HomeMy WebLinkAbout20031482.tiff RESOLUTION
RE: APPROVE ONTRAC FOR EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND
TREATM T(EPSD SERVICES; HIPAA BUSINESS ASSOCIATE ADDENDUM; AND
ATTAC E HIPAA BUSINESS ASSOCIATE ADDENDUM, AND AUTHORIZE
CH SIGN
WHERE S, the
�pBoard
�of County Commissioners of Weld County, Colorado, pursuant to
Colorado statut and tpe-W9Id County Home Rule Charter, is vested with the authority of
admini ering t affai eld County, Colorado, and
WHE , the Board as b en presented with a Contract for the Early and Periodic
Screening, Diagno ' and Treat nt EPSDT Services Program; a HIPAA Business Associate
Addendum; and Attac ent A to the HIP us ess Associate Addendum between the County
of Weld, State of Colora by and thro gh the oard of Co/.Oy Commissioners of Weld County,
on behalf of the Weld Cou Departm tof Public Health`Snd Environment, and the Colorado
Department of Health Care Po • and Financing, com encing July 1, 2003, and ending June 30,
2004, with further terms and c ditions being stated in said contract, addendum, and
attachment, and 1(
WHEREAS,after review,the Board ems it advisable t pprove said contract,addendum,
and attachment, copies of which are attache ereto and inc rporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by e Board f Co nt mmissioners of Weld
County, Colorado,that the Contract for the Early and Pe 'odic Screenin , iagnosis and Treatment
(EPSDT) Services Program; a HIPAA Business Associ e Addend m; and Attachment A to the
HIPAA Business Associate Addendum between the Cou of Weld, St Colorado, by and
through the Board of County Commissioners of Weld Co ty, on beh I he Weld County
Department of Public Health and Environment,and the Colora Departme of Health Care Policy
and Financing be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, nd hereby i thorized to
sign said contract, addendum, and attachment.
2003-1482
HL0030
fin' /1/L (VA)
CONTRACT FOR EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT
SERVICES PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 9th day of June, A.D., 2003.
BOA OF COUNTY COMMISSIONERS
WEL OUNTY, COLORADO
ATTEST: iite#
vid E. Long, Ch it
Weld County Clerk tot At, -,
• �� Robert D. asden, Pro-Tem
BY: — G � '`� ►l
.•
Deputy Clerk to the Board''-
. J. Gel e
O DAST ( k A
Willis H. Jerke
ounty Attorney A4g
GI nn Vaa
Date of signature: 6(/ 8
2003-1482
HL0030
Health Care Policy and Financing
UHA
#2104-0134
CONTRACT
THIS CONTRACT, made this 21s` day of April, 2003, by and between the State of Colorado for
the use and benefit of the Department of Health Care Policy and Financing, 1570 Grant Street,
Denver, Colorado 80203, hereinafter referred to as the State, and Board of County
Commissioners of Weld County, 1555 North 17`h Avenue, Greeley, Colorado 80631,
hereinafter referred to as the Contractor.
WHEREAS, authority exists in the law and funds have been budgeted, appropriated and
otherwise made available and a sufficient unencumbered balance thereof remains available for
payment in the Colorado Financial Reporting Systems (COFRS) Fund Number 100,
Appropriation Code Number 169; and Encumbrance Number ;
WHEREAS, required approval, clearance and coordination has been accomplished from and
with appropriate agencies;
WHEREAS, 42 CFR Sections 441.61-441.61(b) requires that the State must make available a
variety of individual and group providers qualified and willing to provide Early and Periodic
Screening, Diagnosis and Treatment (EPSDT) services.
WHEREAS, Contractor shall assure the continued provision of the mandated Early and Periodic,
Screening, Diagnosis and Treatment (EPSDT) outreach and case management services in a
manner that is consistent with the most current federal regulations governing the conduct of
EPSDT benefits.
NOW THEREFORE, subject to the terms, conditions, provisions and limitations contained in
this contract, the State and the Contractor agree as follows:
I. DEFINITIONS
The following terms as used in this contract shall be construed and interpreted as follows unless
the context otherwise expressly requires a different construction and interpretation:
1. EPSDT Outreach and Case Management: The EPSDT outreach and case management
services provided by the EPSDT Outreach and Case Manager which are complementary to
the health care services provided by the Medicaid provider. The health care services are
aimed at the promotion of health, the prevention and treatment of disease and improved
access to health care services. The EPSDT service includes, but may not be limited to: (a)
contacting Medicaid-enrolled clients to provide in-depth explanation of EPSDT benefits
which are available; (b) offering assistance and information to the Medicaid-enrolled client
which will facilitate overcoming barriers that may impede the client's access to EPSDT
services; (c) clarifying the role of the primary care provider and, when appropriate, the
managed care/prepaid health plan, including Health Maintenance Organizations (HMOs);
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(d) promoting the client's responsibility to maintain the linkage between the child/youth and
the primary care physician; (e) maintaining annual periodic contact, as needed and feasible,
with the client to encourage the utilization of EPSDT services needed or promoted by
referrals and assisting with referrals as needed; (f) initiating collaborative activities with
other child-related health and social services agencies and resources within each county and
referring clients as needed to those agencies and resources; (g) promoting linkages with local
County Departments of Human/Social Services and presumptive eligibility sites, including,
but not limited to, assistance with the mandated EPSDT inform process as well as referrals to
the Enrollment Broker at the time of application for Medicaid.
2. Local Agency: The local health or alternative qualified agency designated by the State to
accomplish the EPSDT outreach and case management activities.
3. Provider Outreach: The responsibility of the EPSDT Outreach and Case Manager to work
with local Medicaid providers. This process may include: (a) identifying providers in a local
county or adjacent client accessible counties, who will deliver medical screening, diagnostic
and treatment services, dental, mental health, vision, hearing, or other services to the
Medicaid-enrolled client; (b) explaining to the providers the nature and importance of the
EPSDT benefits including the PCP referral requirement; (c)referring interested providers to
the coordinator of the Primary Care Physician Program at HCPF for assistance in acquiring
more information concerning the role of the primary care physician; (d) acting as a resource
to providers who have identified families in need assistance with EPSDT case management
services including community referrals; and (e) educating providers about the importance of
the completion of the screening component of the EPSDT claim form.
4. Special Supplemental Food Program for Women, Infants and Children (WIC): A
program providing supplemental food including exempt infant formulas and medical foods to
participants who have a diagnosed medical condition that precludes or restricts the use of
conventional foods.
II. SCOPE OF WORK
The Contractor, in accordance with the terms and conditions of this Contract, shall perform and
complete in a timely and satisfactory manner all EPSDT administrative case management,
outreach, and support services as more fully described in the EPSDT program guidelines, which
are incorporated herein by this reference, made a part hereof, and attached hereto as Attachment
A.
III. GENERAL PROVISIONS
1. Order of Precedence
In the event of conflicts or inconsistencies between this contract and its exhibits or
attachments, such conflicts or inconsistencies shall be resolved by reference to the
document in the following order of priority:
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1. Colorado Special Provisions, pages 15 and16.
2. Contract, pages 1 to 14.
2. Performance Period
The contract performance period is effective as of July 1, 2003 or upon approval by the State
Controller, whichever is later and shall be undertaken and performed in the sequence and manner
set forth in the scope of work and shall extend through June 30, 2004. At the end of that contract
period, the contract may be renewed for up to an additional four(4) years, giving a potential final
ending date of June 30, 2008. Such extensions shall be at the sole discretion of the State,
contingent upon funds being appropriated, budgeted, and otherwise made available and other
contractual requirements, if applicable, being satisfied. Future rate increases may be based on
such factors as contractor performance and/or cost of living increases.
3. Compensation/Maximum Payable
a. Payment pursuant to this contract will be made as earned, in whole or in part, from
available State funds encumbered in an amount not to exceed $119,850 in fiscal
year 2004, ending June 30, 2004, for the purchase of the within-described services.
4. Options (Performance Extension).
The State may require continued performance for a period of one year for any
services at the rates and terms specified in the contract. The State may exercise
the option by written notice to the contractor within 30 days prior to the end of the
current contract term in a form substantially equivalent to Exhibit A. If the State
exercises this option, the extended contract shall be considered to include this
option provision. The total duration of this contract, including the exercise of any
options under this clause, shall not exceed the performance period of the original
contract(July 1, 2003 through June 30, 2004), plus four (4) one year optional
extensions; thus the total performance period may not extend beyond June 30,
2008. Financial obligations of the State of Colorado payable after the current
fiscal year are contingent upon funds for that purpose being appropriated,
budgeted, and otherwise made available.
