HomeMy WebLinkAbout20022779.tiff RESOLUTION
RE: APPROVE CONTRACT AMENDMENT#1 FOR SINGLE ENTRY POINT FOR FISCAL
YEAR 2002-2003 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#1 for Single
Entry Point Fiscal Year 2002-2003 between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Human Services, Area Agency on Aging, and the Colorado Department of Health Care Policy
and Financing, with 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#1 for Single Entry Point Fiscal Year 2002-
2003, between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency
on Aging, and the Colorado Department of Health Care Policy and Financing 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 above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 16th day of October, A.D., 2002.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ikt,/ (Il\) it EXCUSED
Gletud, Chair
Weld County Clerk to t
c
fiCe David E. .ng, Pro-Tem
BY:
Deputy Clerk to the =•a -
�� M. J. eile
9PPRO</EQ AS,TO FORM: i V „„v
� William H. Jerkke
oC unty Atmrr‘y CO ( . C\Nt --
Robert D. Masden
Date of signature:
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2002-2779
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CLIN 03.- a.RHA 001 12-
Agency or Department Name
Health Care Policy&Financing
Department or Agency Number
UHA
Contract Routing Number
0363-6190
CONTRACT AMENDMENT # 1
THIS AMENDMENT,made this 1st day of July 2002,by and between the State of Colorado for the use and benefit
of the Department of Health Care Policy and Financing, 1575 Sherman St.,Denver, CO 80203 hereinafter referred
to as the State, and Weld County Division of Human Services' Area Agency on Aging by and through the Weld
County Board of Commissioners, 1551 North 17th Avenue, P. O. Box 1805, Greeley, CO 80631, hereinafter
referred to as the contractor,
FACTUAL RECITALS
Authority exists in the Law and Funds have been budgeted, appropriated, and otherwise made available and a
sufficient unencumbered balance thereof remains available for payment in Fund Number 100, Appropriation Code
175,Contract Encumbrance Number5C LA-HA 73o3-1304;and
Required approval,clearance,and coordination has been accomplished from and with appropriate agencies; and
The parties entered into a contract dated 30th day of June 2002, for Contractor to serve as a district Single Entry
Point agency through provision of case management for clients in State community-based long term care programs.
The purpose for this amendment is described below.
This contract amendment addresses the adoption of regulations that provide authority for the Single Entry Point
contractors to provide assessment and utilization monitoring of long-term home health, except for clients under the
age of 18 years,which were effective July 1,2002.
This contract amendment is to amend the Contractor's scope of work and change the payment methodology.
NOW THEREFORE,it is hereby agreed that
1. Consideration for this amendment to the original contract,Contract Encumbrance number SCItHR 0363•43)V
Contract Routing Number 2303-1324,dated the 30th day of June, 2002,consists of the payments which shall be
made pursuant to this amendment and the promises and agreements herein set forth.
2. It is expressly agreed by the parties that this amendment is supplemental to the original Contract Routing
Number 2303-1324, dated 30th day of June 2002 referred to as the "original contract," which is, by this
reference, incorporated, and made a part hereof, and attached as exhibit H, and all terms, conditions, and
provisions thereof, unless specifically modified herein, are to apply to this amendment as though they were
expressly rewritten,incorporated,and included herein.
3. It is agreed the original contract is and shall be modified,altered, and changed in the following respects only:
a) Page 3 of 17,Paragraph E. (3)that is in the original contract:
Contractor shall review prior authorization requests for Medicaid funded Home Health Services for
Single Entry Point clients, except for clients enrolled in Medicaid HMOs. Contractor shall determine
compliance with Medicaid rules, and shall approve, deny or return the Prior Authorization Request to
the Home Health Agency for additional information. Contractor shall maintain a database that meets
Department requirements. The database shall be kept timely and accurate to within 14 days for all
Prior Authorization Reviews (PARS) for clients who receive skilled care approved by the contractor.
The contractor shall inform the Department of any significant increases in skilled services.
Page 1 of 8
,;tvaz-27.77
Is replaced by the paragraph:
Contractor shall review prior authorization requests and conduct a thorough assessment using the state
uniform assessment tool for Medicaid funded Long-Term Home Health Services, except for clients
under the age of 18 years. Contractor shall determine compliance with Medicaid rules, and shall
approve, deny or return the Prior Authorization Request to the Home Health Agency for additional
information. Contractor shall maintain a database that meets Department requirements. The database
shall be kept timely and accurate to within 14 days for all Prior Authorization Reviews (PARs) for
clients who receive skilled care approved by the contractor or denied skilled care by the contractor.
