5.1.1.6.1. PERFORMANCE STANDARD: 100% of data errors corrected within 10 Business
Days of notification.
5.1.1.7. Develop and implement a plan to conduct, at minimum, an annual data integrity review.
That includes, but is not limited to, the following:
5.1.1.7.1. Member program records completeness and accuracy as directed by the Department.
5.1.1.7.2. Member demographic information completeness and accuracy.
5.1.1.7.3. Member care team provider and team staff accuracy and completeness, as directed by
the Department.
5.1.1.7.3.1. DELIVERABLE: Data Integrity and Data Quality Policies and Procedures
5.1.1.7.3.2. DUE: Annually, October 1st after the Contract Start Date or within 10 Business
Days as revisions are made.
5.2. Systems Access and Training
5.2.1. Contractor shall develop and implement policies and procedures to internally oversee data
integrity and data quality to include but not limited to how Contractor will:
5.2.1.1. Ensure all staff receive the required systems training as specified in this Contract.
5.2.1.2. Be responsible for management of user access and timely revocation for required systems
to include the CCM, MMIS, Bridge,COGNOS, and PeakPro.
5.2.1.3. Ensure all provision forms are reviewed and submitted accurately and completely within
at least 14 Calendar Days prior to needing access. Any forms submitted without all
necessary information are subject to resubmission and delay.
5.2.1.4. Ensure all revocation forms are submitted immediately upon knowledge of license user's
separation of employment.
5.2.1.5. Conduct an internal audit of all provisioned user licenses monthly or quarterly to ensure
that the list of users is up to date, permissions are accurate, and revocation forms are
submitted in a timely manner.
6. ACCOUNTING
6.1. Contractor's accounting methods shall conform to the standards of Generally Accepted
Accounting Principles (GAAP), and any updates thereto, throughout the Term of the Contract.
6.2. Contractor shall establish and maintain internal control systems and standards that apply to the
operation of the organization.
6.3. Contractor shall assure, all financial documents are filed in a systematic manner to facilitate
audits, all prior years' expenditure documents are maintained for use in the budgeting process
and for audits, and records and source documents are made available to the Department, its
contracted representative, or an independent auditor for inspection, audit, or reproduction.
6.4. Contractor shall establish any necessary cost accounting systems to identify the application of
funds and record the amounts spent.
Exhibit B-6,Statement of Work Page 40 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
6.5. Contractor shall document all transactions and funding sources, and this documentation shall be
available for examination by the Department within 10 Business Days of the Department's
request.
6.5.1. DELIVERABLE: Transaction and Funds Documentation
6.5.2. DUE: Within 10 Business Days of the Department's Request
7. SUBRECIPIENT STATUS AND REQUIREMENTS
7.1. Contractor has been determined to be a Subrecipient under 2 CFR Chapter I, Chapter II,Part 200
et al. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards(Uniform Guidance);Final Rule(the"Final Rule"),released December 26,2013,
and subsequently updated, and thus shall be required to follow all requirements and guidance
contained in the Final Rule.
7.2. Single Audits
7.2.1. Under the Final Rule, all Non-Federal Entities, as defined in the Final Rule, expending
$1,000,000.00 or more from all federal sources (direct or from pass-through entities) must
have a single or program-specific audit conducted for that year in accordance with Subpart F
of the Final Rule.
7.2.2. Contractor shall notify the State when expected or actual expenditures of federal assistance
from all sources equal or exceed$1,000,000.00.
7.2.3. If the expected or actual expenditures of federal assistance from all sources do not equal or
exceed $1,00,000.00 Contractor shall provide an attestation to the State that they do not
qualify for a Single Audit.
7.2.4. Pursuant to the Final Rule§200.512(a)(1)the Single Audit must be completed and submitted
to the Department within the earlier of 30 Calendar Days after receipt of the auditor's
report(s),or nine months after the end of the audit period. If the due date falls on a Saturday,
Sunday, or federal holiday,the reporting package is due the next Business Day.
7.2.4.1. DELIVERABLE: Single Audit
7.2.4.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or
nine months after the end of the audit period
7.2.5. If Contractor did not receive enough federal funds to require a Single Audit,Contractor shall
submit an attestation form stating a Single Audit was not required utilizing the Department's
template.
7.2.5.1. DELIVERABLE: Attestation Form
7.2.5.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or
nine months after the end of the audit period
7.2.6. The audit period shall be Contractor's fiscal year.
7.3. Treatment of Funds
7.3.1. All funding identified as a subaward with matching federal dollars received through this
Contract is subject to the requirements within Uniform Guidance.
7.3.1.1. All subawards must be used on allowable expenses associated with performing the
activities outlined in this Contract and on allowable expenses per Uniform Guidance.
Exhibit B-6,Statement of Work Page 41 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
7.3.1.2. Any subawards not used on the activities outlined in this Contract is subject to recovery
at the end of the Period of Performance as identified by the Department.
7.4. Subcontracting Subawards
7.4.1. Contractor shall ensure any Subcontractors performing activities outlined in this Contract on
behalf of Contractor fulfill all obligations outlined within this Contract and all obligations of
a subrecipient.
8. FINANCIAL TRANSPARENCY
8.1. Contractor shall comply with all transparency requirements pursuant to C.R.S.Title 25.5-6-1708.
8.2. Contractor shall ensure all documents are available on Contractor's website in an easily accessible
location and format. Board of Director or Governing Body Changes
8.2.1. Contractor shall notify the Department in writing of any changes to the Board of Directors or
Governing Body within 10 Business Days.
8.2.1.1. DELIVERABLE: Written notification of changes to Board of Director or Governing
Body membership
8.2.1.2. DUE: Within 10 Business Days of the effective date
9. COMPENSATION AND INVOICING
9.1. State General Fund Program Allocations
9.1.1. The Department will notify Contractor in writing of Contractor's individual allocation for
State SLS, OBRA-SS, and FSSP for each State Fiscal Year.
9.1.2. Reimbursement for activities and services performed by Contractor shall not exceed the
maximum amount identified in Contractor's individual allocation. Activities and services
must be rendered during the State Fiscal Year.
9.1.3. The Department, in its sole discretion, may increase or decrease Contractor's individual
allocations under this Contract by notifying Contractor's Representative. Increases or
decreases in the amount of State funding during the term of this Contract may be made by
written notice by the Department to Contractor or by amendment of the Contract. The
circumstances may include but shall not be limited to:
9.1.3.1. If necessary to fully utilize program appropriations.
9.1.3.2. Adjustments to reflect prior year final contract utilization and current year expenditures.
9.1.3.3. Supplemental appropriation changes resulting in an increase or decrease in the amounts
originally appropriated and available for the purposes of this program.
9.1.3.4. Closure of programs and/or termination of related contracts.
9.1.3.5. Delay or difficulty in implementing new programs or services.
9.1.3.6. Other special circumstances as deemed necessary by the Department.
9.1.3.7. Changes in Member utilization due to changing needs, new enrollments, terminations,
and/or delays in services.
9.1.3.8. Target caseloads not being met.
9.2. State General Fund Program Target Caseloads
Exhibit B-6,Statement of Work Page 42 of 50
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
9.2.I. The Department will notify Contractor in writing of the target number of individuals that
shall be served in State SLS,OBRA-SS,and FSSP prior to the start of each State Fiscal Year.
9.2.2. Contractor may choose to enroll more individuals in State SLS, OBRA-SS, and FSSP than
authorized, ensuring all individuals can be served within the funding allocated.
9.2.3. Target caseload is calculated by the Department using the unique number of Members that
receive direct services during the contract period.
9.2.4. Contractor shall enroll Members into OBRA-SS if the need for services is identified through
the PASRR Level II and shall notify the Department if sufficient funding is not available in
Contractor's individual allocation to support the individual's needs or to enroll a Member
into the program.
9.2.5. Contractor shall redirect unallocated funding from one State General Fund program to
another to fully utilize funding allocated and best serve Member needs within the Defined
Service Area. Contractor shall notify the Department if Contractor cannot use all of the
funding allocated for State General Fund programs or if Contractor has additional funding
needs that could support Members with unmet needs during the Fiscal Year.
9.3. State General Fund Program Compensation
9.3.1. The compensation under this Contract shall consist of rates-based reimbursement intended to
cover the costs of all State General Fund activities provided through this Contract. The
Department shall pay Contractor for the State SLS and OBRA-SS activities at the rates
specified in Exhibit C, Rates. Direct services for State SLS and OBRA-SS shall be
reimbursed at the corresponding HCBS-SLS rates posted and distributed on the Department's
website on the Provider Rates and Fee Schedule. Contractor shall be reimbursed for services
that have individual support level rates at the level 4 rate for State SLS and at the level 6 rate
for OBRA-SS.The Department shall pay Contractor for FSSP activities at the rates specified
in Exhibit C,Rates. Direct services for FSSP shall be reimbursed at one dollar per unit.
9.3.2. The liability of the State, at any time, for such payment shall be limited to the unexpended
amount remaining of such funds available to the Department.
9.3.3. Payments shall be made in accordance with rates as specified in Exhibit C, Rates of this
Contract as determined by the Department and may be amended during the term of the
contract using an Option Letter. When Contractor's maximum allocation of State funding has
been paid to Contractor, no additional funds shall be provided under this Contract.
9.3.4. Payment pursuant to this Contract is contingent upon Contractor, or subcontractor(s),
securing and properly maintaining all necessary licenses, certifications, approvals, etc.,
required to properly provide the services or goods covered by the contract.
9.3.5. The rates specified in Exhibit C; Rates are determined by the approved appropriation from
the Colorado General Assembly. The Department, at its discretion, shall have the option to
increase or decrease these rates as the Department determines is necessary based on its
approved appropriation or to correct an administrative error in rate calculations. To exercise
this option,the Department shall provide written notice to Contractor in a form substantially
• similar to the Sample Option Letter in the original Contract,and any new rates table or exhibit
shall be effective as of the effective date of that notice unless the notice provides for a
different date. The Department may modify the rates shown in this section based on the
Medicaid Provider rate increases or decreases authorized by the Colorado legislature or due
Exhibit B-6,Statement of Work Page 43 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
to an administrative error. If the Department does modify these rates, the Department may
modify them using an Option Letter.
9.3.6. The rates for State SLS and OBRA-SS direct services will be posted on the Department's
website on the HCBS-SLS Provider Rates and Fee Schedule. Contractor shall bill all FSSP
direct services at one dollar per unit.
9.4. Adjustments to Fund Disbursement Amounts
9.4.1. The Department reserves the right to adjust during the Contract period and post-period
adjustment to disbursements following the end of the Contract period, or an adjustment to the
Fiscal Year contract if:
9.4.2. Contractor does not achieve the Performance Standards identified for each program.
9.5. Case Management Agency Compensation
9.5.1. The compensation under this Contract shall consist of rates-based reimbursement intended to
cover the costs of all activities provided through this Contract.
9.5.2. Contractor will receive payment as specified in Exhibit C, Rates.
9.5.2.1. The rates specified in Exhibit C are determined by the approved appropriation from the
Colorado General Assembly. The Department, at its discretion, shall have the option to
increase or decrease these rates as the Department determines necessary based on its
approved appropriation or to correct an administrative error in rate calculations. To
exercise this option, the Department shall provide written notice to Contractor in a form
substantially similar to the Sample Option Letter in the original Contract, and any new
rates table or exhibit shall be effective as of the effective date of that notice unless the
notice provides for a different date. The Department may modify the rates shown in this
section based on the Medicaid Provider rate increases or decreases authorized by the
Colorado legislature or due to an administrative error. If the Department does modify
these rates, the Department may modify them through the use of an Option Letter.
9.6. Rural or Urban Designation
9.6.1. The Department shall determine whether Contractor is a Rural and Frontier or an Urban
agency.
9.7. Detailed Invoicing and Payment Procedures
9.7.1. Contractor shall meet all data entry requirements published by the Department for Contract
payments based on data entered into the CCM, invoices submitted, and deliverables
submitted in order to be reimbursed for the activities described below.
9.7.2. Applications—HCBS-CES
9.7.2.1. Contractor shall submit all HCBS-CES applications to the Department's vendor for
review and approval, as directed by the Department. The Department will pay for initial
application per person applying for HCBS-CES per year, as well as CSR HCBS-CES
application each year thereafter. The Department will not pay for initial or CSR
applications that were denied due to being incomplete. Incomplete applications include
any application that did not contain: a signature page, a completed Level of Care, DD or
Delay Determination date, dates of service, or partial application (missing pages) which
are required from Contractor necessary to process the application. An incomplete
application denial is different than a denial for the individual not meeting nighttime and/or
Exhibit B-6,Statement of Work Page 44 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
daytime criteria. The Department will pay for HCBS-CES applications from reports
received by the Department's vendor on the 11th of the month for assessments from the
previous month.
9.7.3. Appeal Packets and Hearing Attendance
9.7.3.1. Contractor shall ensure that all Appeal Packets and Hearing Attendance information is
entered into the CCM within the required timeframe. The Department will pay for all
Appeal Packets and Hearing Attendances from data pulled from the CCM on the 15th day
of the month for Appeal Packets and Hearing Attendance from the previous month.
Contractor shall maintain all supporting documentation and packets related to all
Appeals.
9.7.4. At-Risk Diversion
9.7.4.1. Contractor shall complete all At-Risk Diversion activities as required by the Department
and shall invoice the Department for all completed contacts by the 15th day of the month
for all contacts completed in the previous month. The Department will pay for contacts
once the invoice and supporting documentation are reviewed and accepted.
9.7.5. Case Management Training
9.7.5.1. Contractor shall submit the Case Management Training deliverable. Contractor will
receive payment once the Department has reviewed and accepted the Deliverable. If the
original submission is rejected by the Department, Contractor shall not receive payment
until a revised deliverable has been received and accepted by the Department. If a case
manager did not receive one or more of the required trainings prior to being assigned
independent duties, Contractor shall not receive payment for the Deliverable until all
trainings have been provided. Contractor shall have 30 Calendar Days to provide any
outstanding trainings and resubmit the Deliverable.
9.7.6. Community Advisory Committee Updates
9.7.6.1. Contractor shall submit the Committee Updates Deliverable. Contractor shall receive
payment once the Department has reviewed and accepted the Deliverable. If the
Deliverable shows that no committee meeting updates have been included, Contractor
shall not receive payment for the Deliverable.