5. Billing/Payment Procedure
a. Unless otherwise provided, and where appropriate, the State shall establish billing
procedures and pay the Contractor the contract price or rate for services performed
and accepted pursuant to the terms of this contract, based on the submission of
statements on forms and in a manner prescribed by the State. Payments pursuant to
this contract shall be made as earned, in whole or in part, from available funds
encumbered for the purchase of the described services. The liability of the State, at
any time, for such payments shall be limited to the amount remaining of such
encumbered funds. Incorrect payments to the Contractor due
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to omission, error, fraud, or defalcation shall be recovered from the Contractor by
deduction from subsequent payment under this contract or other contracts between the
State and the Contractor, or by the State as a debt due to the State.
b. To receive compensation under this contract, the Contractor shall submit an
invoice monthly based on actual expenditures for period specified. A sample
invoice is incorporated herein by this reference, made a part hereof, and attached
hereto as "Attachment B". All invoices shall reference the related Contract by its
contract routing number; which shall appear on the first page of each document;
shall be based upon the costs of the work and services performed during the term
of this contract; and, shall be supplemented or accompanied by supporting data
and subcontractor invoices, if any, covering the work shown on the invoice.
6. Health Insurance Portability & Accountability Act of 1996 ("HIPAA").
Federal law governing the privacy of certain health information requires a"Business
Associate Contract" between the State and the Contractor. 45 CFR Section 164.504(e).
Attached and incorporated herein by reference is a HIPAA Business Associate
Addendum for HIPAA compliance.
7. Legal Authority
The Contractor warrants that it possesses the legal authority to enter into this contract and
that it has taken all actions required by its procedures, by-laws, and/or applicable laws to
exercise that authority, and to lawfully authorize its undersigned signatory to execute this
contract and to bind the Contractor to its terms. The person(s) executing this contract on
behalf of the Contractor warrant(s)that such person(s) have full authorization to execute
this contract.
8. Inspection and Acceptance
The State reserves the right to inspect services provided under this contract at all
reasonable times and places during the term of the contract. "Services" as used in this
clause include services performed or tangible material produced or delivered in the
performance of services. If any of the services do not conform with contract
requirements, the State may require the Contractor to perform the services again in
conformity with contract requirements, with no additional payment. When defects in the
quality or quantity of service cannot be corrected by reperformance, the State may (1)
require the Contractor to take necessary action to ensure that the future performance
conforms to contract requirements and (2) equitably reduce the payment due the
Contractor to reflect the reduced value of the services performed. These remedies in no
way limit the remedies available to the State in the termination provisions of this
contract, or remedies otherwise available at law.
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7. Remedies
In addition to any other remedies provided for in this contract, and without limiting its
remedies otherwise available at law, the State may exercise the following remedial
actions if the Contractor substantially fails to satisfy or perform the duties and obligations
in this contract. Substantial failure to satisfy the duties and obligations shall be defined to
mean significant insufficient, incorrect or improper performance, activities, or inaction by
the Contractor. These remedial actions are as follows:
a. Suspend Contractor's performance pending necessary corrective action as
specified by the State without Contractor's entitlement to adjustment in price/cost
or schedule; and/or
b. Withhold payment to Contractor until the necessary services or corrections in
performance are satisfactorily completed; and/or
c. Request the removal from work on the contract of employees or agents of the
Contractor whom the State justifies as being incompetent, careless, insubordinate,
unsuitable, or otherwise unacceptable, or whose continued employment on the
contract the State deems to be contrary to the public interest or not in the best
interest of the State; and/or
d. Deny payment for those services or obligations which have not been performed
and which, due to circumstances caused by Contractor, cannot be performed, or if
performed would be of no value to the State. Denial of the amount of payment
must be reasonably related to the value of work of performance lost to the State.
e. Terminate the contract for default.
The above remedies are cumulative and the State, in its sole discretion, may exercise any
or all of them individually or simultaneously.
8. Termination for Convenience
Either party may terminate this contract at any time. The terminating party shall effect
such termination by giving written notice of termination to the other party and specifying
the effective date thereof, at least twenty (20) days before the effective date of such
termination. In that event, all finished or unfinished documents, data, studies, surveys,
drawings, maps, models, photographs, and reports or other material prepared by the
Contractor under this contract shall, at the option of the State, become its property, and
the Contractor shall be entitled to receive just and equitable compensation for any
satisfactory services and supplies delivered.
If the contract is terminated as provided herein, the Contractor will be paid an amount
which bears the same ratio to the total compensation as the services satisfactorily
performed bear to the total services of the Contractor covered by this contract, less
payments of compensation previously made, provided, however, that if less than sixty
percent (60%) of the services covered by this contract have been performed upon the
effective date of such termination, the Contractor shall be reimbursed (in
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addition to the above payment) for that portion of the actual out-of-pocket expenses (not
otherwise reimbursed under this contract) incurred by the Contractor during the contract
period which are directly attributable to the uncompleted portion of the services covered
by this contract. In no event shall reimbursement under this clause exceed the contract
amount. If this contract is terminated for cause, or due to the fault of either party, the
Termination for Default/Cause provision shall apply.
9. Termination for Default/Cause
If, through any cause, either party shall fail to fulfill, in a timely and proper manner, its
obligations under this contract, or if either party shall violate any of the covenants,
agreements, or stipulations of this contract, the non-defaulting party shall thereupon have
the right to terminate this contract for cause by giving written notice to the defaulting
party of its intent to terminate and at least ten (10) days opportunity to cure the default or
show cause why termination is otherwise not appropriate. In the event of termination, all
finished or unfinished documents, data, studies, surveys, drawings, maps, models,
photographs, and reports or other material prepared by the Contractor under this contract
shall, at the option of the State, become its property, and the Contractor shall be entitled
to receive just and equitable compensation for any services and supplies delivered and
accepted. The Contractor shall be obligated to return any payment advanced under the
provisions of this contract.
Notwithstanding the above, the defaulting party shall not be relieved of liability to the
non-defaulting party for any damages sustained by virtue of any breach of the contract by
the defaulting party. In addition to other remedies the State may withhold any payment to
the Contractor for the purposes of mitigating its damages until such time as the exact
amount of damages due to the State from the Contractor is determined.
If after such termination it is determined, for any reason, that the defaulting party was not
in default, or that the defaulting party's action/inaction was excusable, such termination
shall be treated as a termination for convenience, and the rights and obligations of the
parties shall be the same as if the contract had been terminated for convenience, as
described herein.
10. Insurance
a. The Contractor shall obtain, and maintain at all times during the term of this
agreement, insurance in the following kinds and amounts:
1) Standard Worker's Compensation and Employer Liability as required by State statute,
including occupational disease, covering all employees on or off the work site, acting
within the course and scope of their employment.
2) General, Personal Injury, and Automobile Liability (including bodily injury, personal
injury, and property damage) minimum coverage:
a) Combined single limit of$600,000 if written on an occurrence basis.
b) Any aggregate limit will not be less than $1,000,000.
c) Combined single limit of$600,000 for policies written on a claims-made
basis. The policy shall include an endorsement, certificate, or
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other evidence that coverage extends two years beyond the
performance period of the contract.
d) If any aggregate limits are reduced below $600,000 because of claims made or
paid during the required policy period, the Contractor shall immediately
obtain additional insurance to restore the full aggregate limit and furnish a
certificate or other document showing compliance with this provision.
b. The State of Colorado shall be named as additional insured on all liability
policies.
c. The insurance shall include provisions preventing cancellation without 60 days
prior notice to the State by certified mail.
d. The Contractor shall provide certificates showing adequate insurance coverage to
the State within seven (7) working days of award or contract execution, unless
otherwise provided.
e. If the Contractor is a "public entity" within the meaning of the Colorado
Governmental Immunity Act, CRS 24-10-101, et seq., as amended ("Act"), the
Contractor shall at all times during the term of this contract maintain such liability
insurance, by commercial policy or self-insurance, as is necessary to meet its
liabilities under the Act. Upon request by the State, the Contractor shall show
proof of such insurance.