The contractor shall inform the Department of any significant increases in skilled services.
b) Page 3 of 17 Paragraph E. (4)that is in the original contract:
Prior to March 31, 2003, the Department shall monitor a representative sample of Single Entry Point
clients who are receiving Home and Community-Based Services non-skilled care services and those
receiving Home Health Services, except for clients enrolled in Medicaid HMOs. Based on standards
set by the Department and communicated to the contractor in training materials, the Department shall
monitor this sample to ascertain that clients are being approved by the contractor to receive only those
types and amounts of Medicaid-funded Home Health services and Home and Community-Based
services that do not exceed the types and amounts medically and/or functionally required by each
client and in compliance with Medicaid rules.
Is replaced by the paragraph:
The Department shall monitor a representative sample of Single Entry Point clients who are receiving
Home and Community-Based Services non-skilled care services and those receiving Long-Term Home
Health Services. Based on standards set by the Department and communicated to the contractor in
training materials, the Department shall monitor this sample to ascertain that clients are being
approved by the contractor to receive only those types and amounts of Medicaid-funded Long-Term
Home Health services and Home and Community-Based services that do not exceed the types and
amounts medically and/or functionally required by each client and in compliance with Medicaid rules.
c) Add to page 3 of 17 Paragraph E. (9)the following paragraphs.
(9)The Contractor shall maintain a complaint log. The complaint log shall include, at a minimum,the
complaint, the resolution, and the dates of contact. The complaint log shall be available for review by
the Department upon request. Complaints regarding quality of care issues against a provider shall be
forwarded to the Health Facilities Division within two business days.
d) Add to page 3 of 17 Paragraph E. (10)the following paragraph.
(10)The Contractor shall verify that each HCBS client has received a monthly service. If a client does
not receive a service for one month,the contractor shall notify the client of discontinuation and appeal
rights.
e) Page 3 of 17 Paragraph G that is in the original contract:
Contractor shall provide case management functions to recipients of publicly funded long term care
programs, including, but not limited to Medicaid nursing facility care, Home and Community-Based
Services for the Elderly, Blind and Disabled (HCBS-EBD), Home and Community-Based Services for
Persons Living with AIDS (HCBS-PLWA), Home and Community-Based Services for Persons with
Brain Injury (HCBS-BI), Home Care Allowance, Adult Foster Care, Consumer Directed Attendant
Support(CDAS),and certain in-home services available under the federal"Older Americans Act of 1965,
as amended". The authorization and administration of services through a publicly funded program shall
Page 2 of 8
be in accordance with the program's eligibility criteria, as defined by applicable state and federal statutes
and regulations, as they exist on the date this Contract is executed, and as they may later be amended.
Contractor shall cooperate with the Department and the community center boards in the admission of
clients with developmental disabilities to the Home and Community-Based Services for the Elderly,
Blind and Disabled Program.
Is replaced by the paragraph:
Contractor shall provide case management functions to recipients of publicly funded long term care
programs, including, but not limited to Medicaid nursing facility care, Home and Community-Based
Services for the Elderly, Blind and Disabled (HCBS-EBD), Home and Community-Based Services for
Persons Living with AIDS (HCBS-PLWA), Home and Community-Based Services for Persons with
Brain Injury (HCBS-BI), Home Care Allowance, Adult Foster Care, Consumer Directed Attendant
Support (CDAS), Long-Term Home Health and certain in-home services available under the federal
"Older Americans Act of 1965, as amended". The authorization and administration of services through a
publicly funded program shall be in accordance with the program's eligibility criteria, as defined by
applicable state and federal statutes and regulations, as they exist on the date this Contract is executed,
and as they may later be amended. Contractor shall cooperate with the Department and the community
center boards in the admission of clients with developmental disabilities to the Home and Community-
Based Services for the Elderly,Blind and Disabled Program.
f) Page 5 of 17 Paragraph 4 Price/Cost that is in the original contract:
The State shall reimburse the contractor's reasonable, allowable costs, as defined herein,not exceeding
$393,525 for work associated with the Scope of Work described under paragraph 2(a)above. Payment
to the contractor for activities associated with deinstitutionalization, described under paragraph 2(b)
above is described and established for the contractor in Exhibit B, hereby made a part of this contract.
The statewide liability of the Department for payment associated with deinstitutionalization, described
under paragraph 2(b) above is limited to the unspent amount remaining of$81,527 during the term of
this contract. Payment to the Contractor for activities associated with Consumer Directed Attendant
Support (CDAS), is described and established for the Contractor in Exhibit C, hereby made a part of
this contract. The statewide liability of the Department for payment associated with CDAS, is limited
to the unspent amount remaining of$149,250 during the term of this contract.