9.7.7. Complaint Log and Trend Analysis
9.7.7.1. Contractor shall submit a quarterly Complaint Log and Trend Analysis deliverable.
Contractor will receive payment once the Department has reviewed and accepted the
Deliverable.If the original submission is rejected by the Department,Contractor shall not
receive payment until a revised deliverable has been received and accepted by the
Department.
9.7.8. Continuous Quality Improvement Plan
9.7.8.1. Contractor shall submit the Continuous Quality Improvement Plan deliverable and
updates. Contractor shall receive payment once the Departthent has reviewed and
accepted the Deliverable. If the original submission is rejected by the Department,
Contractor shall not receive payment until a revised deliverable has been received and
accepted by the Department.
9.7.9. Critical Incident Quarterly Follow-Up Completion and Entry Performance Standard
Exhibit B-6,Statement of Work Page 45 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
9.7.9.1. Contractor is eligible to receive a quarterly performance-based payment for timely
completion of the requested HCBS and CFC CIR follow-up action. To receive this
quarterly performance-based payment, Contractor must have 90% of all CIRs assigned
follow-up completed and entered into the CCM within the timelines assigned by the
Department and/or Department Quality Improvement Organization.The Department will
calculate Contractor's performance at the close of each quarter to determine if Contractor
will be awarded the performance-based payment. HCBS and SGF CIRs will be calculated
and paid separately.
9.7.10. Critical Incident Reports and Critical Incident Report Administrative Review: HCBS IDD
waivers
9.7.10.1. Contractor shall ensure all CIRs have been entered in the CCM within the required
timeframe. The Department will pay per Member enrolled each month based on actively
enrolled Members pulled from the CCM on the 15th day of the month for HCBS-CES,
HCBS-CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous month.
9.7.11. Critical Incident Reports: HCBS LTSS Waivers and CFC
9.7.11.1. Contractor shall ensure all CIRs have been entered in the CCM within the required
timeframe. The Department will pay per Member enrolled each month based on actively
enrolled Members pulled from the CCM on the 15th day of the month for CHCBS,
HCBS-BI, HCBS-CIH, HCBS- CwCHN, HCBS-CMHS, HCBS-EBD, and CFC.
9.7.12. Critical Incident Reporting and Critical Incident Report Administrative Review State SLS,
OBRA-SS, FSSP
9.7.12.1. Contractor shall ensure all CIRs have been entered in the CCM within the required
timeframe.The Department will pay for all State SLS,OBRA-SS,and FSSP CIRs MANE
and CIRs non-MANE based on data pulled from the CCM on the 15th day of the month
for CIRS from the previous month.
9.7.13. Developmental Disability and Delay Determinations
9.7.13.1. Contractor shall input all disability determinations into the CCM within the required
timeframes.The Department will pay disability determinations,based on data pulled from
the CCM on the 15th day of the month for determinations from the previous month.
9.7.14. Direct Services: State SLS, OBRA-SS, FSSP
9.7.14.1. Contractor shall submit the State General Fund program direct service expenditure report
invoice for all direct service expenditures for State SLS, OBRA-SS,and FSSP by the 15th
of each month. The Contract shall receive reimbursement for allowable direct services
not to exceed maximum for State General Fund programs for all reimbursable activities
for the fiscal year.
9.7.15. Testing for IDD Determinations
9.7.15.1. Contractor shall obtain prior approval from the Department for IDD Determination
Testing funding by invoicing the Department each month for the costs of IDD
Determination testing by the 15th day of the month. If approved,the Department will pay
for the actual cost of testing once the request has been approved and the invoice has been
reviewed and accepted. All invoices shall be submitted in the format prescribed by the
Department.
Exhibit B-6,Statement of Work Page 46 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
9.7.16. Family Support Council Meetings
9.7.16.1. Contractor shall submit meeting minutes to the Department for FSC meetings attended
by the 15th day of the month for meetings attended in the previous month, and by June
30th or the Fiscal Year end close date determined by the Department for all meetings
attended in June. The Department will pay for up to six FSC meetings for the Designated
Service Areas attended within the Fiscal Year once the invoice has been reviewed and
accepted. Contractor shall maintain all supporting documentation related to an FSC
meeting and make it available to the Department upon request.
9.7.17. FSSP Annual Report and Evaluation
9.7.17.1. Contractor shall submit an FSSP Annual Report and Evaluation on an annual basis to the
Department. Contractor shall receive payment for the Deliverable after it has been
reviewed and accepted by the Department.
9.7.18. HCBS-DD Waiting List Enrollment Capacity Building
9.7.18.1. The Department will pay Contractor for each new Member enrolled into the HCBS-DD
waiver from the waiting list as authorized by the Department and as funding is
appropriated and earmarked by the General Assembly. The Department will determine
which HCBS-DD enrollments from the waiting list qualify for capacity building funding
as defined in this Contract.
9.7.19. Human Rights Committee: HCBS IDD Waivers
9.7.19.1. Contractor shall create all HRC packets in accordance with Department requirements and
timeframes. Contractor shall maintain all supporting documentation related to a Human
Rights Committee meeting and make it available to the Department upon request. The
Department will pay per Member enrolled each month based on actively enrolled
Members pulled from the CCM on the 15th day of the month for HCBS-CES, HCBS-
CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous month.
9.7.20. Human Rights Committee Packet Creation: State SLS, OBRA-SS, FSSP
9.7.20.1. Contractor shall invoice the Department for all State SLS,OBRA-SS, and FSSP Member
packets created during a Human Rights Committee meeting by the 15th day of the month
for all meetings held in the previous month. The Department will pay for each packet
created once the invoice has been reviewed and accepted. All invoices shall be submitted
in the format prescribed by the Department.
9.7.21. Interim Support Level Assessments
9.7.21.1. Contractor shall submit all completed assessments in the timeline and manor specified by
the Department. The Department will pay for all completed assessments based on data
submitted by Contractor on the 15th of each month.
9.7.22. Level of Care Screen: Initial and Reassessments
9.7.22.1. Contractor shall conduct and enter all initial and reassessment Level of Care Screens into
the CCM within the required timeframes. The Department will pay for initial and
reassessment Level of Care Screens based on data pulled from the CCM on the 15th day
of the month for Screens conducted in the previous month.
9.7.23. Long-Range Plan
Exhibit B-6,Statement of Work Page 47 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
9.7.23.1. Contractor shall submit a Long-Range Plan on an annual basis and present it to the
Department. Contractor shall receive payment for the Long-Range Plan after it has been
reviewed and accepted by the Department.
9.7.24. Monitoring Contacts: State SLS and OBRA-SS
9.7.24.1. Contractor shall conduct and enter all monitoring contacts for State SLS and OBRA-SS
into the CCM within the required timeframe. Contractor shall receive payment for the
four required monitoring contacts per support plan year. The Department will pay for
monitoring contacts based on data pulled from the CCM on the 15th day of the month for
contacts conducted in the previous month.
9.7.25. Most in Need Assessment: FSSP
9.7.25.1. Contractor shall conduct and enter all completed Needs Assessments into the CCM within
the required timeframe. Contractor shall receive payment for one Needs Assessment for
Members enrolled or on the FSSP ASAA waiting list per fiscal year.The Department will
pay for Needs Assessments each month based on data pulled from the CCM on the 15th
day of the month for assessments conducted in the previous month.
9.7.26. Needs Assessment: Initial and Reassessment
9.7.26.1. Contractor shall conduct and enter all initial and reassessment Needs Assessments into
the CCM within the required timeframes. The Department will pay for initial and
reassessment Needs Assessments based on data pulled from the CCM on the 15th day of
the month for assessments conducted in the previous month.
9.7.27. Ongoing Case Management: State SLS, OBRA-SS, FSSP
9.7.27.1. Contractor shall conduct and enter all ongoing case management activities for State SLS,
OBRA-SS, and FSSP into the CCM within the required timeframe. Contractor shall
receive one ongoing case management payment each month per Member for allowable
activities completed. The Department will pay for ongoing case management activities
based on data pulled from the CCM on the 15th day of the month for activities conducted
in the previous month.
9.7.28. Operations Guide
9.7.28.1. Contractor shall develop an Operations Guide that meets all requirements outlined in this
Contract for year one. Contractor shall receive payment for the Operations Guide once
the deliverable has been reviewed and accepted by the Department.
9.7.29. Operations Guide Updates
9.7.29.1. Contractor shall review the Operations Guide for years two, three, four, and five of this
Contract, and determine if any modifications are required. Updates shall include but not
be limited to any changes in the Work, in the Department's processes and procedures, or
in Contractor's processes and procedures. Contractor shall submit the Annual Operations
Guide Update as well as a summary of all changes to the Department or an explanation
demonstrating that the Operations Guide was reviewed, and Contractor determined that
no edits were necessary. The Department shall review the Operations Guide Update and
the summary to determine whether significant modifications were completed. Contractor
shall receive payment for the updated Operations Guide only after the Department has
determined that significant changes were made, and the Department has accepted the
Deliverable. If minor changes or no changes were completed Contractor shall not receive
Exhibit B-6,Statement of Work Page 48 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
payment for this deliverable.The Department does not consider changes such as updating
dates, contact information or locations to be significant changes.
9.7.30. Rapid Reintegration
9.7.30.1. Contractor shall conduct and enter all Rapid Reintegration activities at the Level of Care
Assessment into the CCM within the required timeframes. The Department will pay for
Rapid Reintegration based on an invoice template provided by the Department or data
pulled from the CCM on the 15th day of the month for Rapid Reintegration completed in
the previous month. Rapid Reintegration shall include reimbursement for completing
Rapid Reintegration barrier questions,assessment and support,and post survey questions.
9.7.31. Rural Travel Add-On for Rural and Frontier Counties
9.7.31.1. Contractor shall receive an additional payment for Rural Travel Add-On for Rural and
Frontier Counties for the following activities only:initial and Reassessment Level of Care
Screen, initial and Reassessment Needs Assessment, In-person initial At-Risk Diversion
outreach, State SLS and OBRA-SS In-Person Monitoring, and State SLS and OBRA-SS
In-Person Individualized Support Plans. Payment shall be based on approved invoices or
data pulled from the CCM on the 15th day of the month for activities from the previous
month.
9.7.32. Support Need Level Assessment-HCBS-CHRP
9.7.32.1. Contractor shall maintain all supporting documentation related to the Support Need Level
Assessment and make it available to the Department upon request. Contractor shall
invoice the Department for all completed assessments by the 15th day of the month for
all assessments completed in the previous month. The Department will pay for
assessments once the invoice and supporting documentation are reviewed and accepted.
9.7.33. Waiting List Management
9.7.33.1. Contractor shall enter all waiting list management contacts with individuals and families
into the CCM within the required timeframe. The Department will pay for required
waiting list contacts from data pulled from the CCM on the 15th of the month for contacts
from the previous month. The Department shall not pay for more than one contact per
individual (18 and older) on the HCBS-DD ASAA, See Date and Safety Net waiting list
and State SLS,OBRA-SS, or FSSP ASAA waiting list per year. Contractor shall only be
reimbursed for one waiting list contact for the HCBS-DD, State SLS or FSSP waiting list
when the event occurs during the same contact.
9.7.34. Year End Close Deadlines
9.7.34.1. The due dates identified in this section shall be adhered to, and information entered into
the CCM and/or submitted to the Department by a date identified in this Contract. For the
month of June,the Department will notify Contractor of the modified due date to account
for year-end closing. Any submission past the assigned year end close date will not be
reimbursed.
9.8. Payment and Billing Errors
9.8.1. Contractor shall review all payments made by the Department to ensure all activities are
appropriately reimbursed.
Exhibit B-6,Statement of Work Page 49 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
9.8.2. Contractor shall notify the Department of any errors in billing or payment by the 15th of the
month for the prior month's payment on the Department's prescribed template to ensure over
and under payments are adjusted.
9.8.2.1. DELIVERABLE: Payment Correction Form
9.8.2.2. DUE: On the 15th of each month for corrections on the prior month's payment, with
exception of June payments which must meet year-end close deadlines established by the
Department. Contractor shall specify on the form if corrections have not been identified
for the prior month's payment.
9.9. Unexpended Funds
9.9.1. Contractor shall remit any Subawards disbursed under this Contract that are not expended by
the close of the Period of Performance.
9.10. Closeout Payments
9.10.1. Notwithstanding anything to the contrary in this Contract, all payments for the final month
of this Contract shall be paid to Contractor no sooner than 10 Business Days after the
Department has determined that Contractor has completed all the requirements of the
Closeout Period.