13. Representatives and Notice
a. Representatives. For the purpose of this contract, the individuals identified below
are hereby designated representatives of the respective parties. Either party may
from time to time designate in writing new or substitute representatives:
For the State:
Lynn Barnard Director, Health Benefits Division
Name 1 Rle
For the Contractor:
Judy Nero Business Manager
Name Title
b. Authority. With respect to the representative of the State, such individual shall
have the authority to inspect and reject services, approve invoices for payment,
and act otherwise for the State, except with respect to the execution of formal
amendments to or termination of this agreement pursuant to paragraphs 8, 9, 10
and 21.
c. Notices. All notices required to be given by the parties hereunder shall be hand
delivered or given by certified or registered mail to the individuals at the
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addresses set forth below. Either party may from time to time designate in
writing substitute addresses or persons to whom such notices shall be sent.
For the State:
Individuals Name: Lynn Barnard
Department and Division: Department of Health Care Policy and Financing, Health
Benefits Division
Address: 1570 Grant Street
Denver, CO 80203
For the Contractor:
Individuals Name: Judy Nero
Company Name: Weld County Department of Public Health&
Environment
Address: 1555 North 17`h Avenue
Greeley, CO 80631
14. Assignment and Successors
The Contractor agrees not to assign rights or delegate duties under this contract [or
subcontract any part of the performance required under the contract] without the express,
written consent of the State [which shall not be unreasonably withheld]. Except as herein
otherwise provided, this agreement shall inure to the benefit of, and be binding upon, the
parties hereto and their respective successors and assigns. This provision shall not be
construed to prohibit assignments of the right to payment to the extent permitted by Section
4-9-318,CRS,provided that written notice of assignment adequate to identify the rights
assigned is received by the controller for the agency,department,or institution executing
this contract. Such assignment shall not be deemed valid until receipt by such controller--
as distinguished from the State Controller-- and the Contractor assumes the risk that such
written notice of assignment is received by the controller for the agency,department,or
institution involved.
15. Force Majeure
Neither the Contractor nor the State shall be liable to the other for any delay in, or failure
of performance of, any covenant or promise contained in this contract, nor shall any delay
or failure constitute default or give rise to any liability for damages if, and only to the
extent that, such delay or failure is caused by "force majeure." As used in this contract
"force majeure"means acts of God; acts of the public enemy; acts of the State and any
governmental entity in its sovereign or contractual capacity; fires; floods; epidemics;
quarantine restrictions; strikes or other labor disputes; freight embargoes; or unusually
severe weather.
16. Third Party Beneficiaries
It is expressly understood and agreed that the enforcement of the terms and conditions of
this contract and all rights of action relating to such enforcement, shall be strictly
reserved to the State and the named Contractor. Nothing contained in this agreement
shall give or allow any claim or right of action whatsoever by any other third person. It is
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the express intention of the State and the Contractor that any such person or entity, other
than the State or the Contractor, receiving services or benefits under this agreement shall
be deemed an incidental beneficiary only.
17. Governmental Immunity
Notwithstanding any other provision of this [contract] to the contrary, no term or
condition of this contract shall be construed or interpreted as a waiver, express or
implied, of any of the immunities, rights, benefits, protection, or other provisions of the
Colorado Governmental Immunity Act, Section 24-10-101, et.seq., CRS, as now or
hereafter amended. The parties understand and agree that liability for claims for injuries
to persons or property arising out of negligence of the State of Colorado, its departments,
institutions, agencies, boards, officials and employees is controlled and limited by the
provisions of Section 24-10-101, et. seq., CRS, as now or hereafter amended and the risk
management statutes, Section 24-30-1501, et. seq., CRS, as now or hereafter amended.
18. Severability
To the extent that this contract may be executed and performance of the obligations of the
parties may be accomplished within the intent of the contract, the terms of this contract
are severable, and should any term or provision hereof be declared invalid or become
inoperative for any reason, such invalidity or failure shall not affect the validity of any
other term or provision hereof
19. Waiver
The waiver of any breach of a term, provision, or requirement of this contract shall not be
construed or deemed as waiver of any subsequent breach of such term, provision, or
requirement, or of any other term, provision, or requirement.
20. Entire Understanding
This contract is intended as the complete integration of all understandings between the
parties. No prior or contemporaneous addition, deletion, or other amendment hereto shall
have any force or effect whatsoever, unless embodied herein in writing. No subsequent
novation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a writing executed and approved pursuant to the State Fiscal
Rules.
21. Survival of Certain Contract Terms
Notwithstanding anything herein to the contrary, the parties understand and agree that all
terms and conditions of this contract and the exhibits and attachments hereto which may
require continued performance, compliance, or effect beyond the termination date of the
contract shall survive such termination date and shall be enforceable by the State as
provided herein in the event of such failure to perform or comply by the Contractor.
22. Modification and Amendment
This contract is subject to such modifications as may be required by changes in Federal
or State law, or their implementing regulations. Any such required modification shall
automatically be incorporated into and be part of this contract on the effective date of
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such change as if fully set forth herein. Except as provided above, no modification of this
contract shall be effective unless agreed to in writing by both parties in an amendment to
this contract that is properly executed and approved in accordance with applicable law.
23. Reporting
Unless otherwise provided, in service contracts having a performance term longer than
three (3) months, the Contractor shall submit, on a quarterly basis, a written program
report specifying progress made for each activity identified in the Contractor's duties and
obligations, regarding the performance of the contract. Such written analysis shall be in
accordance with the procedures developed and prescribed by the State. The preparation
of reports in a timely manner shall be the responsibility of the Contractor and failure to
comply may result in delay of payment of funds and/or termination of the contract.
Required reports shall be submitted to the State not later than the end of each calendar
quarter, or at such time as otherwise specified.
24. Confidentiality of Records
The Contractor shall protect the confidentiality of all records and other materials
containing personally identifying information that are maintained in accordance with the
contract. Except as provided by law, no information in possession of the Contractor
about any individual constituent shall be disclosed in a form including identifying
information without the prior written consent of the person in interest, a minor's parent,
or guardian. The Contractor shall have written policies governing access to, duplication
and dissemination of, all such information. The Contractor shall advise its employees,
agents and subcontractors, if any, that they are subject to these confidentiality
requirements. The Contractor shall provide its employees, agents and subcontractors, if
any, with a copy or written explanation of these confidentiality requirements before
access to confidential data is permitted.
25. COMPLIANCE WITH APPLICABLE LAW
The Contractor shall at all times during the execution of this contract strictly adhere to,
and comply with, all applicable Federal and State laws, and their implementing
regulations, as they currently exist and may hereafter be amended, which are
incorporated herein by this reference as terms and conditions of this contract. The
Contractor shall also require compliance with these statutes and regulations in
subcontracts and subgrants permitted under this contract. The Federal laws and
regulations include:
Age Discrimination Act of 1975 42 U.S.C. Sections 6101, et seq.
Age Discrimination in Employment 29 U.S.C. 621-634
Act of 1967
Americans with Disabilities Act 42 U.S.C. 12101, et seq.
of 1990 (ADA)
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Equal Pay Act of 1963 29 U.S.C. 206(d)
Immigration Reform and Control 8 U.S.C. 1324b
Act of 1986
Section 504 of the Rehabilitation 29 U.S.C. 794
Act of 1973
Title VI of the Civil Rights Act 42 U.S.C. 2000d
of 1964
Title VII of the Civil Rights Act 42 U.S.C. 2000e
of 1964
Title IX of the Education Amendment 20 U.S.C. 1681, et seq.
of 1972
Section 24-34-302, et seq., Colorado Revised Statutes 1997, as amended
The Contractor also shall comply with any and all laws and regulations prohibiting
discrimination in the specific program(s) which is/are the subject of this contract. In
consideration of and for the purpose of obtaining any and all Federal and/or State
financial assistance, the Contractor makes the following assurances, upon which the State
relies.
a. The Contractor will not discriminate against any person on the basis of race,
color, national origin, age, sex, religion and handicap, including Acquired
Immune Deficiency Syndrome (AIDS) or AIDS-related conditions, in
performance of work under this contract.
b. At all times during the performance of this contract, no qualified individual with a
disability shall, by reason of such disability, be excluded from participation in, or
denied benefits of the service, programs, or activities performed by the
Contractor, or be subjected to any discrimination by the Contractor.
The Contractor shall take all necessary affirmative steps, as required by 45 CFR 92.36(e)
and (Colorado Executive Order, Procurement Rules), to assure that small and minority
businesses and women's business enterprises are used, when possible, as sources of
supplies, equipment, construction, and services purchased under this contract.