Payment pursuant to this Contract shall be made as earned, in whole or in part, from available state and
federal funds encumbered in an amount not to exceed$393,525 for the purchase of the within-described
services described under paragraph 2(a) above during the period, July 1, 2001 through June 30, 2002.
The specific methodology for calculating the payment to the contractor is described in Exhibit A and
Exhibit E which are attached to this contract and incorporated herein by reference. The liability of the
State, at any time, for such payments shall be limited to the unspent amount remaining of such
encumbered funds.
Is replaced by the following paragraphs:
The State shall reimburse the contractor's reasonable, allowable costs, as defined herein, not exceeding
$443,766 for work associated with the Scope of Work described under paragraph 2(a)above. Payment
to the contractor for activities associated with deinstitutionalization, described under paragraph 2(b)
above is described and established for the contractor in Exhibit B, hereby made a part of this contract.
The statewide liability of the Department for payment associated with deinstitutionalization, described
under paragraph 2(b) above is limited to the unspent amount remaining of$81,527 during the term of
this contract. Payment to the Contractor for activities associated with Consumer Directed Attendant
Support (CDAS), is described and established for the Contractor in Exhibit C, hereby made a part of
this contract. The statewide liability of the Department for payment associated with CDAS, is limited
to the unspent amount remaining of$149,250 during the term of this contract.
Page 3 of 8
Payment pursuant to this Contract shall be made as earned,in whole or in part, from available state and
federal finds encumbered in an amount not to exceed$443,766 for the purchase of the within-described
services described under paragraph 2(a) above during the period, July 1, 2002 through June 30, 2003.
These funds shall be distributed to the Contractor in twelve monthly payments. The liability of the State,
at any time, for such payments shall be limited to the unspent amount remaining of such encumbered
funds.
g) Page 5 of 17 Paragraph 5,first sentence that is in the original contract:
The Department shall pay reasonable, allocable,allowable costs of performance as provided in Exhibit
A,Exhibit B,Exhibit C and Exhibit E to this contract.
Is replaced by the paragraph:
The Department shall pay reasonable, allocable, allowable costs of performance as provided in this
contract.
h) Page 6 of 17,Paragraph 5 F that is in the original contract:
The State shall establish billing procedures and reimburse the Contractor in such amounts as may from
time to time be specified by the State pursuant to applicable federal and state statutes and regulations,
including the Colorado Medical Assistance Act Section 26-4-101 et. seq., C.R.S., as amended, and the
State Rules for the Long Tenn Care Single Entry Point System, as such statutes and rules currently exist
or may hereafter be amended. State funds shall be allocated to each Single Entry Point agency based on
the number of counties in a district and the average number of clients served in community-based care
programs in that district during each quarter of the contract term. The specific methodology for
calculating the payment to the contractor is described in Exhibit A and Exhibit E which are attached to
this contract and incorporated herein by reference.
Is replaced by the paragraph:
The State shall establish billing procedures and reimburse the Contractor in such amounts as may from
time to time be specified by the State pursuant to applicable federal and state statutes and regulations,
including the Colorado Medical Assistance Act Section 26-4-101 et. seq., C.R.S., as amended, and the
State Rules for the Long Term Care Single Entry Point System, as such statutes and rules currently exist
or may hereafter be amended. State funds shall be allocated to each Single Entry Point agency based on
the number of counties in a district and the average number of clients served in community-based care
programs in that district during each quarter of the contract term.
i) Page 6 of 17,Paragraph 5 I that is in the original contract:
The contractor shall be reimbursed an amount to equal the"annual rate"per client calculated as specified
in Exhibits A and E for each client for whom assessment has occurred,and who selects and is enrolled in
the Total Long Term Care program. This shall be achieved by the Contractor continuing to include the
referred client in their monthly client count through the remainder of the Performance Period of the
contract year in which the referral is made.
Is replaced by the paragraph:
The contractor shall be reimbursed an amount of$795.00 per client for each client for whom assessment
has occurred, and who selects and is enrolled in the Total Long Term Care program. This shall be
achieved by the Contractor submitting a monthly client list to be verified by Total Long Term Care.
j) Page 10 of 17,Paragraph 16,first sentence,that is in the original contract:
The State may prospectively increase or decrease the amount payable under this contract through a
Page 4 of 8
"Change Order Letter," approved by the State Controller or his designee, in the form attached hereto as
Exhibit D and provided for in Exhibit A,subject to the following conditions.