Exhibit B-6,Statement of Work Page 50 of 50
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
EXHIBIT C-6, RATES
Case Management Agency (CMA) Subaward Rates Table
Description Rate Frequency Payment Funding Source
Type
Operations Guide $7,905.56 Annually—Year Deliverable Federal/State Funded
1 of the Contract
Operations Guide Update $1,424.14 Annually— Deliverable Federal/State Funded
Years 2+of the
Contract
Long-Range Plan $3,543.31 Annually Deliverable Federal/State Funded
Committee Updates $1,071.73 Semi-Annually Deliverable Federal/State Funded
Continuous Quality $506.72 Annually Deliverable Federal/State Funded
Improvement Plan
Complaint Trend Analysis $3,857.04 Quarterly Deliverable Federal/State Funded
Case Management Training $648.75 Semi-Annually Deliverable Federal/State Funded
Creation of Packet - Appeals $531.60 Per Packet Report Federal/State Funded
Attendance at Hearing - $490.97 Per Hearing Report Federal/State Funded
Appeals
IDD Critical Incident $6.30 Monthly, Per Report Federal/State Funded
Reporting (HCBS —CES, Member
HCBS—CHRP, HCBS—DD, Enrolled
HCBS — SLS)
LTSS Critical Incident $1.61 Monthly, Per Report Federal/State Funded
Reporting (HCBS—BI, Member
HCBS—CHCBS, CMHS, Enrolled
HCBS—EBD, HCBS—SCI,
HCBS - CLLI)
HCBS Critical Incident $3,457.07 Quarterly Deliverable Federal/State Funded
Follow-Up Performance
Standard
Human Rights Committee $5.95 Monthly, Per Report Federal/State Funded
(HCBS—CES, HCBS— Member
CHRP, HCBS—DD, HCBS— Enrolled
SLS)
Initial Level of Care $283.62 Per Assessment Report Federal/State Funded
Assessment(100.2)
CSR Level of Care $214.03 Per Assessment Report Federal/State Funded
Assessment (100.2)
Rapid Reintegration Barrier $48.54 Per Assessment Invoice or Federal/State Funded
Questions Report
Rapid Reintegration $107.73 Per Assessment Invoice or Federal/State Funded
Assessment and Support Report
Post Rapid Reintegration $22.84 Per Survey Invoice or Federal/State Funded
Survey Questions Report
Exhibit C-6,Rates Page 1 of 3
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
Interim Support Level $294.17 Per Assessment Report Federal/State Funded
Assessment
Initial At-Risk Diversion—In $104.70 Monthly Invoice or Federal/State Funded
Person Report
Initial At-Risk Diversion - $87.45 Monthly Invoice or Federal/State Funded
Virtual Report
HCBS-CHRP Support Level $165.26 Per Assessment Invoice Federal/State Funded
Needs Assessment
Initial HCBS-CES $189.21 Per Application Report Federal/State Funded
Application
CSR HCBS-CES Application $142.76 Per Application Report Federal/State Funded
Medicaid Eligible IDD $458.81 Per Report Federal/State Funded
Determination Determination
Medicaid Eligible Delay $272.96 Per Report Federal/State Funded
Determination Determination
IDD Determination Testing $481.10 Actual Costs up Invoice Federal/State Funded
to Rate for
Testing
Rural Travel Add-On $37.46 Per Required in Report Federal/State Funded
Person Contact
for Rural and
Frontier
Agencies
Case Management Agency (CMA) State Only Rates Table
Waiting List Management $95.42 Per Contact Report State Funded
Non-Medicaid Eligible IDD $458.81 Per Report State Funded
Determination Determination
Non-Medicaid Eligible Delay $272.96 Per Report State Funded
Determination Determination
Non-Medicaid Eligible IDD $481.10 Actual Costs up Invoice State Funded
Determination Testing to Rate for
Testing
State SLS, OBRA-SS, and $349.18 Per Incident Report State Funded
FSSP Critical Incident
Reporting& Investigation:
MANE
State SLS, OBRA-SS, and $46.71 Per Incident Report State Funded
FSSP Critical Incident
Reporting &Investigation:
Non-MANE
State SLS, OBRA-SS, and $125.73 Per Member Invoice State Funded
FSSP Human Rights Reviewed
Committee
Exhibit C-6,Rates Page 2 of 3
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
State SLS and OBRA-SS $220.69 Quarterly Deliverable State Funded
Complaints Trend Analysis
State SLS, OBRA-SS, and $51.81 Quarterly Deliverable State Funded
FSSP CIR Follow-Up
Performance Standard
State SLS, OBRA-SS, and $91.67 Monthly, Per Report State Funded
FSSP Ongoing Case Activity
Management
State SLS and OBRA-SS $104.70 Per Contact Report State Funded
Monitoring—In Person
Rural Travel Add-On $38.06 Per Required in Report State Funded
(OBRA-SS and State SLS) Person Contact
for Rural and
Frontier
Agencies
State SLS and OBRA-SS $87.45 Per Contact Report State Funded
Monitoring -Virtual
State SLS Expenditure Report $625.76 Monthly Invoice State Funded
OBRA-SS Expenditure $369.56 Monthly Invoice State Funded
Report
FSSP Needs Assessment $33.25 Per Assessment Report State Funded
FSSP Expenditure Report $556.57 Monthly Invoice State Funded
Family Support Council $418.29 Per Meeting Invoice State Funded
Meetings
FSSP Annual Report & $1,150.98 Annually Deliverable State Funded
Evaluation
Exhibit C-6,Rates Page 3 of 3
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
EXHIBIT D-5, TERMINOLOGY
1. TERMINOLOGY
1.1. In addition to the terms defined in Section 3 of this Contract, the following list of terms shall be
construed and interpreted as follows:
1.1.1. Adverse Action —A denial, reduction, termination, or suspension from a long-term service
and support program or service.
1.1.2. Affiliated Entity — An organization that directly or indirectly controls another entity, has
substantially similar ownership of another entity, and/or owns a substantial share of another
entity.
1.1.3. Appeal—The process a case manager participates in when an individual or Member appeals
an adverse action made by the case manager.
1.1.4. At Risk Diversion — is a Person-Centered process through which services are arranged or
provided to enable a Member of an At-Risk Population to avoid admission to a nursing
facility and live, instead, in a setting of their choice.
1.1.5. Behavioral Health Authorities (BHA) —The behavioral health administration established in
Part 200 of Article 50 of Title 27, C.R.S.
1.1.6. Business Day — Any day in which the State is open and conducting business, but shall not
include Saturday, Sunday, or any day which the State observes one of the holidays listed in
C.R.S. §24-11-101(1).
1.1.7. Business Interruption—Any event that disrupts Contractor's ability to complete the Work for
a period of time, and may include, but is not limited to a Disaster, power outage, strike, loss
of necessary personnel or computer virus.
1.1.8. Care and Case Management System (CCM) — The Department's case management
Information Technology(IT) platform.
1.1.9. Case Management—The assessment of a Member eligible to receive or receiving long-term
services and supports, the development and implementation of a Support Plan for such
Member,referral and related activities,the coordination and monitoring of long-term service
and supports delivery, the evaluation of service effectiveness, and the periodic reassessment
of such Member's needs.
1.1.10. Case Management Agency (CMA) — A public or private not-for-profit or for-profit
organization contracted with the state of Colorado to provide case management services and
activities pursuant to C.R.S. 25.5-6-1702.
1.1.11. Case Manager—A person who provides case management services and activities pursuant to
Article 6 and Article 10 of C.R.S. Title 25.5 for Members receiving long-term services and
supports.
1.1.12. Child Health Plan Plus — Colorado's public low—cost health insurance for certain children
and pregnant women. It is for people who earn too much to qualify for Health First Colorado,
but not enough to pay for private health insurance.
1.1.13. Closeout Period—The period beginning on the earlier of 90 Calendar Days prior to the end
of the last Extension Term or notice by the Department of its decision to not exercise its
option for an Extension Term, and ending on the day that the Department has accepted the
Exhibit D-5,Terminology Page 1 of 10
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
final deliverable for the Closeout Period, as determined in the Department—approved and
updated Closeout Plan, and has determined that the closeout is complete.
1.1.14. Coaching-"Coaching"means any conduct by a Provider Agency,its employees,or affiliates
that attempts to guide,script,or otherwise influence an applicant,Member,guardian,or CMA
staff in responding to eligibility assessments, Level of Care Screens, Support Level
Assessments, or Person-Centered Planning discussions for the purpose of securing a
particular eligibility outcome, rate, or service authorization. Coaching may include the
creation of prepared statements or scripts, instructing Members or staff on how to answer
assessment questions, or encouraging specific responses intended to impact eligibility or rate
determinations. Authority: 10 CCR 2505-10 §§ 8.7202.B, 8.7202.M, 8.7101.J; 42 C.F.R. §
441.301(c)(1)(vi).
1.1.15. Coercion- "Coercion" means any act or communication that compels, intimidates, or
pressures a Member, guardian, or CMA staff member to act contrary to their independent
judgment or the Member's best interest in order to influence an eligibility determination,
service authorization, or provider selection. This includes threats of service disruption,
withdrawal of care, retaliation, or emotional manipulation to obtain a specific outcome.
Authority: 10 CCR 2505-10 § 8.7202.M; 10 CCR 2505-10 § 8.7202.Q (Human Rights
Committee safeguards); 42 C.F.R. § 441.301(c)(1)(vi)(B); 45 C.F.R. § 92.4 (non-
discrimination and autonomy).
1.1.16. Colorado Revised Statutes(C.R.S.)—The legal code of Colorado;the legal codified general
and permanent statutes of the Colorado General Assembly.
1.1.17. Community Centered Board(CCB)—A private for-profit or not-for profit organization that
is an administrator of locally generated funding pursuant to CRS 25.5-10-206(6) and acts as
a resource for persons with an intellectual and developmental disability or a child with a
developmental delay.
1.1.18. Community First Choice (CFC) — Servies and supports authorized through the section
1915(k)of the Social Security Act and provided in community settings to an individual client
who requires an institutional level of care that would otherwise be provided in a Hospital,
Nursing Facility, Intermediate Care Facility for Individuals with Intellectual Disabilities
(ICF-IID), an institution providing inpatient psychiatric services for individuals under age
21, or an institution for mental diseases for individuals age 65 or over.
1.1.19. Complaints — Any complaint received by Contractor as it relates to the services provided
through this Contract to include,but not limited to general business functions,administration,
State General Fund program functions, and case management functions. Excludes any
complaints regarding activities outside the scope of this Contract.
1.1.20. Consumer-Directed Attendant Support Services (CDASS)—The service delivery option for
services that assist an individual in accomplishing activities of daily living when included as
a waiver benefit that may include health maintenance, personal care, and homemaker
activities.
1.1.21. Contract — The agreement, including all attached Exhibits, all documents incorporated by
reference, all referenced statutes, rules and cited authorities, and any future modifications
thereto, that is entered into as a result of this solicitation.
Exhibit D-5,Terminology Page 2 of 10
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.22. Contract Funds — The funds that have been appropriated, designated, encumbered, or
otherwise made available for payment by the State under the Contract resulting from this
Solicitation.
1.1.23. Contractor—The individual or entity selected as a result of this solicitation to complete the
Work contained in the Contract.
1.1.24. Contractor Pre—Existing Material—Material,code,methodology,concepts,process, systems,
technique, trade or service marks, copyrights, or other intellectual property developed,
licensed, or otherwise acquired by Contractor prior to the Effective Date of this Contract and
independent of any services rendered under any other contract with the State.
1.1.25. Corrective Action Plan—A written plan,which includes the specific actions the agency shall
take to correct non-compliance with regulations and contractual obligations,which stipulates
the date by which each action shall be completed.
1.1.26. Critical Incident—An actual or alleged event that creates the risk of serious harm to the health
or welfare of an individual receiving services; and it may endanger or negatively impact the
mental and/or physical well-being of an individual.
1.1.27. Critical Incident Report (CIR) Mistreatment, Abuse, Neglect or Exploitation (MANE) — A
Critical Incident Report entered into the CCM with a category of Mistreatment, Abuse,
Neglect, or Exploitation.
1.1.28. Critical Incident Report (CIR) Non-MANE — A Critical Incident Report entered into the
CCM with a category of criminal activity, damage to consumer's property/theft, death,
injury/illness, medication management issues, missing persons, other high-risk issues, and
unsafe housing/displacement.
1.1.29. Data — State Confidential Information and other State information resources transferred to
Contractor for the purpose of completing a task or project assigned in the Statement of Work.
1.1.30. Deliverable — Any tangible or intangible object produced by Contractor as a result of the
work that is intended to be delivered to the Department, regardless of whether the object is
specifically described or called out as a"Deliverable" or not.
1.1.31. Department—The Colorado Department of Health Care Policy and Financing, a department
of the government of the State of Colorado.
1.1.32. Designated Service Area—The geographical area determined by the State Department to be
served by a Case Management Agency per C.R.S. 25.5-6-1702.
1.1.33. Disaster— An event that makes it impossible for Contractor to perform the Work out of its
regular facility or facilities, and may include, but is not limited to, natural disasters, fire, or
terrorist attacks.
1.1.34. Effective Date—The date on which the Contract resulting from this solicitation is approved
and signed by the Colorado State Controller or designee,as shown on the Signature and Cover
Page for the Contract.
1.1.35. Eligibility Determination — The eligibility of an individual for a Long-Term Services and
Supports (LTSS) program is determined by meeting all the requirements of the program,
including Level of Care Determination and financial eligibility.
Exhibit D-5,Terminology Page 3 of 10
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.36. Fraud—An intentional deception or misrepresentation made by a person with the knowledge
that the deception could result in some unauthorized benefit to that person or some other
person and includes any act that constitutes fraud under any federal or state law.
1.1.37. Goods—Any movable material to be acquired, produced, or delivered by Contractor which
shall include any movable material acquired, produced, or delivered by Contractor in
connection with the Services.
1.1.38. Health First Colorado—Colorado's Medicaid program.
1.1.39. Health Insurance Portability and Accountability Act (HIPAA) — The Health Insurance
Portability and Accountability Act of 1996, as amended.
1.1.40. Home and Community Based Services(HCBS) Waivers—Services and supports authorized
through a 1915(c) waiver of the Social Security Act and provided in community settings to
an individual who requires an institutional level of care that would otherwise be provided in
a Hospital, Nursing Facility, or Intermediate Care Facility for Individuals with Intellectual
Disabilities (ICF-IID). This includes: Children's Home and Community Based Services
Waiver (CHCBS), Home and Community Based Services Waiver for Persons with Brain
Injury (HCBS-BI), Home and Community Based Services Children's Extensive Services
Waiver (HCBS-CES), Home and Community Based Services Children's Residential
Habilitation Program Waiver(HCBS-CHRP),Home and Community Based Services Waiver
for Children with Complex Health Needs (HCBS-CwCHN), Home and Community Based
Services Community Mental Health Supports Waiver (HCBS-CMHS), Home and
Community Based Services Waiver for Persons with Developmental Disabilities (HCBS-
DD), Home and Community Based Services Waiver for Persons who are Elderly, Blind and
Disabled (HCBS-EBD), Home and Community Based Services Supported Living Services
Waiver (HCBS-SLS), and Home and Community Based Services Waiver for Persons with
Spinal Cord Injury(HCBS-CIH).
1.1.41. Hospital Back-Up - A LTSS program for Members who have complex wound care and/or
are ventilator-dependent or medically complex.
1.1.42. Incident—Any accidental or deliberate event that results in or constitutes an imminent threat
of the unauthorized access or disclosure of State Confidential Information or of the
unauthorized modification, disruption, or destruction of any State Records.
1.1.43. In-Home Services and Supports (IHSS)—Means services that are provided in the home and
in the community by an Attendant under the direction of the Member or Member's
Authorized Representative, including Health Maintenance Activities and support for
activities of daily living or instrumental activities of daily living,Personal Care services and
Homemaker services.
1.1.44. Intermediate Care Facility (ICF) - A residential facility that is certified by the Centers for
Medicare and Medicaid (CMS) to provide habilitative, therapeutic and specialized support
services to persons with intellectual and developmental disabilities.
1.1.45. Intake, Screening and Referral — The initial contact between the individual and Contractor
and shall include but is not limited to a preliminary screening in the following areas: an
individual's need for long term services and supports; an individual's need for referral to
other programs or services; an individual's eligibility for financial and program assistance;
and the need for a Level of Care Screen of the individual seeking services.
Exhibit D-5,Terminology Page 4 of 10
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.46. Key Personnel — The position or positions that are specifically designated as such in the
Contract.