26. Licenses, Permits, and Responsibilities
Contractor certifies that, at the time of entering into this contract, it has currently in effect
all necessary licenses, certifications, approvals, insurance, permits, etc. required to
properly perform the services and/or deliver the supplies covered by this contract. The
Contractor warrants that it will maintain all necessary licenses, certifications, approvals,
insurance, permits, etc. required to properly perform this contract, without reimbursement
by the State or other adjustment in contract price. Additionally, all employees of the
Contractor performing services under this contract shall hold the required licenses or
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certification, if any, to perform their responsibilities. The Contractor further certifies
that, if it is a foreign corporation or other entity, it currently has obtained and shall
maintain any applicable certificate of authority to do business in the State of Colorado
and has designated a registered agent in Colorado to accept service of process. Any
revocation, withdrawal or non-renewal of necessary licenses, certifications, approvals,
insurance, permits, etc. required for the Contractor to properly perform this contract, shall
be grounds for termination of this contract by the State for default.
27. Litigation Reporting
Unless otherwise provided, the Contractor shall promptly notify the State in the event that
the Contractor learns of any actual litigation in which it is a party defendant. The
Contractor, within ten (10) days after being served with a summons, complaint, or other
pleading in a case which involves services provided under this contract and which has
been filed in any Federal or State court or administrative agency, shall deliver copies of
such document to the representative designated in this contract, or in absence of such
designation, to the chief executive officer of the department, agency, or institution
executing this contract on behalf of the State.
28. Software Piracy Prohibition
No State or other public funds payable under this Contract shall be used for the
acquisition, operation or maintenance of computer software in violation of United States
copyright laws or applicable licensing restrictions. The Contractor hereby certifies that,
for the term of this Contract and any extensions, the Contractor has in place appropriate
systems and controls to prevent such improper use of public funds. If the State
determines that the Contractor is in violation of this paragraph, the State may exercise
any remedy available at law or equity or under this Contract, including, without
limitation, immediate termination of the Contract and any remedy consistent with United
States copyright laws or applicable licensing restrictions.
29. Venue
The parties agree that venue for any action related to performance of this contract shall be
in the City and County of Denver, Colorado.
30. Federal Funding
This contract is subject to and contingent upon the continuing availability of Federal
funds for the purposes hereof.
31. Maintenance of Records
The Contractor shall maintain a complete file of all records, documents, communications,
and other written materials which pertain to the operation of programs or the delivery of
services under this contract, and shall maintain such records for a period of three (3)
years after the date of termination of this contract or final payment hereunder, whichever
is later, or for such further period as may be necessary to resolve any matters which may
be pending, or until an audit has been completed with the following qualification: If an
audit by or on behalf of the federal and/or state government has begun but is not
completed at the end of the three (3) year period, or if audit findings have not been
Page 12 of 16
resolved after a three (3) year period, the materials shall be retained until the resolution of
the audit findings. All such records, documents, communications and other materials
shall be the property of the State, and shall be maintained by the Contractor in a central
location and the Contractor shall be custodian on behalf of the State.
32. Audit, Inspection of Records, and Monitoring
The Contractor shall permit the State, Federal Government, or any other duly authorized
agent of a governmental agency to audit, inspect, examine, excerpt, copy and/or
transcribe Contractor's records during the term of this contract and for a period of three
(3)years following termination of this contract or final payment hereunder, whichever is
later, to assure compliance with the terms hereof, or to evaluate the Contractor's
performance hereunder. The Contractor shall also permit these same described entities to
monitor all activities conducted by the Contractor pursuant to the terms of this contract.
As the monitoring agency may in its sole discretion deem necessary or appropriate, such
monitoring may consist of internal evaluation procedures, examination of program data,
special analyses, on-site checking, formal audit examinations, or any other reasonable
procedure. All such monitoring shall be performed in a manner that will not unduly
interfere with contract work.
33. Federal Audit Provisions
The Office of Management and Budget (OMB) Circular No. A-133 Audits of States,
Local Governments, and Non-Profit Organizations defines audit requirements under the
Single Audit Act of 1996 (Public Law 104-156). All state and local governments and
non-profit organizations expending $300,000 or more from all sources (direct or from
pass-through entities) are required to comply with the provisions of Circular No. A-133.
The Circular also requires pass-through entities to monitor the activities of subrecipients
and ensure that subrecipients meet the audit requirements. To identify its pass-through
responsibilities, the State of Colorado requires all subrecipients to notify the State when
expected or actual expenditures of federal assistance from all sources equal or exceed
$300,000.
34. Conflict of Interest
a. During the term of this contract, the Contractor shall not engage in any business
or personal activities or practices or maintain any relationships which conflict in
any way with the Contractor fully performing his/her obligations under this
contract.
b. Additionally,the Contractor acknowledges that, in governmental contracting,
even the appearance of a conflict of interest is harmful to the interests of the State.
Thus, the Contractor agrees to refrain from any practices, activities or
relationships which could reasonably be considered to be in conflict with the
Contractor's fully performing his/her obligations to the State under the terms of
this contract, without the prior written approval of the State.
Page 13 of 16
c. In the event that the Contractor is uncertain whether the appearance of a conflict
of interest may reasonably exist, the Contractor shall submit to the State a full
disclosure statement setting forth the relevant details for the State's consideration
and direction. Failure to promptly submit a disclosure statement or to follow the
State's direction in regard to the apparent conflict shall be grounds for termination
of the contract.
d. The Contractor(and subcontractors or subgrantees permitted under the terms of
this contract) shall maintain a written code of standards governing the
performance of its employees engaged in the award and administration of
contracts. No employee, officer or agent of the Contractor, subcontractor, or
subgrantee shall participate in the selection, or in the award or administration of a
contract or subcontract supported by Federal funds if a conflict of interest, real or
apparent, would be involved. Such a conflict would arise when:
1. The employee, officer or agent;
2. Any member of the employee's immediate family;
3. The employee's partner; or
4. An organization which employs, or is about to employ, any of the
above, has a financial or other interest in the firm selected for award. The
Contractor's, subcontractor's, or subgrantee's officers, employees, or
agents will neither solicit nor accept gratuities, favors, or anything of
monetary value from Contractors, potential Contractors, or parties to sub-
agreements
Page 14 of 16
SPECIAL PROVISIONS
(For Use Only with Inter-Governmental Contracts)
1. CONTROLLER'S APPROVAL. CRS 24-30-202(1)
This contract shall not be deemed valid until it has been approved by the Controller of the State of Colorado or
such assistant as he may designate.
2. FUND AVAILABILITY. CRS 24-30-202 (5.5)
Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for
that purpose being appropriated,budgeted,and otherwise made available.
3. INDEMNIFICATION.
Indemnity: The contractor shall indemnify, save, and hold harmless the State against any and all claims,
damages, liability and court awards including costs, expenses, and attorney fees incurred as a result of any act
or omission by the Contractor, or its employees, agents, subcontractors, or assignees pursuant to the terms of
this contract.
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of
the immunities, rights, benefits, protection, or other provisions for the parties, of the Colorado Governmental
Immunity Act, Section 24-10-101 et seq. C.R.S. or the Federal Tort Claims Act, 28 U.S.C. 2671 et seq. as
applicable,as now or hereafter amended.
4. INDEPENDENT CONTRACTOR. 4 CCR 801-2
THE CONTRACTOR SHALL PERFORM ITS DUTIES HEREUNDER AS AN INDEPENDENT CONTRACTOR AND NOT AS AN
EMPLOYEE. NEITHER THE CONTRACTOR NOR ANY AGENT OR EMPLOYEE OF THE CONTRACTOR SHALL BE OR
SHALL BE DEEMED TO BE AN AGENT OR EMPLOYEE OF THE STATE. CONTRACTOR SHALL PAY WHEN DUE ALL
REQUIRED EMPLOYMENT TAXES AND INCOME TAX AND LOCAL HEAD TAX ON ANY MONIES PAID BY THE STATE
PURSUANT TO THIS CONTRACT. CONTRACTOR ACKNOWLEDGES THAT THE CONTRACTOR AND ITS EMPLOYEES ARE
NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS THE CONTRACTOR OR THIRD PARTY PROVIDES
SUCH COVERAGE AND THAT THE STATE DOES NOT PAY FOR OR OTHERWISE PROVIDE SUCH COVERAGE.