Is replaced by the sentence:
The State may prospectively increase or decrease the amount payable under this contract through a
"Change Order Letter," approved by the State Controller or his designee,in the form attached hereto as
Exhibit D,subject to the following conditions.
k) Page 10 of 17,Paragraph 16 B.that is in the original contract:
Upon proper execution and approval, such letter shall become an amendment to this contract and,
except for the general terms and conditions and Special Provisions of the contract, the letter shall
supersede the contract in the event of a conflict between the two. It is understood and agreed that the
letter may be used only for increased or decreased funding, and corresponding adjustments to service
levels and any budget line items. The process to increase or decrease the level of funding under this
contract is as specified in Exhibit A,Paragraph 11,to this contract.
Is replaced by the paragraph:
Upon proper execution and approval, such letter shall become an amendment to this contract and,
except for the general terms and conditions and Special Provisions of the contract, the letter shall
supersede the contract in the event of a conflict between the two. It is understood and agreed that the
letter may be used only for increased or decreased funding, and corresponding adjustments to service
levels and any budget line items.
I) Exhibit A, Methodology for Calculating Total Compensation and Monthly Payments to Contractor,
that is in the original contract is deleted.
m) Exhibit E,Performance Based Payment Methodology,that is in the original contract is deleted.
n) Attachment 1 to Exhibit E,Recommended List of Courses for Performance Based Qualification,that is
in the original contract is deleted.
o) The following is added to the original contract on Page 15 of 17 as Paragraph 36.
36. HIPAA Compliance
Contractor may receive or create certain health or medical information("Protected Health Information"
or "PHI," as defined below) in connection with the performance of this Contract. This PHI is subject
to protection under state and federal law, including the Health Insurance Portability and Accountability
Act of 1996,Public Law 104-191 ("HIPAA")and regulations, as amended,promulgated thereunder by
the U.S. Department of Health and Human Services (the "Regulations"). Unless otherwise defined
herein, all capitalized terms shall have the meaning given to them under HIPAA and its implementing
Regulations,as may be amended from time-to-time.
The State may be a"Covered Entity"under the Regulations,and Contractor's receipt or creation of PHI
from or on behalf of the State in connection with this Contract means that Contractor may be a
"Business Associate" of the State under the Regulations. Contractor represents and warrants that it has
in place policies and procedures that will adequately safeguard any PHI it receives or creates, and
Contractor specifically agrees, on behalf of its subcontractors and agents, to safeguard and protect the
confidentiality of PHI consistent with applicable law, including currently effective provisions of
HIPAA and the Regulations.
The parties acknowledge that state and federal laws relating to electronic data security and privacy for
PHI are rapidly evolving and that modification of this Contract may be required to provide for
Page 5 of 8
procedures to insure compliance with such developments. Contractor specifically agrees that such
compliance is within the scope of this contract and is a cost of doing Contractor's business. The
parties specifically agree that they will take such action as is necessary to implement the requirements
of HIPAA,the Regulations, and other applicable laws relating to the security or confidentiality of PHI
by any compliance date that may be established therein. The parties understand and agree that the
State must receive satisfactory written assurance from Contractor that it will adequately safeguard all
PHI that it receives from the State or that it creates or receives on behalf of the State. Upon the State's
written request, Contractor agrees promptly to enter into negotiations with the State concerning the
terms of an addendum to this contract embodying written assurances consistent with the requirements of HIPAA and the Regulations.
Notwithstanding any other provision of this Contract, the State may, in its sole discretion, terminate
this Contract upon thirty (30) days' notice in the event: (a) Contractor does not promptly enter into
negotiations to modify this Contract when requested by the State; or (b) Contractor does not execute
and deliver to the State an addendum to this Contract providing assurances and other covenants
regarding the safeguarding of PHI that the State, in its sole judgement, deems reasonably necessary or
appropriate to meet the requirements and standards of HIPAA and the Regulations ("HIPAA
Addendum").
In the event the parties cannot agree on the terms of the required HIPAA Addendum within a reasonable
period,but in any event not less than ninety(90)days prior to the applicable compliance dates,the State
reserves the right, in lieu of terminating the Contract, to unilaterally change this Contract to include
such reasonable HIPAA Addendum terms and conditions as are acceptable to the State. Contractor
agrees that such unilateral change will not invalidate this Contract, and that Contractor shall not be
entitled to any additional compensation from the State in order to comply with applicable provisions of
HIPAA,the Regulations,or any HIPAA Addendum.