1.1.47. Learning Management System (LMS) - An online software application for the
administration, delivery and tracking of case management training programs and materials.
1.1.48. Level of Care.—The level of assistance needed by an individual seeking services or a Member
to perform activities of daily living, to include mobility; bathing; dressing; eating; toileting;
transferring; and need for supervision as determined by the Level of Care Screen.
1.1.49. Level of Care Determination—The eligibility determination of an individual for a Long-Term
Services and Supports(LTSS)program by a Case Management Agency as determined by the
requirements of the program, using the Department prescribed instrument.
1.1.50. Long Term Care notice of action—The form required to be sent to individuals by Contractor
within 11 Business Days regarding their appeal rights in accordance with 10 CCR 2505-10
8.507 et seq.
1.1.51. Long Term Services and Supports (LTSS)—The services and supports used by Members of
all ages with functional limitations and chronic illnesses who need assistance to perform
routine daily activities such as bathing, dressing, preparing meals, and administering
medications.
1.1.52. Long Term Services and Supports(LTSS)Programs -Any of the following publicly funded
programs: CHCBS, FSSP, HCBS-BI, HCBS-CES, HCBS-CHRP, HCBS-CwCHN, HCBS-
CMHS, HCBS-DD, HCBS-EBD, HCBS-CIH, HCBS-SLS, CFC, HBU, Medicaid Nursing
Facilities, OBRA-SS, PACE, State SLS.
1.1.53. Long Term Services and Supports Level of Care Eligibility Determination Screen (LOC
Screen)—An evaluation conducted by the case manager with the individual seeking services
and others chosen by the individual to participate (such as family members, friends, and/or
caregivers), to determine an applicant or Member's eligibility for long-term services and
supports based on their need for institutional level of care as determined by utilizing the
Department's prescribed instrument, with supporting diagnostic information from the
Individual's medical providers, for the purpose of determining the Individual's level of
functioning for admission or continued stay in Long-Term Services and Supports (LTSS)
programs.
1.1.54. Medical Assistance (MA) Site - Designated sites allowed by statute or certified by the
Department of Health Care Policy and Financing (Department) to process the State-
authorized Medical Assistance application for the programs that are administered by the
Department and determine eligibility for said programs.
1.1.55. Member— Any individual enrolled in the Colorado Medicaid program, State General Fund
program, Colorado's CHP+program or the Colorado Indigent Care Program, as determined
by the Department.
1.1.56. National Core Indicators-Aging and Disabilities(NCI-AD)—Standard measures used across
participating states to assess the quality of life and outcomes of seniors and adults with
physical disabilities—including traumatic or acquired brain injury—who are accessing
publicly-funded services through the Older Americans Act(OAA),Program of All-Inclusive
Care for the Elderly (PACE), Medicaid, and/or state-funded programs. The project is
coordinated by Advancing States and Human Services Research Institute (HSRI). NCI-AD
Exhibit D-5,Terminology Page 5 of 10
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
data are gathered through yearly in-person Adult Consumer Surveys administered by state
Aging, Disability, and Medicaid Agencies (or an Agency-contracted vendor) to a sample of
at least 400 individuals in each participating state. NCI-AD data measures the performance
of states' long-term services and supports (LTSS) systems and service recipient outcomes,
helping states prioritize quality improvement initiatives, engage in thoughtful decision
making, and conduct futures planning with valid and reliable LTSS data.
1.1.57. Nursing Facility-A facility provider that meets the state nursing facility licensing standards
established pursuant to C.R.S. §25-1.5-103 and is maintained primarily for the care and
treatment of inpatients under the direction of a physician.
1.1.58. Offeror—Any individual or entity that submits a proposal, or intends to submit a proposal,
in response to this solicitation.
1.1.59. Operational Start Date —When the Department authorizes Contractor to begin fulfilling its
obligations under the Contract.
1.1.60. Organized Health Care Delivery System - A Case Management Agency that contracts with
other qualified providers to furnish services authorized in CHCBS, HCBS-BI, HCBS-
CwCHN, HCBS-CES, HCBS-CIH, HCBS-CHRP, HCBS-CMHS, HCBS-DD, HCBS-EBD,
and HCBS-SLS waivers. CMAs are responsible for purchasing specific goods and services
for Members, authorized on the Person-Centered Support Plan, as set forth by the
Department's prescribed guidelines for OHCDS.
1.1.61. Other Personnel—Individuals and Subcontractors, in addition to Key Personnel, assigned to
positions to complete tasks associated with the Work.
1.1.62. Pandemic—Refers to an epidemic that has spread over several countries or continents,usually
affecting a large number of people.
1.1.63. Period of Performance—Means the total estimated time interval between the start of an initial
Federal award and the planned end date,which may include one or more funded portions,or
budget periods. Identification of the period of performance in the Federal award per §
200.211(b)(5)does not commit the awarding agency to fund the award beyond the currently
approved budget period.
1.1.64. Person-Centered Approach—Respecting and valuing individuals' and Members'preferences,
strengths, and contributions.
1.1.65. Person-Centered Support Plan - A document, using the State-prescribed instrument, that
identifies approved services, regardless of funding source, necessary to assist a Member to
remain safely in the community and develop in accordance with the Department rules. The
plan includes the funding source, frequency, amount, and provider of each service and is
developed with the Member and people chosen by the Member to identify goals, needed
services, individual choices and preferences, and appropriate service providers based on the
Member's Assessment and knowledge of the individual and community resources and
informs the member of their rights and responsibilities.
1.1.66. Person-Centered Support Planning — The process of working with the Member receiving
services and people chosen by the Member to identify goals, needed services, individual
choices and preferences, and appropriate service providers based on the Member seeking or
receiving services, assessment, and knowledge of the Member and of community resources.
Support planning informs the Member receiving services of their rights and responsibilities.
Exhibit D-5,Terminology Page 6 of 10
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.67. Personally Identifiable Information—Personally identifiable information including, without
limitation, any information maintained by the State about an individual that can be used to
distinguish or trace an individual's identity, such as name, social security number, date and
place of birth,mother's maiden name,or biometric records; and any other information that is
linked or linkable to an individual, such as medical, educational, financial, and employment
information. PII includes, but is not limited to, all information defined as personally
identifiable information in §24-72-501 C.R.S.
1.1.68. Pre-Admission Screening and Resident Review (PASRR) — The review that occurs for all
individuals seeking admission to a Medicaid nursing facility to screen the Client for evidence
of serious mental illness and/or intellectual and developmental disabilities or related
conditions. The review determines whether the individual needs the level of services that a
nursing facility provides and whether individuals who need nursing facility services also need
specialized services.
1.1.69. Professional Medical Information Page (PMIP)—The medical information document signed
by a licensed medical professional used as a component of the Level of Care Screening and
Assessment to determine the individual's or Member's need for an LTSS program.
1.1.70. Program—A publicly funded program including but not limited to: Home and Community
Based Services Waivers, Community First Choice (CFC), Medicaid Nursing Facility,
Hospital Back-Up,Program for All-Inclusive Care for the Elderly(PACE),and State General
Funded (SGF) Programs.
1.1.71. Protected Health Information — Any protected health information, including, without
limitation any information whether oral or recorded in any form or medium: (i) that relates
to the past, present or future physical or mental condition of an individual; the provision of
health care to an individual; or the past, present or future payment for the provision of health
care to an individual; and(ii) that identifies the individual or with respect to which there is a
reasonable basis to believe the information can be used to identify the individual. PHI
includes, but is not limited to, any information defined as Individually Identifiable Health
Information by the federal Health Insurance Portability and Accountability Act.
1.1.72. Provider—Any health care professional or entity that has been accepted as a provider in the
Colorado Medicaid program, Colorado's CHP+ program or the Colorado Indigent Care
Program, as determined by the Department.
1.1.73. Provider Agency Influence- Provider Agency Influence"means any direct or indirect action
by a Medicaid-enrolled Provider Agency, its employees, contractors, or representatives that
attempts to shape,alter,or predetermine the Case Management Agency's(CMA's)eligibility
determinations, assessments, or Person-Centered Service Planning processes. This includes,
but is not limited to, attempts to recommend or discourage specific service authorizations,
Support Levels, funding levels, or provider selections; provide prewritten narratives or
documentation for use in CMA eligibility determinations; or otherwise engage in actions that
create an appearance or risk of conflict of interest.Authority: 10 CCR 2505-10 §§ 8.7202.M,
8.7202.B; 42 C.F.R. § 441.301(c)(1)(vi);42 C.F.R. § 431.10(e)(3).
1.1.74. Quality Improvement Strategy (QIS) — The Department's process to measure and improve
its performance in meeting the HCBS waiver assurances annually as set forth in 42 CFR
441.301 and 441.302. QIS is also utilized to measure and improve quality performance for
CFC.
Exhibit D-5,Terminology Page 7 of 10
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.1.75. Quarter—Four(4) distinct time periods during the State Fiscal Year. Quarter one (1) begins
on July 1 and ends September 30. Quarter two (2) begins on October 1 and ends December
31. Quarter three(3)begins on January 1 and ends March 31.Quarter four(4)begins on April
1 and ends June 30.
1.1.76. Rapid Referral —The Person-Centered process that occurs when a Member, who is seeking
admission to a nursing facility,does not oppose living in the Community,and is experiencing
Unstable Housing, is rapidly referred to a Transition Coordinator to receive Transition
Coordination Services.
1.1.77. Rapid Reintegration—the Person-Centered process that occurs when a Member, who will be
admitting into a nursing facility, does not oppose living in the Community, and is not
experiencing Unstable Housing and receives services as described in the Member's Rapid
Reintegration Plan.
1.1.78. Rapid Reintegration Plan — a written Person-Centered plan developed for the purpose of
rapidly transitioning a Member(s) from a nursing facility and safely into the Community.
1.1.79. Regional Accountable Entity (RAE) — A single regional entity responsible for duties
previously performed by Regional Care Collaborate Organizations and Behavioral Health
Organizations (BHO).
1.1.80. Resource Development — The study, establishment and implementation of additional
resources or services that extend the capabilities of community based LTSS systems to better
serve LTSS applicants and Members and those likely to need community based LTSS in the
future.
1.1.81. Rural and Frontier — Defined Service Areas that are eligible for rural travel add-on
reimbursement for required in-person activities reimbursed through this Contract.
1.1.82. Services — The services and activities to be performed by Contractor as set forth in this
Contract and shall include any services and activities to be rendered by Contractor in
connection with the Goods. Services identified through this Contract specifically exclude any
Home and Community Based Services, State Plan Benefit Services, and other Medicaid
services reimbursed through a Medicaid Provider Agreement.
1.1.83. Start—Up Period—The period starting on the Effective Date and ending on the Operational
Start Date.
1.1.84. State—The State of Colorado, acting by and through any State agency.
1.1.85. State Fiscal Rules—The fiscal rules promulgated by the Colorado State Controller pursuant
to C.R.S. §24-30-202(13)(a).
1.1.86. State Fiscal Year — The 12-month period beginning on July 1 of each calendar year and
ending on June 30 of the following calendar year. If a single calendar year follows the term,
then it means the State Fiscal Year ending in that calendar year.
1.1.87. State Intellectual Disability Authority(SIDA)—The person authorized by the Department to
review PASRR Level II Evaluations and approve or deny a nursing facility admission for
individuals with intellectual and developmental disabilities. SIDA issues the Letter of
Determination to the nursing facility.
1.1.88. State General Fund Programs—Case management, services, and supports authorized by the
General Assembly and provided in the family home, a community setting,or Nursing Facility
Exhibit D-5,Terminology Page 8 of 10
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
using 100% General Fund dollars. Including, the Family Support Services Program (FSSP),
State Supported Living Services Program (State SLS), and Omnibus Reconciliation Act of
1987 Specialized Services Program (OBRA-SS).
1.1.89. State Records—Any and all State data, information,and records,regardless of physical form,
including, but not limited to, information subject to disclosure under CORA.
1.1.90. Subcontractor — Third parties, if any, engaged by Contractor to aid in performance of the
Work.
1.1.91. Support Need Level Assessment -The standardized assessment tool to identify and measure
the practical support requirements for HCBS-CHRP waiver participants.
1.1.92. Surcharge -Any additional amount added by Contractor, over and above the rate charged by
the subcontractor to Contractor,which would be shown on an individual's support plan or on
encounter data service rates submitted to the Department.
1.1.93. Systems - Systems include, but are not limited to, the Colorado interChange Medicaid
Management Information System(MMIS)and its subsystems: Bridge HCBS PAR subsystem
and the Care and Case Management(CCM) System.
1.1.94. Target Criteria — Department defined criteria based on Member needs to access services
under a HCBS waiver.
1.1.95. Targeted Case Management (TCM) — Required case management activities for Members
enrolled in a HCBS waivers and/or CFC as defined in 10 CCR 2505-10 8.760 et seq. that are
reimbursed as a State Plan benefit and through a Medicaid Provider Agreement. TCM
activities are excluded from the Work within this Contract.
1.1.96. Undue Influence - Undue Influence" means the exertion of pressure by a Provider Agency,
family member, or any other party in a manner that interferes with the independent decision-
making, assessment, or planning responsibilities of the CMA or with the Member's freedom
of choice in providers and services. Undue Influence may be explicit or implicit and may
arise through repeated persuasion, manipulation of information, or exploitation of trust or
dependency.Authority: 10 CCR 2505-10 §§ 8.7202.M, 8.7202.R(appeals), 8.7202.Q (HRC
independence); 42 C.F.R. § 441.301(c)(1)(vi)(B)—(D).
1.1.97. Waiting List - A list of otherwise eligible individuals established to manage selection of
individuals' entrance into the waiver or State General Fund programs until approved capacity
and funding become available.
1.1.98. Work—The delivery of the Goods and performance of the Services described in the Contract.
1.1.99. Work Product — The tangible and intangible results of the Work, whether finished or
unfinished, including drafts. Work Product includes, but is not limited to, documents, text,
software (including source code), research, reports, proposals, specifications, plans, notes,
studies, data, images, photographs, negatives, pictures, drawings, designs, models, surveys,
maps, materials, ideas, concepts, know—how, and any other results of the Work. "Work
Product" does not include any material that was developed prior to the Effective Date that is
used, without modification, in the performance of the Work.