CONTRACTOR SHALL HAVE NO AUTHORIZATION, EXPRESS OR IMPLIED,TO BIND THE STATE TO ANY AGREEMENTS,
LIABILITY, OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH HEREIN. CONTRACTOR SHALL PROVIDE AND
KEEP IN FORCE WORKERS' COMPENSATION(AND PROVIDE PROOF OF SUCH INSURANCE WHEN REQUESTED BY THE
STATE) AND UNEMPLOYMENT COMPENSATION INSURANCE IN THE AMOUNTS REQUIRED BY LAW, AND SHALL BE
SOLELY RESPONSIBLE FOR THE ACTS OF THE CONTRACTOR,ITS EMPLOYEES AND AGENTS.
5. NON-DISCRIMINATION.
The contractor agrees to comply with the letter and the spirit of all applicable state and federal laws respecting
discrimination and unfair employment practices.
6. CHOICE OF LAW.
The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the
interpretation, execution, and enforcement of this contract. Any provision of this contract, whether or not
incorporated herein by reference,which provides for arbitration by any extra judicial body or person or which is
otherwise in conflict with said laws,rules, and regulations shall be considered null and void. Nothing contained
in any provision incorporated herein by reference which purports to negate this or any other special provision in
whole or in part shall be valid or enforceable or available in any action at law whether by way of complaint,
defense, or otherwise. Any provision rendered null and void by the operation of this provision will not
invalidate the remainder of this contract to the extent that the contract is capable of execution.
At all times during the performance of this contract,the Contractor shall strictly adhere to all applicable federal
and state laws,rules,and regulations that have been or may hereafter be established.
7. EMPLOYEE FINANCIAL INTEREST. CRS 24-18-201 &CRS 24-50-507
The signatories aver that to their knowledge, no employee of the State of Colorado has any personal or
beneficial interest whatsoever in the service or property described herein.
Revised 12/1/01
HCPF LAN VERSION. 12/1/01 Page 15 of 16
SPECIAL PROVISIONS
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
CONTRACTOR: STATE OF COLORADO:
BILL OWENS,GOVERNOR
Board of County Commissioners of Weld County By
Legal Name of Contracting Entity - Karen Reinertson,Executive Director
Department of Health Care Policy and Financing
84-6000-813
Social Security Number or FEIN
•
LEGAL REVIEW:
Signature of Authorize t r Ken Salazar,ATTORNEY GENERAL
David E. Long, Chair (06/09/03) By
Print Name&Title of Authorized Officer
•
CORPORATIONS: WELD COUNTY DEPARTMENT OF
(A corporate seal or attestation is required.) PUBLIC,,H,E,A,LIT,H<Ai5 ' t(V V ('`d ME T BY:Iails
Mark E. Wallace. MD, MPH-Director
Attest:
Clerk to the Board•
4
4l �1
Attest(Seal)By
Deputy Clerk to L�, :T' S` ` �►�
ALL CONTRACTS MUST BEw'i D 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 the goods and/or services provided.
STATE CONTROLLER:
Arthur L.Bamhart
. By
Date
Revised 12/1/01
HCPF LAN VERSION, 12/1/01 Page 16 of 16
/9'a
HIPAA BUSINESS ASSOCIATE ADDENDUM
This Business Associate Addendum ("Addendum") is a part of the Contract dated April
21, 2003 between the Colorado Department of Health Care Policy and Financing and Board of
County Commissioners of Weld County, contract number 2104-0134. For purposes of this
Addendum, the State is referred to as "Covered Entity" or"CE" and the Contractor is referred to
as "Associate"). Unless the context clearly requires a distinction between the Contract document
and this Addendum, all references herein to "the Contract" or"this Contract" include this
Addendum.
RECITALS
A. CE wishes to disclose certain information to Associate pursuant to the terms of the
Contract, some of which may constitute Protected Health Information("PHI") (defined
below).
B. CE and Associate intend to protect the privacy and provide for the security of PHI
disclosed to Associate pursuant to this Contract in compliance with the Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191 ("HIPAA") and
regulations promulgated thereunder by the U.S. Department of Health and Human
Services (the "HIPAA Regulations") and other applicable laws, as amended.
C. As part of the HIPAA Regulations, the Privacy Rule(defined below) requires CE to enter
into a contract containing specific requirements with Associate prior to the disclosure of
PHI, as set forth in, but not limited to, Title 45, Sections 160.103, 164.502(e) and
164.504(e) of the Code of Federal Regulations ("CFR") and contained in this Addendum.
The parties agree as follows:
1. Definitions.
a. Except as otherwise defined herein, capitalized terms in this Addendum shall have
the definitions set forth in the HIPAA Privacy Rule at 45 CFR Parts 160 and 164, as amended
("Privacy Rule"). In the event of any conflict between the mandatory provisions of the Privacy
Rule and the provisions of this Contract, the Privacy Rule shall control. Where the provisions of
this Contract differ from those mandated by the Privacy Rule, but are nonetheless permitted by
the Privacy Rule,the provisions of this Contract shall control.
b. "Protected Health Information" or"PHI" means any information, whether oral or
recorded in any form or medium: (i) that relates to the past, present or 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, and shall have the meaning given to such term under the Privacy
Rule, including, but not limited to, 45 CFR Section 164.501.
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c. "Protected Information" shall mean PHI provided by CE to Associate or created
or received by Associate on CE's behalf.
2. Obligations of Associate.
a. Permitted Uses. Associate shall not use Protected Information except for the
purpose of performing Associate's obligations under this Contract and as permitted under this
Addendum. Further, Associate shall not use Protected Information in any manner that would
constitute a violation of the Privacy Rule if so used by CE, except that Associate may use
Protected Information: (i) for the proper management and administration of Associate; (ii) to
carry out the legal responsibilities of Associate; or(iii) for Data Aggregation purposes for the
Health Care Operations of CE. Additional provisions, if any, governing permitted uses of
Protected Information are set forth in Attachment A to this Addendum.
b. Permitted Disclosures. Associate shall not disclose Protected Information in any
manner that would constitute a violation of the Privacy Rule if disclosed by CE, except that
Associate may disclose Protected Information: (i) in a manner permitted pursuant to this
Contract; (ii) for the proper management and administration of Associate; (iii) as required by
law; (iv) for Data Aggregation purposes for the Health Care Operations of CE; or (v) to report
violations of law to appropriate federal or state authorities, consistent with 45 CFR Section
502(j)(1). To the extent that Associate discloses Protected Information to a third party, Associate
must obtain, prior to making any such disclosure: (i) reasonable assurances from such third party
that such Protected Information will be held confidential as provided pursuant to this Addendum
and only disclosed as required by law or for the purposes for which it was disclosed to such third
party; and (ii) an agreement from such third party to notify Associate within two (2) business
days of any breaches of confidentiality of the Protected Information, to the extent it has obtained
knowledge of such breach. Additional provisions, if any, governing permitted disclosures of
Protected Information are set forth in Attachment A.
c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are
necessary to prevent the use or disclosure of Protected Information other than as permitted by
this Contract. Associate shall maintain a comprehensive written information privacy and
security program that includes administrative, technical and physical safeguards appropriate to
the size and complexity of the Associate's operations and the nature and scope of its activities.
d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing
any use or disclosure of Protected Information other than as provided for by this Contract within
five (5) business days of becoming aware of such use or disclosure.
e. Associate's Agents. If Associate uses one or more subcontractors or agents to
provide services under the Contract, and such subcontractors or agents receive or have access to
Protected Information, each subcontractor or agent shall sign an agreement with Associate
containing substantially the same provisions as this Addendum and further identifying CE as a
third party beneficiary with rights of enforcement and indemnification from such subcontractors
or agents in the event of any violation of such subcontractor or agent agreement. Associate shall
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implement and maintain sanctions against agents and subcontractors that violate such restrictions
and conditions and shall mitigate the effects of any such violation.
f. Access to Protected Information. Associate shall make Protected Information
maintained by Associate or its agents or subcontractors in Designated Record Sets available to
CE for inspection and copying within ten (10)business days of a request by CE to enable CE to
fulfill its obligations to permit individual access to PHI under the Privacy Rule, including, but
not limited to, 45 CFR Section 164.524.
g. Amendment of PHI. Within ten (10) business days of receipt of a request from
CE for an amendment of Protected Information or a record about an individual contained in a
Designated Record Set, Associate or its agents or subcontractors shall make such Protected
Information available to CE for amendment and incorporate any such amendment to enable CE
to fulfill its obligations with respect to requests by individuals to amend their PHI under the
Privacy Rule, including, but not limited to, 45 CFR Section 164.526. If any individual requests
an amendment of Protected Information directly from Associate or its agents or subcontractors,
Associate must notify CE in writing within five (5) business days of receipt of the request. Any
denial of amendment of Protected Information maintained by Associate or its agents or
subcontractors shall be the responsibility of CE.