Notwithstanding any other provision of this Contract, the State may immediately terminate this
Contract in the event: (a) Contractor, or any of its subcontractors or agents, uses or discloses PHI in a
manner that is not authorized by the State or by applicable law; (b) Contractor breaches any of the
provisions of this section; or (c) Contractor or any of its subcontractors or agents engages in any other
act or omission that is contrary to the obligations of a Business Associate or Covered Entity under any
currently effective applicable provision of HIPAA or the Regulations, or that otherwise prevents either
party from meeting the requirements of HIPAA, the HIPAA Regulations or other applicable law
concerning the security or confidentiality of PHI.
Upon termination of this Contract for any reason, Contractor shall return or destroy all PHI received
from the State (or created or received by Contractor on behalf of the State) that Contractor still
maintains in any from and shall retain no copies of such PHI. If return or destruction is not feasible,
Contractor shall notify the State, continue to extend the protections of this agreement and applicable
law to such information and limit further use of such PHI to those purposes that make the return or
destruction of PHI infeasible.
For purposes of this section, "Protected Health Information" means any information, whether oral or
recorded in any form or medium: (a)that relates to the past,present or future physical or mental health
or 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(b) that identifies the individual or with
respect to which there is a reasonable basis to believe the information can be use to identify the
individual.
This section shall be interpreted in a manner consistent with HIPAA,the Regulations and other state or
federal laws applicable to PHI. Nothing in this section is intended to create any third party rights or
third party beneficiary status. In the event of any conflict or inconsistency between the terms and
conditions of this section on HIPAA Compliance and any other provision of this Contract (with the
exception of the Colorado Special Provisions),the terms and conditions of this section shall control.
Page 6 of 8
4. The effective date of this amendment is July 1, 2002, or upon approval of the State Controller, whichever is
later.
5. Except for the "Special Provisions," in the event of any conflict, inconsistency, variance, or contradiction
between the provisions of this amendment and any of the provisions of the original contract, the provisions of
this amendment shall in all respects supersede, govern, and control. The "Special Provisions" shall always be
controlling over other provisions in the contract or amendments. The representations in the Special Provisions
concerning the absence of bribery or corrupt influences and personal interest of State employees are presently
reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR ARE
CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED, AND
OTHERWISE MADE AVAILABLE.
•
Page 7 of 8
IN WITNESS WHEREOF,the parties hereto have executed this amendment on the day fast above written.
Contractor: State of Colorado
Bill Owens,Gove or
Weld County Division of Human Services' Area
Agency on Aging by and through the Weld County 1
Board of Commissioners By: ktryt4/4/---
(Full al Name) • - Kare Reinertson
Executive Director
(Signatur Individu 1) DEPARTMENT OF HEALTH CARE
POLICY AND FINANCING
David E. Lon Pi-2. L-
(Name of Individual) Attorney General,Ken Salazar
Chair Pro—Tem (10/16/2002) (N EL_L By: --4,‹ 2<
Position(Title)
84-6000-813 Date: / 2-/z-c/o 2-
Social Security Number C f
or Federal Employer Identification Number 1&Ct /^*"" 61 - )k &�Gl
AAG az
Attestation �� / I '
, >,,
By: 'i Y �Sa �Aif• �, (SEAL)
ini bXaE[Sttdtl,`ait.lC
'�.i•y..fi ,;� P.a-.i� If q, J/ °I
Deputy Clerk to the
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State
Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance
until the contract is signed and dated below. If performance begins prior to the date below,the State of Colorado may
not be obligated to pay for goods and/or services provided.
State (
By: 4z7
Date: 0/ a 9 n ,
Page 8 of 8
,-..2602„.277,7
MEMORANDUM
a
fr
DATE: October 9, 2002 Glenn Vaad, Chair, Weld County Board ofWITO:1D .Commissioners \lY.)
COLORADO FROM: Walter Speckman, Executive Director, Division of Human
Services
SUBJECT: The Weld County Single Entry Amended Contract for
Fiscal Year 2002-2003
Enclosed for Board approval is an amended Single Entry Point Contract for Fiscal Year 2002-2003. The
Weld County Area Agency on Aging provides case management services for Medicaid clients who fall under
the responsibility of the Single Entry Point. This contract amendment increases our annual contract amount
from a maximum of $387,960 to $443,766. This increase is directly related to an increase of case
management duties required of the Single Entry Point and an increase of the number of clients who will fall
under the responsibility of the Single Entry Point.
If you have additional questions,please contact Eva Jewell, Director of the Weld County Area Agency on
Aging at 353-3800,extension 3331.
2002-2779
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