2. ACRONYMS AND ABBREVIATIONS
2.1. The following list is provided to assist the reader in understanding certain acronyms and
abbreviations used in this Contract:
Exhibit D-5,Terminology Page 9 of 10
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.1.1. CFC—Community First Choice
2.1.2. CFR—Code of Federal Regulations
2.1.3. CHP+—Child Health Plan Plus
2.1.4. CORA—Colorado Open Records Act, C.R.S. §24-72-200.1, et. seq.
2.1.5. C.R.S.—Colorado Revised Statutes
2.1.6. CPI —Consumer Price Index
2.1.7. CPI-U—CPI for all urban consumers
2.1.8. HIPAA—Health Insurance Portability and Accountability Act of 1996, as amended.
2.1.9. MFCU—the Colorado Medicaid Fraud Control Unit in the Colorado Department of Law
2.1.10. PCI—Payment Card Information
2.1.11. PHI—Protected Health Information
2.1.12. PII—Personally Identifiable Information
2.1.13. SFY—State Fiscal Year
2.1.14. U.S.C. —United States Code
2.1.15. VARA—Visual Rights Act of 1990
Exhibit D-5,Terminology Page 10 of 10
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EXHIBIT E-6, CONTRACTOR'S ADMINISTRATIVE REQUIREMENTS
1. CONTRACTOR'S GENERAL REQUIREMENTS
1.1. The Department will contract with only one organization, Contractor, and will work solely with
that organization with respect to all tasks and deliverables to be completed, services to be
rendered and performance standards to be met under this Contract.
1.2. Contractor shall serve as the Case Management Agency for the following counties:
1.2.1. Weld County
1.3. Contractor may be privy to internal policy discussions, contractual issues, price negotiations,
confidential medical information, Department financial information, advance knowledge of
legislation and other Confidential Information. In addition to all other confidentiality
requirements of the Contract, Contractor shall also consider and treat any such information as
Confidential Information and shall only disclose it in accordance with the terms of the Contract.
1.4. Contractor shall work cooperatively with Department staff and, if applicable, the staff of other
State contractors to ensure the completion of the Work. The Department may, in its sole
discretion, use other contractors to perform activities related to the Work that are not contained
in the Contract or to perform any of the Department's responsibilities. In the event of a conflict
between Contractor and any other State contractor, the State will resolve the conflict and
Contractor shall abide by the resolution provided by the State.
1.5. Contractor shall inform the Department on current trends and issues in the healthcare marketplace
and provide information on new technologies in use that may impact Contractor's responsibilities
under this Contract.
1.6. Contractor shall maintain complete and detailed records of all meetings, system development life
cycle documents, presentations, project artifacts, and any other interactions or Deliverables
related to the Work described in the Contract. Contractor shall make such records available to
the Department upon request throughout the term of the Contract.
1.7. Contractor shall submit a Media Event Report in instances where Contractor is contacted directly
or indirectly by the media, including but not limited to newspaper or television, or Contractor
believes an event has occurred that may result in what Contractor deems to be potentially
negative media coverage for Contractor's agency, the Department, or the Member's served by
Contractor. Immediately following direct or indirect contact with or knowledge of media contact,
Contractor must notify the Department using the template provided.
1.7.1. DELIVERABLE: Media Event Report
1.7.2. DUE: Immediately Following Direct or Indirect Contact with or Knowledge of Media
Contact
1.8. Deliverables
1.8.1. All Deliverables shall meet Department-approved format and content requirements. The
Department will specify the number of copies and media for each Deliverable.
Exhibit E-6,Contractor's Administrative Requirements Page 1 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.8.1.1. Contractor shall submit each Deliverable to the Department for review and approval and
shall adhere to the following Deliverable process such for any documentation creation,
review, and acceptable cycle, Contractor shall:
1.8.1.1.1. Gather and document requirements for the Deliverable.
1.8.1.1.2. Create a draft in the Department-approved format for the individual Deliverable.
1.8.1.1.3. Perform internal quality control review(s) of the Deliverable, including, but not
limited to:
1.8.1.1.3.1. Readability.
1.8.1.1.3.2. Spelling.
1.8.1.1.3.3. Grammar.
1.8.1.1.3.4. Completion.
1.8.1.1.3.5. Accessibility.
1.8.1.1.4. Adhere to all required templates or development of templates.
1.8.1.1.5. Perform modifications that include version control and tracked changes.
1.8.1.2. The Department will review the Deliverable and may direct Contractor to make changes
to the Deliverable.Contractor shall make all changes within five Business Days following
the Department's direction to make the change unless the Department provides a longer
period in writing.
1.8.1.2.1. Changes the Department direct include, but are not limited to, modifying portions of
the Deliverable, requiring new pages or portions of the Deliverable, requiring
resubmission of the Deliverable or requiring inclusion of information or components
that were left out of the Deliverable.
1.8.1.2.2. The Department may also direct Contractor to provide clarification or provide a
walkthrough of any Deliverable to assist the Department in its review. Contractor
shall provide the clarification or walkthrough as directed by the Department.
1.8.1.3. Once the Department has received an acceptable version of the Deliverable, including all
changes directed by the Department, the Department will notify Contractor of its
acceptance of the Deliverable in writing. A Deliverable shall not be deemed accepted
prior to the Department's notice to Contractor of its acceptance of that Deliverable.
1.8.2. Contractor shall employ an internal quality control process to ensure that all Deliverables are
complete, accurate, easy to understand and of high quality, as described herein. Contractor
shall provide Deliverables that, at a minimum, are responsive to the specific requirements for
that Deliverable, organized into a logical order, contain accurate spelling and grammar, are
formatted uniformly, and contain accurate information and correct calculations. Contractor
shall retain all draft and marked-up documents and checklists utilized in reviewing
Deliverables for reference as directed by the Department.
1.8.3. In the event any due date for a Deliverable falls on a day that is not a Business Day, the due
date shall be automatically extended to the next Business Day, unless otherwise directed by
the Department.
Exhibit E-6,Contractor's Administrative Requirements Page 2 of 24
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
1.8.4. All due dates or timelines that reference a period of days, months or quarters shall be
measured in Calendar Days,months and quarters unless specifically stated as being measured
in Business Days or otherwise. All times stated in the Contract shall be considered to be in
Mountain Time, adjusted for Daylight Saving Time as appropriate,unless specifically stated
otherwise.
1.8.5. No Deliverable, report, data, procedure or system created by Contractor for the Department
that is necessary to fulfilling Contractor's responsibilities under the Contract, as determined
by the Department, shall be considered proprietary.
1.8.6. If any Deliverable contains ongoing responsibilities or requirements for Contractor, such as
Deliverables that are plans, policies or procedures, then Contractor shall comply with all
requirements of the most recently approved version of that Deliverable. Contractor shall not
implement any version of any such Deliverable prior to receipt of the Department's written
approval of that version of that Deliverable. Once a version of any Deliverable described in
this subsection is approved by the Department, all requirements, milestones, and other
Deliverables contained within that Deliverable shall be considered to be requirements,
milestones and Deliverables of this Contract.
1.8.6.1. Any Deliverable described as an update of another Deliverable shall be considered a
version of the original Deliverable for the purposes of this subsection.
1.9. Stated Deliverables and Performance Standards
1.9.1. Any section within this Statement of Work headed with or including the term
"DELIVERABLE" or "PERFORMANCE STANDARD" is intended to highlight a
Deliverable or performance standard contained in this Statement of Work and provide a clear
due date for the Deliverables. The sections with these headings are for ease of reference not
intended to expand or limit the requirements or responsibilities related to any Deliverable or
performance standard, except to provide the due date for the Deliverables.
1.10. Communication with the Department
1.10.1. Contractor shall enable all Contractor staff to exchange documents and electronic files with
the Department staff in formats compatible with the Department's systems, including
Microsoft Office products. Contractor shall communicate with the Department's primary
designee, who will be identified to Contractor, to obtain information about the specific
Microsoft products currently in use, as may be upgraded from time to time. At a minimum,
Contractor shall have the capability to exchange documents and electronic files compatible
with Microsoft Office 365,unless the Department's primary designee otherwise specifies. If
Contractor uses a compatible program, then Contractor shall ensure that all documents or
files delivered to the Department are completely transferrable and reviewable, without error,
on the Department's systems.
1.10.2. The Department will use a transmittal process to provide Contractor with official direction
within the scope of the Contract. Contractor shall comply with all direction contained within
a completed transmittal. For a transmittal to be considered complete, it must include, at a
minimum, all of the following:
1.10.2.1. The date the transmittal will be effective.
1.10.2.2. Direction to Contractor regarding performance under the Contract.
Exhibit E-6,Contractor's Administrative Requirements Page 3 of 24
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1.10.2.3. A due date or timeline by which Contractor shall comply with the direction contained in
the transmittal.
1.10.2.4. The signature of the Department employee who has been designated to sign transmittals.
1.10.2.4.1. The Department will provide Contractor with the name of the person it has designated
to sign transmittals on behalf of the Department, who will be the Department's
primary designee. The Department will also provide Contractor with a list of backups
who may sign a transmittal on behalf of the Department if the primary designee is
unavailable. The Department may change any of its designees from time to time by
providing notice to Contractor through a transmittal.
1.10.2.5. The Department may deliver a completed transmittal to Contractor in hard copy, as a
scanned attachment to an email or through a dedicated communication system, if such a
system is available.
1.10.2.5.1. If a transmittal is delivered through a dedicated communication system or other
electronic system, then the Department may use an electronic signature to sign that
transmittal.
1.10.2.6. If Contractor receives conflicting transmittals, Contractor shall contact the Department's
primary designee, or backup designees if the primary designee is unavailable, to obtain
direction. If the Department does not provide direction otherwise, then the transmittal
with the latest effective date shall control.
1.10.2.7. In the event that Contractor receives direction from the Department outside of the
transmittal process, it shall contact the Department's primary designee, or backup
designees if the primary designee is unavailable, and have the Department confirm that
direction through a transmittal prior to complying with that direction.
1.10.2.8. Transmittals may not be used in place of an amendment, and may not, under any
circumstances be used to modify the term of the Contract or any compensation under the
Contract. Transmittals are not intended to be the sole means of communication between
the Department and Contractor, and the Department may provide day-to-day
communication to Contractor without using a transmittal.
1.10.2.9. Contractor shall retain all transmittals for reference and shall provide copies of any
received transmittals upon request by the Department.
1.10.3. Contractor shall provide written notification to the Department in instances where Contractor
has not been successful in meeting requirements or timelines identified in this Contract. This
requirement applies to instances where multiple Members are impacted and there is an
established pattern over time. Contractor shall not include single instances. This notification
must be provided to the Department within three Business Days of discovery on a template
provided by the Department.
1.10.3.1. DELIVERABLE: Self-Disclosure of Contract Requirements Not Met
1.10.3.2. DUE: Within Three Business Days of Discovery
1.11. Individual and Member Engagement
1.11.1. Person-and Family-Centered Approach
1.11.2. Contractor shall actively engage Members in their health and well-being by demonstrating
the following:
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Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.11.2.1. Responsiveness to Member and family/caregiver needs by incorporating best practices in
communication and cultural responsiveness in service delivery.
1.11.2.2. Utilization of various tools to communicate clearly and concisely.
1.11.2.3. Contractor shall align Member engagement activities with the Department's person- and
family-centered approach that respects and values individual preferences, strengths, and
contributions.
1.12. Cultural Responsiveness
1.12.1. Contractor shall comply with the requirements within 42 CFR§ 438.206(c)(2)to provide and
facilitate the delivery of services in a culturally competent manner to all individuals and
Members consistent with a Managed Care Organization.
1.12.2. Contractor shall provide all information for individuals and Members in a manner and format
that may be easily understood and is readily accessible by individuals and Members.
1.12.3. Readily accessible is defined as electronic information and services that comply with modern
accessibility standards, such as Section 508 of the Americans with Disabilities Act, Section
504 of the Rehabilitation Act.
1.13. Language Assistance Services
1.13.1. Contractor shall provide language assistance services including bilingual staff and/or
interpreter services, at no cost to any individual or Member. Language assistance shall be
provided at all points of contact, in a timely manner and during all hours of operation.
1.13.2. Contractor shall make oral interpretation available in all languages.
1.13.3. Contractor shall ensure the competence of language assistance provided by interpreters and
bilingual staff.
1.13.4. Contractor shall not use family and friends to provide interpretation services except by
request of the individual or Member.
1.13.5. Contractor shall provide interpreter services for all interactions with individuals and
Members when there is no Contractor staff person available who speaks a language
understood by an individual or Member.
1.13.6. Contractor shall notify individuals and Members verbally regarding the individual's or
Member's right to receive the following language assistance services, as well as how to
access the following language assistance services.
1.13.7. Oral interpretation for any language. Oral interpretation requirements apply to all non-
English languages, not just those that the state identifies as prevalent.
1.13.8. Contractor shall ensure that language assistance services shall include,but are not limited to,
the use of auxiliary aids such as TTY/TDY and American Sign Language.
1.13.9. Contractor shall ensure that customer service telephone functions easily access interpreter or
bilingual services.
1.14. Correspondence Pertaining to Medicaid Benefits
1.14.1. The following provisions in this Section 1.14. describe Contractor's responsibilities and
performance standards per C.R.S. § 25.5-4-212 when the purpose of that correspondence is
to provide notice to a Medicaid applicant or Member of denial, reduction, termination,
Exhibit E-6,Contractor's Administrative Requirements Page 5 of 24
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
suspension, or change to a Medicaid benefit or to Medicaid eligibility. Contractor shall also
follow these requirements for correspondence where the purpose is to request additional
information that is relevant to determining the applicant's or Member's eligibility or benefits.
1.14.2. Contractor shall ensure that any correspondence addressed to an applicant or Member shall:
1.14.2.1. Be written in collaboration with the Department for all new and revised Member
correspondence.
1.14.2.2. Be written in person-first plain language using clear statements including a specific and
plain language description for any denial, reduction, suspension, or termination of
benefits.
1.14.2.3. Include the date (with the month written out followed by numbers for the day and year)
and a greeting.
1.14.2.4. Use a font size no smaller than 12 point.
1.14.2.5. Use terms that are used consistently throughout the correspondence and utilize commonly
used program names.
1.14.2.6. Clearly communicate the purpose of the correspondence, the action taken by Contractor,
and the specific actions that the applicant or Member must take in response to the
correspondence.
1.14.2.7. Provide contact information for the applicant or Member to obtain answers to the
applicant's or Member's questions.
1.14.2.8. Include a statement translated into the top fifteen languages most commonly spoken in
Colorado informing the applicant or Member on how to seek further assistance in
understanding the correspondence.