h. Accounting Rights. Within ten (10) business days of notice by CE of a request
for an accounting of disclosures of Protected Information, Associate and its agents or
subcontractors shall make available to CE the information required to provide an accounting of
disclosures to enable CE to fulfill its obligations under the Privacy Rule, including, but not
limited to, 45 CFR Section 164.528. As set forth in, and as limited by, 45 CFR Section 164.528,
Associate shall not provide an accounting to CE of disclosures: (i)to carry out treatment,
payment or health care operations, as set forth in 45 CFR Section 164.506; (ii) to individuals of
Protected Information about them as set forth in 45 CFR Section 164.502; (iii) pursuant to an
authorization as provided in 45 CFR Section 164.508; (iv)to persons involved in the individual's
care or other notification purposes as set forth in 45 CFR Section 164.510; (v) for national
security or intelligence purposes as set forth in 45 CFR Section 164.512(k)(2); or(vi) to
correctional institutions or law enforcement officials as set forth in 45 CFR Section
164.512(k)(5). Associate agrees to implement a process that allows for an accounting to be
collected and maintained by Associate and its agents or subcontractors for at least six (6) years
prior to the request, but not before the compliance date of the Privacy Rule. At a minimum, such
information shall include: (i)the date of disclosure; (ii)the name of the entity or person who
received Protected Information and, if known, the address of the entity or person; (iii) a brief
description of Protected Information disclosed; and (iv) a brief statement of purpose of the
disclosure that reasonably informs the individual of the basis for the disclosure, or a copy of the
individual's authorization, or a copy of the written request for disclosure. In the event that the
request for an accounting is delivered directly to Associate or its agents or subcontractors,
Associate shall within five (5) business days of the receipt of the request forward it to CE in
writing. It shall be CE's responsibility to prepare and deliver any such accounting requested.
Associate shall not disclose any Protected Information except as set forth in Section 2(b) of this
Addendum.
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i. Governmental Access to Records. Associate shall make its internal practices,
books and records relating to the use and disclosure of Protected Information available to the
Secretary of the U.S. Department of Health and Human Services (the "Secretary"), in a time and
manner designated by the Secretary, for purposes of determining CE's compliance with the
Privacy Rule. Associate shall provide to CE a copy of any Protected Information that Associate
provides to the Secretary concurrently with providing such Protected Information to the
Secretary.
j. Minimum Necessary. Associate (and its agents or subcontractors) shall only
request, use and disclose the minimum amount of Protected Information necessary to accomplish
the purpose of the request, use or disclosure, in accordance with the Minimum Necessary
requirements of the Privacy Rule including, but not limited to 45 CFR Sections 164.502(b) and
164.514(d).
k. Data Ownership. Associate acknowledges that Associate has no ownership rights
with respect to the Protected Information.
1. Retention of Protected Information. Notwithstanding Section 4(d) of this
Addendum, Associate and its subcontractors or agents shall retain all Protected Information
throughout the term of this Contract and shall continue to maintain the information required
under Section 2(h) of this Addendum for a period of six (6) years after termination of the
Contract.
at. Associate's Insurance. In addition to any insurance requirements in the Contract,
Associate shall maintain casualty and liability insurance to cover loss of PHI data and claims
based upon alleged violations of privacy rights through improper use or disclosure of PHI. All
such policies shall meet or exceed the minimum insurance requirements of the Contract(e.g.,
occurrence basis, combined single dollar limits, annual aggregate dollar limits, additional insured
status and notice of cancellation). Associate shall use its best efforts to procure such insurance
within six (6) months from the effective date of this Addendum.
n. Notification of Breach. During the term of this Contract, Associate shall notify
CE within twenty-four (24) hours of any suspected or actual breach of security, intrusion or
unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in
violation of any applicable federal or state laws or regulations. Associate shall take (i) prompt
corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized
disclosure required by applicable federal and state laws and regulations.
o. Audits, Inspection and Enforcement. Within ten (10)business days of a written
request by CE, Associate and its agents or subcontractors shall allow CE to conduct a reasonable
inspection of the facilities, systems, books, records, agreements, policies and procedures relating
to the use or disclosure of Protected Information pursuant to this Addendum for the purpose of
determining whether Associate has complied with this Addendum; provided, however, that: (i)
Associate and CE shall mutually agree in advance upon the scope, timing and location of such an
inspection; (ii) CE shall protect the confidentiality of all confidential and proprietary information
of Associate to which CE has access during the course of such inspection; and (iii) CE shall
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execute a nondisclosure agreement, upon terms mutually agreed upon by the parties, if requested
by Associate. The fact that CE inspects, or fails to inspect, or has the right to inspect,
Associate's facilities, systems, books, records, agreements, policies and procedures does not
relieve Associate of its responsibility to comply with this Addendum, nor does CE's (i) failure to
detect or(ii) detection, but failure to notify Associate or require Associate's remediation of any
unsatisfactory practices, constitute acceptance of such practice or a waiver of CE's enforcement
rights under the Contract.
p. Safeguards During Transmission. Associate shall be responsible for using
appropriate safeguards to maintain and ensure the confidentiality, privacy and security of
Protected Information transmitted to CE pursuant to the Contract, in accordance with the
standards and requirements of the Privacy Rule, until such Protected Information is received by
CE, and in accordance with any specifications set forth in Attachment A.
3. Obligations of CE.
a. Safeguards During Transmission. CE shall be responsible for using appropriate
safeguards to maintain and ensure the confidentiality, privacy and security of PHI transmitted to
Associate pursuant to this Contract, in accordance with the standards and requirements of the
Privacy Rule, until such PHI is received by Associate, and in accordance with any specifications
set forth in Attachment A.
b. Notice of Changes. CE shall provide Associate with a copy of its notice of
privacy practices produced in accordance with 45 CFR Section 164.520, as well as any
subsequent changes or limitation(s) to such notice, to the extent such changes or limitations may
effect Associate's use or disclosure of Protected Information. CE shall provide Associate with
any changes in, or revocation of, permission to use or disclose Protected Information, to the
extent it may affect Associate's permitted or required uses or disclosures. To the extent that it
may affect Associate's permitted use or disclosure of PHI, CE shall notify Associate of any
restriction on the use or disclosure of Protected Information that CE has agreed to in accordance
with 45 CFR Section 164.522. CE may effectuate any and all such notices of non-private
information via posting on CE's web site. Associate shall monitor CE's designated web site for
notice of changes to CE's HIPAA privacy policies and practices on the last day of each calendar
quarter.
4. Termination.
a. Material Breach. In addition to any other provisions in the Contract regarding
breach, a breach by Associate of any provision of this Addendum, as determined by CE, shall
constitute a material breach of this Contract and shall provide grounds for immediate termination
of this Contract by CE pursuant to the provisions of the Contract covering termination for cause,
if any. If the Contract contains no express provisions regarding termination for cause, the
following terms and conditions shall apply:
(1) Default. If Associate refuses or fails to timely perform any of the
provisions of this Contract, CE may notify Associate in writing of the non-performance, and if
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not promptly corrected within the time specified, CE may terminate this Contract. Associate
shall continue performance of this Contract to the extent it is not terminated and shall be liable
for excess costs incurred in procuring similar goods or services elsewhere.
(2) Associate's Duties. Notwithstanding termination of this Contract, and
subject to any directions from CE, Associate shall take timely, reasonable and necessary action
to protect and preserve property in the possession of Associate in which CE has an interest.
(3) Compensation. Payment for completed supplies delivered and accepted
by CE shall be at the Contract price. In the event of a material breach under paragraph 4a, CE
may withhold amounts due Associate as CE deems necessary to protect CE against loss from
third party claims of improper use or disclosure and to reimburse CE for the excess costs
incurred in procuring similar goods and services elsewhere.