1.14.2.9. Follow the Health First Colorado Member Communication Standards Guide.
1.14.3. In addition to the elements described in the preceding Section 1.2, for any notice of approved
eligibility, Contractor must include clear statements containing the following information:
1.14.3.1. The basis and effective date of the eligibility.
1.14.3.2. The circumstances under which the individual must report, and procedures for reporting,
any changes that may affect the individual's eligibility.
1.14.3.3. Basic information regarding the level of benefits and services based upon the Member's
eligibility.
1.14.3.4. Description of any required cost-sharing expenses.
1.14.3.5. An explanation of how the Member can receive additional detailed information regarding
benefits and financial responsibilities.
1.14.3.6. An explanation of any right to appeal the eligibility status or level of benefits or services
that the Member has.
1.14.4. In addition to the elements described in Section 1.14.2. above,for any notice of adverse action
including a denial, reduction, termination, or suspension of eligibility or change in benefits
or services, Contractor must also include the following information:
1.14.4.1. A statement of the action the Department or its designee intends to take and the effective
date of such action.
Exhibit E-6,Contractor's Administrative Requirements Page 6 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.14.4.2. The specific regulation(s)or change in law that support the action,includes a specific and
plain language explanation of the basis for the denial, reduction, suspension, or
termination of the benefit, if applicable.
1.14.4.3. The right of the Member to be provided reasonable access to and copies of all documents,
records, and other information relevant to the Member's adverse benefit determination
upon the Member's request and free of charge to the Member.
1.14.4.4. An explanation of the Member's right to request a hearing to appeal the determination
and the method by which the Member may request a hearing
1.14.4.5. The circumstances under which the Member will be granted a hearing if the action is
based upon a change in law.
1.14.4.6. That the individual may represent themselves or use legal counsel, a relative, a friend,or
other representative at the hearing.
1.14.4.7. The circumstances under which a Member's benefits are continued during an appeal if a
hearing is requested and the process to request the continuation of benefits.
1.14.4.8. The circumstances under which an appeal process can be expedited and the process for
the Member to request an expedited appeal.
1.14.4.9. For notices concerning a medical assistance program eligibility determination, an
explanation of the applicant's or Member's right to a county or service delivery agency
dispute resolution conference.
1.14.5. If Contractor prepares any type of correspondence that requests information from the
applicant or Member, then the correspondence must provide a specific description of the
information being requested.
1.14.6. Contractor shall provide all correspondence in English and accurately translated into Spanish.
1.14.7. Upon request and free of charge, Contractor shall make any written correspondence
accessible for applicants and Members through the provision of auxiliary aids and services
for individuals with disabilities and language assistance services for individuals with limited
English proficiency.
1.14.8. The Contractor shall allow the Department access to view correspondence.
1.15. Written Materials for Individuals and Members
1.15.1. Contractor shall ensure that all written materials it creates for distribution to individuals and
Members meet all noticing requirements of 45 C.F.R. Part 92.
1.15.2. Contractor shall ensure that all written materials it creates for distribution to individuals and
Members are culturally and linguistically appropriate to the recipient.
1.15.3. Contractor shall write all materials in easy-to-understand language.
1.16. Individual and Member Communications
1.16.1. Contractor shall maintain consistent communication, both proactive and responsive, with
individuals and Members.
1.16.2. Contractor shall assist any individual or Member who contacts Contractor, including
individuals and Members not in Contractor's Defined Service Area who need assistance with
contacting their CMA, CCB, RAE, or other agencies.
Exhibit E-6,Contractor's Administrative Requirements Page 7 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.17. Individual and Member Rights
1.17.1. Contractor shall have written policies guaranteeing each individual's and Member's right to
be treated with respect and due consideration for their dignity and privacy.
1.17.2. Contractor shall provide information to individuals and Members regarding their rights that
include, but are not limited to:
1.17.2.1. The right to be treated with respect and due consideration for their dignity and privacy.
1.17.2.2. The right to participate in decisions regarding their services.
1.17.2.3. The right to be free from any form of restraint or seclusion used as a means of coercion,
discipline, convenience or retaliation.
1.17.2.4. The right to request and receive a copy of their records.
1.17.2.5. The right to obtain available and accessible services under the Contract.
1.17.3. Contractor shall post and distribute rights to individuals, including but not limited to:
1.17.3.1. Individuals/Members.
1.17.3.2. Individual's/Member's families.
1.17.3.3. Providers.
1.17.3.4. Case Workers.
1.17.3.5. Stakeholders.
1.18. Start-Up Plan
1.18.1. Contractor shall create a Start-Up Plan in year one of the Contract that contains, at a
minimum,the following:
1.18.1.1. A description of all steps, timelines, and milestones necessary to fully transition the
services described in the Contract from a prior contractor to Contractor.
1.18.1.2. A description of all steps, timelines, milestones, and Deliverables necessary for
Contractor to be fully able to perform all Work by the Operational Start Date.
1.18.1.3. A listing of all personnel involved in the start-up and what aspect of the start-up they are
responsible for.
1.18.1.4. An operational readiness review for the Department to determine if Contractor is ready
to begin performance of all Work.
1.18.1.5. The risks associated with the start-up and a plan to mitigate those risks.
1.18.1.5.1. DELIVERABLE: Start-Up Plan
1.18.1.5.2. DUE: 20 Calendar Days Prior to the Contract Start Date
1.19. Start-Up Period
1.19.1. With input from the Department, Contractor shall complete all of the following during the
Start-Up Period in year one of the Contract:
1.19.1.1. Schedule and facilitate a Kickoff Meeting that includes the following:
1.19.1.1.1. Key Personnel.
Exhibit E-6,Contractor's Administrative Requirements Page 8 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.19.1.1.2. Department Leadership.
1.19.1.1.3. Department Project Team Members.
1.19.1.1.4. Any other relevant and needed persons or organizations.
1.19.1.2. Develop Kickoff Meeting materials and an agenda that contains, at a minimum, the
following:
1.19.1.2.1. Initial timelines for starting the Work and creating initial Deliverables.
1.19.1.2.2. Establishment of Communication channels to describe how the Work is to be
completed.
1.19.1.2.3. Transmission methods and specific Deliverable templates or requirements.
1.19.1.2.4. Any other item required to initiate and ensure Work is started and completed on time.
1.19.1.3. Prepare Kickoff Meeting Minutes and deliver them to the Department for review and
approval.
1.19.1.3.1. DELIVERABLE: Kickoff Meeting Agenda& Materials
1.19.1.3.2. DUE: Within three Business Days after the Kickoff Meeting
1.19.1.4. Policy and Procedures Manual
1.19.1.4.1. Create a Policy and Procedures Manual that contains the policies and procedures for
all systems and functions necessary for Contractor to complete its obligations under
the Contract. Such policies and/or procedures shall be included, but are not limited
to:
1.19.1.4.1.1. Determination of Developmental Disability
1.19.1.4.1.2. Defined Service Area Exceptions Process
1.19.1.4.1.3. Member Rights
1.19.1.4.1.4. Critical Incident Reporting
1.19.1.4.1.5. Grievance/Complaint Procedures
1.19.1.4.1.6. Monitoring
1.19.1.4.1.7. Human Rights Committee
1.19.1.4.1.8. Community Advisory Committee
1.19.1.4.2. Training
1.19.1.4.3. Case Management Operations
1.19.1.4.4. After-hours Policies and Procedures
1.19.1.4.5. Denial and Discontinuation of Services
1.19.1.4.6. Safeguards Necessary to Prevent Conflict of Interest
1.19.1.5. Prepare all documents, forms, training materials, and any other documents, information
and protocols that require approval by the Department prior to the end of the Start-Up
Period and are necessary for Contractor to begin work on the Operational Start Date.
Contractor shall deliver all documents, forms, training materials, and any other
Exhibit E-6,Contractor's Administrative Requirements Page 9 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
documents, information and protocols that require approval by the Department to the
Department for review and approval in a timely manner that allows the Department to
review and approve those documents prior to end of the Start-Up Period.
1.19.1.5.1. DELIVERABLE: Policies&Procedures Manual
1.19.1.5.2. DUE: No later than the Operational Start Date
1.19.2. Operations Guide
1.19.2.1. Contractor shall not engage in any Work under the Contract, other than the Work
described in Sections 1.17 and 1.18 prior to the Operational Start Date. The Department
shall not be liable to Contractor for, and Contractor shall not receive, any payment for
any period prior to the Operational Start Date under this Contract.
1.19.2.2. Contractor shall create and implement an Operations Guide. The Operations Guide shall
include the creation and management of the following:
1.19.2.2.1. Communication Plan.
1.19.2.2.2. Business Continuity Plan.
1.19.2.2.3. Closeout Plan.
1.19.2.3. Contractor shall submit the Operations Guide to the Department for review and approval.
1.19.2.3.1. DELIVERABLE: Operations Guide
1.19.2.3.2. DUE: Within 30 Business Days after the Effective Date
1.19.2.4. Contractor shall review its Operations Guide on annual basis and determine if any
modifications are required to account for any changes in the Work, in the Department's
processes and procedures or in Contractor's processes and procedures and update the
Guide as appropriate to account for any changes. Contractor shall submit an Annual
Operations Guide Update that contains all changes from the most recently approved prior
Operations Guide or Annual Operations Guide Update or shall note that there were no
changes.
1.19.2.4.1. DELIVERABLE: Annual Operations Guide Update
1.19.2.4.2_ DUE: Annually, by July 31st
1.19.2.5. The Operational Start Date shall not occur until Contractor has completed all
requirements of the Operations Guide unless the Department provides written approval
otherwise.
1.19.3. Communication with Members, Providers,and Other Entities
1.19.3.1. Contractor shall create a Communication Plan that includes, but is not limited to, all of
the following:
1.19.3.1.1. A description of how Contractor will communicate to Members any changes to the
services those Members will receive or how those Members will receive the services.
1.19.3.1.2. A description of the communication methods, including things such as email lists,
newsletters and other methods, that Contractor will use to communicate with
Providers and Subcontractors.
Exhibit E-6,Contractor's Administrative Requirements Page 10 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.19.3.1.3. The specific means of immediate communication with Members and a method for
accelerating the internal approval and communication process to address urgent
communications or crisis situations.
1.19.3.1.4. A general plan for how Contractor will address communication deficiencies or crisis
situations, including how Contractor will increase staff, contact hours or other steps
Contractor will take if existing communication methods for Members or Providers
are insufficient.
1.19.3.1.5. A listing of the following individuals within Contractor's organization, including cell
phone numbers and email addresses:
1.19.3.1.5.1. An individual who is authorized to speak on the record regarding the Work, the
Contract or any issues that arise that are related to the Work.
1.19.3.1.5.2. An individual who is responsible for any website or marketing related to the
Work.
1.19.3.1.5.3. Back-up communication staff that can respond in the event that the other
individuals listed are unavailable.
1.19.3.1.5.4. An outline of the process for Contractor's communication, timely responses and
emergency protocols in the event there is a natural disaster or Pandemic.
1.19.3.1.5.5. Communication Plan shall include steps for responding to the Department,
provider agencies, Members and community organizations in the event there is a
natural disaster or Pandemic.
1.19.4. Business Continuity Plan
1.19.4.1. Contractor shall create a Business Continuity Plan that Contractor will follow in order to
continue operations after a Disaster or a Business Interruption to include but not limited
to a Disaster, Pandemic, power outage, strike, loss of necessary personnel, or computer
virus. The Business Continuity Plan shall include, but is not limited to, all of the
following:
1.19.4.1.1. The essential services and functions provided by Contractor.
1.19.4.1.2. The lead person and response team responsible for implementing the business
continuity plan, individual/team roles, and contact information.
1.19.4.1.3. How emergency responses procedures will be implemented and who will activate the
business continuity plan.
1.19.4.1.4. How Contractor will implement a flexible work plan that includes social distancing,
hygiene etiquette,cancellation of non-essential activities, closure of buildings, and/or
relocation to alternative facilities.
1.19.4.1.5. How Contractor will address training personnel, preparing equipment, and backup
systems.
1.19.4.1.6. How Contractor will address budget and finance mechanisms to ensure financing of
essential services.
1.19.4.1.7. How Contractor will ensure necessary supplies and equipment are available to
maintain essential services.
Exhibit E-6,Contractor's Administrative Requirements Page 11 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.19.4.1.8. How Contractor will replace staff that are lost or unavailable during or after a
Business Interruption so that the Work is performed in accordance with the Contract.
1.19.4.1.9. How Contractor will manage employees who are exposed to a Pandemic related
illness or are suspected to be ill or become ill at a worksite, such as infection control
response and immediate mandatory sick leave.
1.19.4.1.10. How Contractor will ensure or enhance communication and information technology
infrastructure to support tele-commuting.
1.19.4.1.11. How Contractor will back-up all information necessary to continue performing the
Work remotely, so that no information is lost because of a Business Interruption.
1.19.4.1.12. In the event of a Disaster, the plan shall also include how Contractor will make all
information available at its back-up facilities.
1.19.4.1.13. How Contractor will maintain complete back-up copies of all data, databases,
operating programs,files,systems,and software pertaining to enrollment information
at a Department-approved, off-site location.
1.19.4.1.14. How Contractor will minimize the effects on Members of any Business Interruption
to include how Contractor will notify Members of closures and cancellations.
1.19.4.1.15. How Contractor will communicate with the Department during the Business
Interruption and points of contact within Contractor's organization the Department
can contact in the event of a Business Interruption.
1.19.4.1.16. How Contractor will transition from in-person meetings to conference calls or other
virtual platforms or cancel or delay meetings as necessary.
1.19.4.1.17. Planned long-term back-up facilities out of which Contractor can continue operations
after a Disaster.
1.19.4.1.18. The time period it will take to transition all activities from Contractor's regular
facilities to the back-up facilities after a Disaster.
1.19.4.1.19. How Contractor will prepare necessary internal staff for implementing the business
continuity plan, which may include tests, drills, or training annually and revising the
plan based on lessons learned.
1.19.4.1.20. How Contractor will identify and engage with external organizations to help the
community, such as sharing best practices and sharing timely and accurate
information about a Business Interruption.
1.19.4.1.21. How Contractor will implement steps to return to normal after a Business
Interruption.
1.19.5. Closeout Plan
Contractor shall create a Closeout Plan that describes all requirements, steps, timelines,
milestones, and Deliverables necessary to fully transition the services described in the
Contract from Contractor to the Department or to another contractor selected by the
Department to be Contractor after the termination of the Contract. The Closeout Plan
shall include,but is not limited to:
Transfer of individuals and Members
Exhibit E-6,Contractor's Administrative Requirements Page 12 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.19.5.1.1. Transfer of documentation to include all electronic and physical documentation.