(4) Erroneous Termination for Default. If after such termination it is
determined, for any reason, that Associate was not in default, or that Associate's action/inaction
was excusable, such termination shall be treated as a termination for convenience, and the rights
and obligations of the parties shall be the same as if this Contract had been terminated for
convenience, as described in this Contract.
b. Reasonable Steps to Cure Breach. If CE knows of a pattern of activity or practice
of Associate that constitutes a material breach or violation of the Associate's obligations under
the provisions of this Addendum or another arrangement and does not terminate this Contract
pursuant to Section 4(a), then CE shall take reasonable steps to cure such breach or end such
violation, as applicable. If CE's efforts to cure such breach or end such violation are
unsuccessful, CE shall either(i) terminate the Contract, if feasible or (ii) if termination of this
Contract is not feasible, CE shall report Associate's breach or violation to the Secretary of the
Department of Health and Human Services.
c. Judicial or Administrative Proceedings. Either party may terminate the
Contract, effective immediately, if(i)the other party is named as a defendant in a criminal
proceeding for a violation of HIPAA, the HIPAA Regulations or other security or privacy laws
or (ii) a finding or stipulation that the other party has violated any standard or requirement of
HIPAA, the HIPAA Regulations or other security or privacy laws is made in any administrative
or civil proceeding in which the party has been joined.
d. Effect of Termination.
(1) Except as provided in paragraph (2) of this subsection, upon termination
of this Contract, for any reason, Associate shall return or destroy all Protected Information that
Associate or its agents or subcontractors still maintain in any form, and shall retain no copies of
such Protected Information. If Associate elects to destroy the PHI, Associate shall certify in
writing to CE that such PHI has been destroyed.
(2) If Associate believes that returning or destroying the Protected
Information is not feasible, Associate shall promptly provide CE notice of the conditions making
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return or destruction infeasible. Upon mutual agreement of CE and Associate that return or
destruction of Protected Information is infeasible, Associate shall continue to extend the
protections of Sections 2(a), 2(b), 2(c), 2(d) and 2(e) of this Addendum to such information, and
shall limit further use of such PHI to those purposes that make the return or destruction of such
PHI infeasible.
5. Injunctive Relief. CE shall have the right to injunctive and other equitable and legal
relief against Associate or any of its subcontractors or agents in the event of any use or
disclosure of Protected Information in violation of this Contract or applicable law.
6. No Waiver of Immunity. No term or condition of this Contract shall be construed or
interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection,
or other provisions of the Colorado Governmental Immunity Act, CRS 24-10-101 et seq. or the
Federal Tort Claims Act, 28 U.S.C. 2671 et seq. as applicable, as now in effect or hereafter
amended.
7. Limitation of Liability. Any limitation of Associate's liability in the Contract shall be
inapplicable to the terms and conditions of this Addendum.
8. Disclaimer. CE makes no warranty or representation that compliance by Associate with
this Contract, HIPAA or the HIPAA Regulations will be adequate or satisfactory for Associate's
own purposes. Associate is solely responsible for all decisions made by Associate regarding the
safeguarding of PHI.
9. Certification. To the extent that CE determines an examination is necessary in order to
comply with CE's legal obligations pursuant to HIPAA relating to certification of its security
practices, CE or its authorized agents or contractors, may, at CE's expense, examine Associate's
facilities, systems, procedures and records as may be necessary for such agents or contractors to
certify to CE the extent to which Associate's security safeguards comply with HIPAA, the
HIPAA Regulations or this Addendum.
10. Amendment.
a. Amendment to Comply with Law. The parties acknowledge that state and federal
laws relating to data security and privacy are rapidly evolving and that amendment of this
Addendum may be required to provide for procedures to ensure compliance with such
developments. The parties specifically agree to take such action as is necessary to implement the
standards and requirements of HIPAA, the Privacy Rule and other applicable laws relating to the
security or privacy of PHI. The parties understand and agree that CE must receive satisfactory
written assurance from Associate that Associate will adequately safeguard all Protected
Information. Upon the request of either party, the other party agrees to promptly enter into
negotiations concerning the terms of an amendment to this Addendum embodying written
assurances consistent with the standards and requirements of HIPAA, the Privacy Rule or other
applicable laws. CE may terminate this Contract upon thirty (30) days written notice in the event
(i) Associate does not promptly enter into negotiations to amend this Contract when requested by
CE pursuant to this Section or(ii) Associate does not enter into an amendment to this Contract
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providing assurances regarding the safeguarding of PHI that CE, in its sole discretion, deems
sufficient to satisfy the standards and requirements of HIPAA and the Privacy Rule.
b. Amendment of Attachment A. Attachment A may be modified or amended by
mutual agreement of the parties in writing from time to time without formal amendment of this
Addendum.
11. Assistance in Litigation or Administrative Proceedings. Associate shall make itself, and
any subcontractors, employees or agents assisting Associate in the performance of its obligations
under the Contract, available to CE, at no cost to CE up to a maximum of thirty (30) hours, to
testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being
commenced against CE, its directors, officers or employees based upon a claimed violation of
HIPAA, the Privacy Rule or other laws relating to security and privacy or PHI, except where
Associate or its subcontractor, employee or agent is a named adverse party.
12. No Third Party Beneficiaries. Nothing express or implied in this Contract is intended to
confer, nor shall anything herein confer, upon any person other than CE, Associate and their
respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.
13. Interpretation and Order of Precedence. The provisions of this Addendum shall prevail
over any provisions in the Contract that may conflict or appear inconsistent with any provision in
this Addendum. Together, the Contract and this Addendum shall be interpreted as broadly as
necessary to implement and comply with HIPAA and the Privacy Rule. The parties agree that
any ambiguity in this Contract shall be resolved in favor of a meaning that complies and is
consistent with HIPAA and the Privacy Rule. This Contract supercedes and replaces any
previous separately executed HIPAA addendum between the parties.
14. Survival of Certain Contract Terms. Notwithstanding anything herein to the contrary,
Associate's obligations under Section 4(d) ("Effect of Termination") and Section 12 ("No Third
Party Beneficiaries") shall survive termination of this Contract and shall be enforceable by CE as
provided herein in the event of such failure to perform or comply by the Associate.
15. Representatives and Notice.
a. Representatives. For the purpose of the Contract, the individuals identified
elsewhere in this Contract shall be the representatives of the respective parties. If no
representatives are identified in the Contract, the individuals listed below are hereby designated
as the parties' respective representatives for purposes of this Contract. Either party may from
time to time designate in writing new or substitute representatives.
b. Notices. All required notices shall be in writing and shall be hand delivered or
given by certified or registered mail to the representatives at the addresses set forth below.
Page 8 of 9
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. 1/13/03
State/Covered Entity Representative:
Name: Lynn Barnard
Title: Director
Department and Division: Health Care Policy and Financing, Health Benefits Division
Address: 1570 Grant Street
Denver, Colorado 80203
Business Associate Representative:
Name: Judy Nero
Company Name: Weld County Department of Public Health & Environment
Address: 1555 North 17th Avenue
Greeley, CO 80631
IN WITNESS WHEREOF, the parties hereto have duly executed this Addendum as of the
Addendum Effective Date.
Contractor/Associate State/Covered Entity
Name: Board of County Commissioners of STATE OF COLORADO
Weld ty BILL OWENS, GOVERNOR
By: By:
Karen Reinertson, Executive Director
Its: David E. Lon Ch it
Department of: Health Care Policy and
Financing
Date: 06/09/2003 Date:
STATE CONTROLLER
ARTHUR L. BARNHART
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTHCA D E ViRO MENT By:
BY3P4"1/el Date:
Mark E. Wallace, MD, MPH-Director
Page 9 of 9
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. 1/13/03
ATTACHMENT A TO THE HIPAA BUSINESS ASSOCIATE ADDEMDUM
This Attachment sets forth additional terms to the HIPAA Business Associate
Addendum, which is part of the Contract dated April 21, 2003, between the Department of
Health Care Policy and Financing and Board of County Commissioners of Weld County,
contract number 2104-0134 ("Contract") and is effective as of April 21, 2003 or upon approval
by the State Controller, whichever is later(the "Attachment Effective Date"). This Attachment
may be amended from time to time as provided in Section 10(b) of the Addendum.
1. Additional Permitted Uses. In addition to those purposes set forth in Section 2(a) of the
Addendum, Associate may use Protected Information as follows:
Review Medicaid data for incidence, and health system access issues. Any uses or disclosures
permitted pursuant to the terms of the contract between CE and Associate dated April 21, 2003,
routing number UHA 2104-0119, copies of which are attached hereto. The terms of the contract
is incorporated herein by reference and any amendment, restatement or termination of such
contract shall be incorporated herein.