1.19.5.1.2. Transfer of all individual and Member records through the Department Case
Management Systems.
1.19.5.1.3. Transfer of services
1.19.5.1.4. Transfer of Case Management Services
1.19.5.2. The Closeout Plan shall also designate an individual to act as a closeout coordinator who
will ensure that all requirements, steps, timelines,milestones, and deliverables contained
in the Closeout Plan are completed and work with the Department and any other
contractor to minimize the impact of the transition on Members and the Department.
1.19.5.2.1. Contractor shall ensure all policy, procedures, training, and appeals information are
transferred to the Department.
1.19.5.3. Contractor shall deliver the Closeout Plan to the Department for review and approval.
1.19.5.4. Contractor shall provide weekly updates to the Department throughout the creation of and
the performances within the Operations Guide, that show Contractor's status toward
meeting the milestones described herein.
1.19.5.5. Contractor shall be ready to perform all Work by the Operational Start Date.
1.19.6. Closeout Period
1.19.6.1. During the Closeout Period, Contractor shall complete all of the following:
1.19.6.1.1. Implement the most recent Closeout Plan or Closeout Plan Update as approved by the
Department in the Operations Guide, as described herein and complete all steps,
Deliverables and milestones contained in the most recent Closeout Plan or Closeout
Plan Update that has been approved by the Department.
1.19.6.1.2. Provide to the Department, or any other contractor at the Department's direction, all
reports, data, systems, Deliverables, and other information reasonably necessary for
a transition as determined by the Department or included in the most recent Closeout
Plan or Closeout Plan Update that has been approved by the Department.
1.19.6.1.3. Ensure that all responsibilities under the Contract have been transferred to the
Department,or to another contractor at the Department's direction,without significant
interruption.
1.19.6.1.4. Notify any Subcontractors of the termination of the Contract, as directed by the
Department.
1.19.6.1.5. Notify all Members that Contractor will no longer be the CMA as directed by the
Department. Contractor shall create these notifications and deliver them to the
Department for approval. Once the Department has approved the notifications,
Contractor shall deliver these notifications to all Members, but in no event shall
Contractor deliver any such notification prior to approval of that notification by the
Department.
1.19.6.1.5.1. DELIVERABLE: Member Notifications
1.19.6.1.5.2. DUE: 90 Calendar Days prior to termination of the Contract
Exhibit E-6,Contractor's Administrative Requirements Page 13 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
Continue meeting each requirement of the Contract as described in the Department-
approved and updated Closeout Plan, or until the Department determines that specific
requirement is being performed by the Department or another contractor, whichever is
sooner. The Department will determine when any specific requirement is being
performed by the Department or another contractor and will notify Contractor of this
determination for that requirement.
1.19.6.2. The Closeout Period may extend past the termination of the Contract. The Department
will perform a closeout review to ensure that Contractor has completed all requirements
of the Closeout Period. If Contractor has not completed all of the requirements of the
Closeout Period by the date of the termination of the Contract, then any incomplete
requirements shall survive termination of the Contract.
1.19.7. Long-Range Plan
1.19.7.1. Contractor shall create and present to the Department a Long-Range Plan for its Defined
Service Area that describes, at a minimum,the following:
1.19.7.1.1. Administrative and case management accomplishments of Contractor in the previous
year.
1.19.7.1.2. Identified unmet needs of eligible persons in the Defined Service Area and action
steps necessary to meet those needs.
1.19.7.1.3. How Contractor will solicit input from Members and families to ensure quality
services.
1.19.7.1.4. Local area issues that impact or are expected to impact the Defined Service Area and
action steps on how to resolve those issues.
1.19.7.1.5. Policies that are considered by Contractor to be a barrier to ensuring a comprehensive
case management system and suggested modifications to overcome the barriers.
1.19.7.1.6. A summary of how Contractor is working to recruit and retain case management staff
currently and for the future to maintain and improve the case management services in
its Defined Service Area.
1.19.7.1.7. A summary of how Contractor is working to recruit new and existing providers to
expand their services in the Defined Service Area.
1.19.7.1.8. A summary of past efforts and future plans to accelerate access for people with
disabilities.
1.19.7.1.9. Contractor's efforts to recruit members of the Community Advisory Committee who
represent the characteristics of the community.
1.19.7.1.10. How Contractor will engage with and facilitate existing social networks including,
but not limited to: CCBs, RAEs, Behavioral Health Authorities, schools, nursing
facilities and other unpaid supports and advocacy partners will be used to support
Members in the Defined Service Area.
1.19.7.1.11. How State General Fund programs and supports will be used to support individuals,
Members, and families within the Defined Service Area.
1.19.7.1.12. How feedback will be obtained from community members, Members receiving
services, and individuals seeking or waiting for services and how the feedback will
Exhibit E-6,Contractor's Administrative Requirements Page 14 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
be incorporated into strategies for delivering case management services within the
Defined Service Area.
1.19.7.1.12.1. DELIVERABLE: Long-Range Plan
1.19.7.1.12.2. DUE: At this interval:
1.19.7.1.13. September 15, 2026 for Contractors with names beginning in A through M
1.19.7.1.14. September 15, 2027 for Contractors with names beginning in N through Z
1.19.7.1.15. September 15, 2028 for Contractors with names beginning in A through M
1.19.7.1.16. September 15, 2029 for Contractors with names beginning in N through Z
1.19.7.2. Contractor shall present the key findings from the Long-Range Plan to the Department
within 20 Business Days of the Long-Range Plan being submitted to the Department.
1.19.7.3. Contractor shall make any changes to the Long-Range Plan as directed by the Department
and resubmit the Deliverable within 10 Business Days of the request.
1.19.8. Community Advisory Committee
1.19.8.1. Within 30 Calendar Days of the Contract execution date, Contractor shall establish a
Community Advisory Committee of no less than five committee members that will meet
at least quarterly to obtain public input and guidance for CMA operations and follow rules
and regulations set forth in C.R.S. 8.7201.C.
1.19.9. The Community Advisory Committee shall include, but not be limited to, at least one person
as the regional representation from among the following categories:
1.19.9.1. The Defined Service Area's county commissioners, area agencies on aging, medical
professionals, physical and/or intellectual disability professionals, ombudsmen, human
services agencies, county government officials, mental/behavioral health professionals,
and
1.19.9.2. Regional representation from one or more LTSS Members or family members of
individuals receiving LTSS and make every effort to recruit and maintain a majority of
individuals with this lived experience on the committee:
Members with I/DD and/or
1.19.9.2.1. Members with disabilities
1.19.9.2.2. Members shall be given priority of selection over family members.
1.19.10. Contractor shall submit the Community Advisory Committee member list annually on the
template prescribed by the Department.
1.19.11. If Contractor is unable to recruit and maintain a majority of members, advocates, and people
with lived experience on the committee, Contractor shall outline efforts to do so with their
deliverable submissions.
1.19.11.1. DELIVERABLE: Community Advisory Committee Member List
1.19.11.2. DUE: Annually, by August 15th
1.19.12. Contractor shall notify the Department of any changes to Community Advisory Committee
membership within 10 Business Days of the date of change.
Exhibit E-6,Contractor's Administrative Requirements Page 15 of 24
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
1.19.12.1. DELIVERABLE: Community Advisory Committee Membership Updates
1.19.12.2. DUE: Within 10 Business Days of the date of change to the membership list.
1.19.13. The Community Advisory Committee shall include at least two regional representatives of
individuals or family members of individuals receiving long-term disability and/or I/DD
services.
1.19.14. Contractor shall demonstrate efforts to recruit members of the committee who represent the
characteristics of the community. These efforts shall be reflected in the Long-Range Plan.
1.19.15. The Community Advisory Committee is an advisory body to Contractor that provides
recommendations and is not a decision-making body. As such the Community Advisory
Committee shall:
1.19.15.1. Provide public input and guidance to Contractor in the review of service delivery policies
and procedures, marketing strategies, resource development, overall operations, service
quality, individual Member satisfaction and other related programmatic opportunities.
Contractor shall receive and consider recommendations from the Community Advisory
Committee to modify policies and procedures to address systemic barriers at a local or
regional level, in the Long-Range Plan.
1.19.15.2. Support Contractor with developing strategies for resolving complaints at the local or
regional level.
1.19.15.3. Maintain and post public notices of meetings, meeting minutes, and documented follow
up on Contractor's website.
1.19.15.4. Contractor shall post the meeting date, time, and location of the meeting and the meeting
agenda at least 10 Business Days prior to the meeting on Contractor's website.
1.19.15.5. Contractor shall post meeting minutes and any related follow-up action items once
approved by the Community Advisory Committee and Contractor on Contractor's
website.
1.19.15.6. Report to Contractor's governing body or board of directors quarterly on all case
management complaints trends and follow-up completed by Contractor.
1.19.15.7. Provide reports to the Department and its committees upon request.
1.19.15.8. The Community Advisory Committee may be combined in purpose or name with other
CMA committees in Contractor's defined service area so long as it meets the above
purpose, criteria, and reports.
1.19.15.9. The Community Advisory Committee must use the operational templates prescribed by
the Department as minimum standards.
1.19.15.9.1. DELIVERABLE: Semi-annual Community Advisory Committee Meetings
Summary
1.19.15.9.2. DUE: Semi-Annually, for meetings held between July Pt and December 31)st,
Committee Updates are due January 15th, and for meetings held between January 1st
through June 1st, Committee Updates are due June 15th
1.20. Performance Reviews
Exhibit E-6,Contractor's Administrative Requirements Page 16 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.20.1. The Department may conduct performance reviews or evaluations of Contractor in relation
to the Work performed under the Contract.
1.20.2. The Department may work with Contractor in the completion of any performance reviews or
evaluations or the Department may complete any or all performance reviews or evaluations
independently, at the Department's sole discretion.
1.20.3. Contractor shall provide all information necessary for the Department to complete all
performance reviews or evaluations, as determined by the Department, upon the
Department's request. Contractor shall provide this information regardless of whether the
Department decides to work with Contractor on any aspect of the performance review or
evaluation.
1.20.4. The Department may conduct these performance reviews or evaluations at any point during
the term of the Contract, or after termination of the Contract for any reason.
1.20.5. The Department may make the results of any performance reviews or evaluations available
to the public or may publicly post the results of any performance reviews or evaluations.
1.20.6. The Department may recoup funding as a result of any performance review or evaluation
where payment was rendered for services not complete or not in alignment with federal and/or
state regulations or this Contract.
1.21. Corrective Action Plan
1.21.1. When the Department determines that Contractor is not in compliance with any term of this
Contract, Contractor,upon written notification by the Department, shall develop a corrective
action plan. Corrective action plans shall include,but not be limited to:
1.21.1.1. A detailed description of actions to be taken including any supporting documentation.
Contractor's employee(s) responsible for implementing the actions.
1.21.1.2. The implementation time frames and a date for completion.
1.21.1.3. Contractor shall submit the Corrective Action Plan to the Department within 10 Business
Days of the receipt of a written request from the Department.
1.21.1.3.1. DELIVERABLE: Corrective Action Plan
1.21.1.3.2. DUE: Within 10 Business Days of receipt of a written request from the Department
1.21.2. Contractor shall notify the Department in writing, within three Business Days, if it will not
be able to present the Corrective Action Plan by the due date. Contractor shall explain the
rationale for the delay and the Department may grant an extension, in writing, of the deadline
for Contractor's compliance.
1.21.3. Upon receipt of Contractor's Corrective Action Plan, the Department will accept, modify, or
reject the proposed Corrective Action Plan. Modifications and rejections shall be
accompanied by a written explanation.
1.21.4. In the event of a rejection of Contractor's Corrective Action Plan Contractor shall re-write a
revised Corrective Action Plan and resubmit it along with requested documentation to the
Department for review.
1.21.4.1. DELIVERABLE: Revised Corrective Action Plan
1.21.4.2. DUE: Within five Business Days of the Department's rejection
Exhibit E-6,Contractor's Administrative Requirements Page 17 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.21.5. Upon acceptance by the Department Contractor shall implement the Corrective Action Plan.
1.21.6. If corrections are not made by the timeline and/or quality specified by the Department then
funds may be withheld from this Contract.Payments of funds from this Contract will resume
beginning the month that the correction is made and accepted by the Department.
1.21.7. As part of the Corrective Action Plan, supporting documentation demonstrating that
deficiencies have been remediated may be required. Contractor shall ensure all supporting
documentation is submitted within the timeframes established in the Corrective Action Plan.
1.21.8. Upon receipt of Contractor's supporting documentation, the Department will accept, request
modifications, or reject the documentation. Modifications and rejections shall be
accompanied by a written explanation.
1.21.9. In the event of a rejection of Contractor's supporting documentation to the Corrective Action
Plan, Contractor shall correct and resubmit the supporting documentation to the Department
for review.
1.21.10. If a Corrective Action Plan or any supporting activities or documentation are required to
correct a deficiency, are not submitted within the requested timeline and/or quality specified
by the Department, funds may be suspended or withheld from this Contract.
1.21.10.1. DELIVERABLE: Revised Supporting Documentation
1.21.10.2. DUE: Within five Business Days of the Department's rejection
1.21.11. If corrections are not made by the timeline and quality specified by the Department then funds
may be withheld and recovered from this Contract.Payments of funds from this Contract will
resume beginning the month that the correction is made and accepted by the Department.
1.22. Renewal Options and Extensions
1.22.1. The Department may, within its sole discretion, choose to not exercise any renewal option in
the Contract for any reason. If the Department chooses to not exercise an option, it may
reprocure the performance of the Work in its sole discretion.
1.22.2. The Parties may amend the Contract to extend beyond eight years, in accordance with the
Colorado Procurement Code and its implementing rules, in the event that the Department
determines the extension is necessary to align the Contract with other Department contracts,
to address state or federal programmatic or policy changes related to the Contract, or to
provide sufficient time to transition the Work.
1.23. Department System Access
1.23.1. In the event that Contractor requires access to any Department computer system to complete
the Work,Contractor shall have and maintain all hardware, software,and interfaces necessary
to access the system without requiring any modification to the Department's system.
Contractor shall follow all Department policies,processes, and procedures necessary to gain
access to the Department's systems.
1.23.2. Contractor shall be responsible for any costs associated with obtaining and maintaining
access to systems needed to perform the Work under this solicitation, as determined by the
Department. The Department will not reimburse Contractor for any costs associated with
obtaining and maintaining access to Department systems.
1.24. Provider Fraud
Exhibit E-6,Contractor's Administrative Requirements Page 18 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
1.24.1. Contractor shall notify the Department and the Colorado Medicaid Fraud Control Unit of the
Colorado Department of Law (MFCU) if it identifies or suspects possible Provider Fraud as
a result of any activities in its performance of this Contract.
1.24.2. Upon identification or suspicion of possible Provider Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.24.2.1. For each incident of identified or suspected Provider Fraud, Contractor shall provide all
of the following, at a minimum:
1.24.2.1.1. Written documentation of the findings.
1.24.2.1.2. Information on any verbal or written reports.
1.24.2.1.3. All details of the findings and concerns, including a chronology of Contractor actions
which resulted in the reports, in a format agreed to by the Department.
1.24.2.1.4. Information on the identification of any affected claims that have been discovered.
1.24.2.1.5. Any claims data associated with its report (in a mutually agreed upon format, if
possible).
1.24.2.1.6. Any additional information as required by the Department.
1.24.3. For each incident of identified or suspected Provider Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department and the
MFCU.
1.24.3.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.24.3.2. DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.24.4. Contractor shall revise or provide additional information related to Contractor Suspected
Fraud Written Notice Form as requested by the Department or the MFCU.
1.24.4.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and Additional
Information
1.24.4.2. DUE: Within three Business Days following the Department's or the MFCU's request,
unless the Department or MFCU provides for a different period in its request.
1.25. Member Fraud
1.25.1. Contractor shall notify the Department if it identifies or suspects possible Member Fraud as
a result of any activities in its performance of this Contract.
1.25.2. Upon identification or suspicion of possible Member Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.25.2.1. For each incident of identified or suspected Member Fraud, Contractor shall provide all
of the following, at a minimum:
1.25.2.1.1. All verbal and written reports related to the suspected fraud.
1.25.2.1.2. All details of the findings and concerns, including a chronology of Contractor actions
which resulted in the reports, and the Member's State ID number, and Member's date
of birth if applicable.
1.25.2.1.3. Information on the identification of any affected claims that have been discovered.
Exhibit E-6,Contractor's Administrative Requirements Page 19 of 24
Docusign Envelope ID:881 F36A8-242F-494F-AA6E-D95DFCDD35F5
1.25.2.1.4. Any claims data associated with its report in a format agreed to by the Department.
1.25.2.1.5. Any additional information as required by the Department.
1.25.3. For each incident of identified or suspected Member Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department at
report.clientfraud@state.co.us, or at such other email address as provided by the Department
from time to time.
1.25.3.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.25.3.2. DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.25.4. Contractor shall revise or provide additional information related to Contractor Suspected
Fraud Written Notice Form as requested by the Department.
1.25.4.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and Additional
Information
1.25.4.2. DUE: Within three Business Days following the Department's request, unless the
Department provides for a different period in its request.
2. CONTRACTOR PERSONNEL
2.1. Personnel General Requirements
2.1.1. Contractor shall provide qualified Key Personnel and Other Personnel as necessary to
perform the Work throughout the term of the Contract.
2.2. The following positions can concurrently be assigned to other CMA contractual designee roles
and responsibilities as needed by the CMA but must be included in at least one position
description within the CMA.
2.2.1. Contractor shall designate the following Key Personnel positions:
2.2.1.1. Executive Director or Administrator
2.2.1.2. Finance Director
2.2.1.3. Case Management Director
2.2.1.4. Continuous Quality Improvement Lead
2.2.1.5. Contract Lead
2.2.1.6. Information Technology Liaison -
2.2.1.7. Regional Accountable Entity(RAE) Liaison
2.2.1.8. Medical Assistance(MA) Site/County Eligibility Liaison
2.2.1.9. Member and Family Liaison
2.2.2. The Contract Lead shall be responsible for all the following:
2.2.2.1. Serving as Contractor's primary point of contact for the Department.
2.2.2.2. Serving as Contractor's primary point of contact for contract deliverables and other
contract-related questions or issues for the Department.
Exhibit E-6,Contractor's Administrative Requirements Page 20 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.2.2.3. Ensuring the completion of all Work in accordance with the Contract's requirements.
This includes, but is not limited to, ensuring the accuracy, timeliness, and completeness
of all work.
2.2.2.4. Ensuring the timely submission and accuracy of all Deliverables submitted to the
Department.
2.2.3. The Continuous Quality Improvement Lead shall be responsible for all the following:
2.2.3.1. Development, implementation and ongoing oversight of Contractors Continuous Quality
Improvement Plan,
2.2.3.2. Reporting to the Department on identified quality trends
2.2.3.3. Operate as Contractor's point of contact for activities including but not limited to Quality
Improvement Strategies, Performance and Quality Reviews, Corrective Action Plan
implementation.
2.2.4. The Information Technology Liaison shall be responsible for all the following:
2.2.4.1. Operate as Contractor's point of contact for CCM and Bridge vendors,
2.2.4.2. Provide oversight of data integrity within Contractor system(s), if applicable, and data
entered into CCM and Bridge.
2.2.5. The RAE Liaison shall be responsible for all the following:
2.2.5.1. Coordination between Contractor and the RAE(s) contracted within Contractor's
designated service area,
2.2.5.2. Actively participate in RAE/CMA workgroup meetings.
2.2.6. The MA Site/County Eligibility Liaison shall be responsible for all of the following:
2.2.6.1. Coordination between Contractor and MA Site/County Eligibility within Contractor
designated service area,
2.2.6.2. Establishing and maintaining point of contact between agencies for Member escalations
as they occur.
2.2.7. The Member and Family Liaison shall be responsible for all the following:
2.2.7.1. Regulatory and contractual requirements of Community Advisory Committee,
2.2.7.2. CMA internal policies and procedures to ensure Member and family access to a primary
point of contact at the CMA to ensure a Member and family always have a point of contact
regardless of case management assigned,
2.2.7.3. CMA internal policies and procedures to ensure Member and family access to
communication in their primary language and any reasonable accommodations,
2.2.7.4. CMA internal policies and procedures to review:
2.2.7.4.1. Critical Incident Reports Trends Analysis,
2.2.7.4.2. Complaints and Grievances,
2.2.7.5. Review and ensure responses occur to urgent and prioritized needs as outlined in the
Member's contingency plan and/or back-up plan and the CMA's After-hours policy and
Exhibit E-6,Contractor's Administrative Requirements Page 21 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
procedures as outlined in 1.18.2 to mitigate health and safety risks and deploy appropriate
community resources.
2.2.8. Contractor shall post the name and contact information for the individual appointed as the
Member and Family Liaison on Contractor's website.
2.2.9. Contractor shall provide the Department with a final list of individuals assigned to the
Contract and appropriate contact information for those individuals using the template
provided by the Department. Contractors with more than one Defined Service Area must
submit the final list of individuals assigned to the Contract using the template provided by
the Department for each Defined Service Area. The Department shall determine which Key
Personnel may be allocated across organizational functions, which Key Personnel must be
dedicated to the Contract, and which Key Personnel or Other Personnel must be dedicated to
each Defined Service Area.
2.2.9.1. DELIVERABLE: Key Personnel, final list of individuals assigned to the Contract
2.2.9.2. DUE: Within five Business Days after the Effective Date and annually by July 15th
2.2.10. Contractor shall update this list upon the Department's request to account for changes in the
individuals assigned to the Contract.
2.2.10.1. DELIVERABLE: Key Personnel, updated list of individuals assigned to the Contract
2.2.10.2. DUE: Within five Business Days after any change to the Key Personnel list
2.2.11. Contractor shall not permit any individual proposed for assignment to Key Personnel
positions to perform any Work prior to the Department's approval of that individual to be
assigned as Key Personnel.
2.2.12. Other Personnel
2.2.12.1. Contractor shall have sufficient staffing levels to include case managers, case aids,
supervisors, and other staff as necessary to complete the Work and to maintain caseload
sizes to support the Work. Contractor shall meet or exceed best practice standards as set
forth by the Department. Contractor shall not exceed the best practice caseload size
standard of 1:65 without written approval from the Department.
2.2.12.2. Contractor's Case Manager(s) shall meet all the qualifications listed in 10 C.C.R. 2505-
10, Section 8.7203.A et seq.
2.2.12.3. Contractor shall ensure appropriate staffing and infrastructure to address the needs of all
populations including children and adults for all HCBS waivers and CFC.
2.3. Background Checks
2.3.1. Contractor shall conduct background checks on all new applicants for positions in which
direct care,as defined in section§26.3.1.101(3.5),C.R.S. will be provided to an at-risk adult,
as defined in section §26-3.1-101 (1.5), C.R.S to include at a minimum a Colorado Bureau
of Investigation check. On and after January 1, 2019,prior to employment, Contractor shall
submit the name of a person who will be providing direct care, to an at-risk adult, as well as
any other required identifying information, to the Colorado Department of Human Services
for a check of the Colorado Adult Protective Services data system pursuant to section §26-
3.1-111, C.R.S.to determine if the person is substantiated in a case of mistreatment of an at-
risk adult.
Exhibit E-6,Contractor's Administrative Requirements Page 22 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.3.2. If any of Contractor's Key Personnel, or Other Personnel, are required to have and maintain
any professional licensure or certification issued by any federal, state, or local government
agency, then Contractor shall maintain copies of such current licenses and certifications and
provide them to the Department upon request.
2.4. Personnel Availability
2.4.1. Contractor shall ensure Key Personnel and Other Personnel assigned to the Contract are
available for meetings with the Department during the Department's normal business hours,
as determined by the Department. Contractor shall also make these personnel available
outside of the Department's normal business hours and on weekends with prior notice from
the Department.
2.4.2. Contractor shall ensure that appropriate Key Personnel and Other Personnel are available for
all regularly scheduled meetings between Contractor and the Department. The Department
may, at times, require specific personnel to attend a meeting and will notify Contractor of
such request.
2.4.3. Contractor shall ensure that the Key Personnel and Other Personnel attending all meetings
between the Department and Contractor have the authority to represent and commit
Contractor regarding work planning, problem resolution and program development.
2.4.4. At the Department's direction, Contractor shall make its Key Personnel and Other Personnel
available to attend meetings as subject matter experts with stakeholders both within the State
government and external private stakeholders.
2.4.5. All of Contractor's Key Personnel and Other Personnel that attend any meeting with the
Department or other Department stakeholders shall be present at the meeting through video
conference, telephonic, or in-person depending on the purpose and intent of the meeting. If
Contractor has any personnel attend by telephone or video conference, Contractor shall
provide all additional equipment necessary for attendance, including any virtual meeting
space or telephone conference lines.
2.4.6. Contractor shall respond to all telephone calls, voicemails, and emails from the Department
within two Business Days of receipt by Contractor.
2.4.7. Contractor shall respond to Department directed escalations according as prescribed by the
Department.
2.5. Other Personnel Responsibilities
2.5.1. Contractor shall use its discretion to determine the number of Other Personnel necessary to
perform the Work in accordance with the requirements of this Contract. If the Department
determines that Contractor has not provided sufficient Other Personnel to perform the Work
in accordance with the requirements of this Contract, Contractor shall provide all additional
Other Personnel necessary to perform the Work in accordance with the requirements of this
Contract at no additional cost to the Department.
2.5.2. Contractor shall ensure that all Other Personnel have sufficient training and experience to
complete all portions of the Work assigned to them. Contractor shall provide all necessary
training to its Other Personnel, except for State-provided training specifically described in
this Contract.
2.5.3. Contractor may subcontract to complete a portion of the Work required by the Contract. The
conditions for using a Subcontractor or Subcontractors are as follows:
Exhibit E-6,Contractor's Administrative Requirements Page 23 of 24
Docusign Envelope ID:881F36A8-242F-494F-AA6E-D95DFCDD35F5
2.5.3.1. Contractor shall not subcontract more than 40%of the Work.
2.5.3.2. Contractor shall provide the organizational name of each Subcontractor and all items to
be worked on by each Subcontractor to the Department for approval prior to
commencement of Work.
2.5.3.2.1. DELIVERABLE: Name of each Subcontractor, description of work being
completed, and percentage of work being completed by the Subcontractor.
2.5.3.2.2. DUE: Annually, by July 15th
2.5.3.3. Contractor shall notify the Department of any changes to Subcontractors within 10
Business Days of the change.
2.5.3.4. Contractor shall obtain prior consent and written approval for any use of Subcontractor(s).
Exhibit E-6,Contractor's Administrative Requirements Page 24 of 24
Contract Form
Entity Information
Entity Name* Entity ID* New Entity?
DEPARTMENT OF HEALTH CARE @00023890
POLICIES & FINANCIAL
Contract Name* Contract ID Parent Contract ID
DEPARTMENT OF HEALTH CARE POLICIES & FINANCIAL 10190 202401 21
AMENDMENT#5 TO THE INTERGOVERNMENTAL
AGREEMENT C24-188034 Contract Lead* Requires Board Approval
SADAMS YES
Contract Status
CTB REVIEW Contract Lead Email Department Project#
sadams@weld.gov;cobbx
xlk@weld.gov
Contract Description*
AMEND #6 TO THE CMA IGA UPDATES EXHIBIT B, C, D & E. CMA RFP AND AWARD (TYLER# 2023-0543),
AGREEMENT (2024-0121) AMEND #1(2024-1 535); AMEND #2 (2024-3344); AMEND #3 (2025-0557); AMEND #4
(2025-1396); AMEND #5 (2025-1488).
Contract Description 2
PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB IS 12/23/2025.
Contract Type* Department Requested BOCC Agenda Due Date
AMENDMENT HUMAN SERVICES Date* 12/27/2025
Amount* 1 2 r 31 ,202 5
Department Email
$0.00 CM- Will a work session with BOCC be required?*
HumanServices@weld.gov NO
Renewable*
NO Department Head Email Does Contract require Purchasing Dept. to be
CM-HumanServices- included?
Automatic Renewal
DeptHead@weld.gov
Grant
County Attorney
IGA GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date Review Date* Renewal Date
04/30/2026
Termination Notice Period Expiration Date*
Committed Delivery Date 06/30/2026
Contact Information
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH RUSTY WILLIAMS
BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
12/22/2025 12/22/2025 12/22/2025
Final Approval
BOCC Approved
Tyler Ref#
BOCC Signed Date AG 122925
BOCC Agenda Date Originator
SADAMS
1 2/29/2025
Hello