2. Additional Permitted Disclosures. In addition to those purposes set forth in Section 2(b)
of the Addendum, Associate may disclose Protected Information as follows:
No additional disclosures.
3. Subcontractor(s). The parties acknowledge that the following subcontractors or agents of
Associate shall receive Protected Information in the course of assisting Associate in the
performance of its obligations under this Contract:
a. Surrounding county EPSDT staff;
b. Overflow programming staff and other information or data aggregation staff as needed by the
above programs to perform the indicated work;
c. Temporary clerical and program staff.
4. Receipt. Associate's receipt of Protected Information pursuant to this Contract shall be
deemed to occur as follows, and Associate's obligations under the Addendum shall commence
with respect to such PHI upon such receipt:
IRIS records for EPSDT.
5. Additional Restrictions on Use of Data. CE is a Business Associate of certain other
Covered Entities and, pursuant to such obligations of CE, Associate shall comply with the
following restrictions on the use and disclosure of Protected Information:
6. Additional Terms. [This section may include specifications for disclosure format,
method of transmission, use of an intermediary, use of digital signatures or PKI, authentication,
additional security of privacy specifications, de-identification or re-identification of data and
other additional terms.]
Page 1 of 2
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. 8/20/02
a. While no HCPF/Decision Support System data will be routinely provided to PHE for either
the Health Care Program for Children with Special Needs (HCP) or the Breast and Cervical
Cancer Program, communication containing Protected Health Information will occur between
employees of HCPF and PHE to ensure quality health care operations. For any operational
communication required, all safeguards and privacy protections set forth in this MOU will be
followed.
Contractor/Associate State/Covered Entity
Board of County Commissioners of Weld STATE OF COLORADO
County BILL OWENS, GOVERNOR
By: By:
Print Name: David E. Lo Karen Reinertson, Executive Director
Title: Chair Department of Health Care Policy &
Financing
Date: 06/09/2003 Date:
Attest: � �`
LEGAL REVIEW
Clerk to the �•�: t; KEN SALAZAR, ATTORNEY GENERAL
Atte ;.eal .\a...y�� By
•
B tiC s i >♦
gUylbi,
Deputy Clerk to the `•T:� SVr'
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMENT
BYJAI‘C04/11(402°6
Mark E. Wallace, MD, MPH-Director
Page 2 of 2
Colorado Model BA Provision and
Addendum For New or Amended Contracts
Rev. 8/20/02
ATTACHMENT A
EARLY AND PERIODOC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT)
EPSDT Outreach and Case Management Program
Colorado Department of Health Care Policy and Financing
FY 2003 - 2004
SCOPE OF WORK
FOR CONTRACTED LOCAL PUBLIC HEALTH DEPARTMENTS AND COUNTY
NURSING SERVICES
SCOPE OF WORK
The Contractor will act as the prime contractor under this contract and shall develop a
plan by which EPSDT Outreach and Case Management services are provided, either
through vouchers or subcontracts to the following surrounding counties: Logan, Morgan,
Phillips, Sedwick, Washington and Yuma ("the participating counties"). The participating
counties may be increased or decreased upon at least thirty (30) days notice to the
Contractor from the State.
I. The role of the Contractor in directing activities of Logan, Morgan, Phillips, Sedwick,
Washington and Yuma counties:
a) Establish voucher system in each county with health care providers;
b) Invoice the State for vouchers for services provided; and
c) Distribute funds to cover vouchers as appropriate.
2. The role of the State in directing activities of Logan, Morgan, Phillips, Sedwick,
Washington and Yuma counties:
a) Track activities of Contractor;
b) Enforce contract deliverables and obligations against the prime Contractor.
Contractor Outreach Requirements
Assure the continued provision of mandated EPSDT outreach and case management
services through providing EPSDT services described herein 75% of each staff's time. All
EPSDT Medicaid eligible clients (children,youth and pregnant women) will receive a range
of outreach services from providing resource and referral information to support of
activities for priority clients.
1. Target Populations
a) Contact newly eligible pregnant women and families with newborns to ensure
notification of available EPSDT services and benefits. Encounter includes, but is not
limited to:
i. In-depth explanation of EPSDT benefits and the importance of preventive care
and regular medical visits;
ii. Assistance with selecting a Primary Care Provider(PCP), Obstetrician/
Gynecologist(OB/GYN) or specialty provider and clarification of the role of the
PCP;
iii. When appropriate, provide information on managed care (HMO) options
available including phone number for the Colorado Medicaid Enrollment Broker;
iv. Assistance, as requested, for making appointments with the PCP, OB/GYN,
specialist, dentist, dental hygienist, orthodontist, hearing aid vendor, mental health
provider or other appropriate Medicaid providers;
v. Assistance with appropriate community services and benefits; and
vi. Assistance including providing information to facilitate overcoming barriers
which might impede the clients access to EPSDT services,
vii. Coordinate with county Presumptive Eligibility (P/E) sites to receive timely and
appropriate referrals to allow EPSDT to assure that pregnant woman understand
benefits and care options, and to allow EPSDT to promote the need for regular
prenatal care.
b) Contact newly eligible children with SSI eligibility to ensure notification of available
EPSDT services and benefits. Encounter includes, but is not limited to:
i. In-depth explanation of EPSDT benefits and the importance of preventive care
and regular medical visits;
ii. Assistance with selecting a Primary Care Provider (PCP) or specialty provider
and clarification of the role of the PCP;
iii. When appropriate, provide information on managed care (HMO) options
available including phone number for the Colorado Medicaid Enrollment Broker;
iv. Assistance, as requested, for making appointments with the PCP, specialist,
dentist, dental hygienist, orthodontist, hearing aid vendor, mental health provider,
and other appropriate Medicaid providers;
v. Assistance with appropriate community services and benefits including but not
limited to providing information regarding Health Care Program for Children with
Special Needs, Part C, Community Center Boards and Child Find, to facilitate
overcoming barriers which might impede the clients access to EPSDT services;
and
vi. Inform parent or guardian of the need to arrange Medicaid care and services with
private Primary Insurance, including wrap around benefits and assistance in
obtaining additional Medicaid benefits.
2. Provide outreach to local Medicaid providers
a) Meet with Medicaid provider office staff and provide information including lists of
dentists, Presumptive Eligibility sites and schedules, mental health centers, etc. regarding
what EPSDT can offer providers if the provider refers clients to the EPSDT Outreach
office;
b) Maintain an accurate list of current Medicaid providers who are accepting new clients,
including office hours and ages accepted to assure current and proper referrals;
c) Offer assistance with EPSDT Medicaid eligible clients who have excessive missed
appointments or need assistance in scheduling appointments as requested by the provider;
d) Maintain a list of local community resources that offer Medicaid-covered and non-
covered services that are provided free or at a reduced rate and provide this information
to the provider community.
3. Utilize IRIS (Integrated Registration Information System) to record and report EPSDT
outreach services. IRIS uses the Internet to transmit information about client and
community case management activities on a statewide basis. IRIS includes internal security
that includes data accessible by specific Department staff members. All users of IRIS must
be authorized, required to have separate user identifiers and passwords for access to IRIS.
Additionally IRIS training matters shall include matters related to confidentially and
approval procedures.
a) Contact with target populations
Report on the following measurable objectives:
i. Contact 90%of Medicaid eligible pregnant women by June 30, 2004 to ensure
notification of EPSDT benefits and services. The Department will pull IRIS reports
on Contractor data the 10th of each contract month, as well as semi-annually, no
later than January 15, 2004 and July 10, 2004 as final reporting documentation from
Contractor; and
Documentation shall include:
• Contractor introductory contact recorded in IRIS client chart, within 60 days
of client eligibility into IRIS Database, unless the pregnant client has been
followed from initial Presumptive Eligibility period;
• Acceptable contact methods include face-to-face or telephone contacts. First
attempt to locate client can by phone or face-to-face attempt. Second contact
should reflect the EPSDT attempt to locate the client through community
partners. Only after two unsuccessful attempts to locate and inform clients in
this manner, then a letter to the client be sent. All attempts must be recorded
in the IRIS client chart. Appropriate outcome must be included to show
completion of inform process;
• Follow-up recorded in IRIS client chart within 60 days of initial notification if
client was unable to locate, or was not currently using, an appropriate provider
at the time the initial outreach was completed by Contractor. Follow up must
continue until pregnant client is in a Medical Home, which includes OB
services or OB/GYN provider;
• Follow-up recorded in IRIS client chart at 8 months Estimated Date of
Confinement (EDC) or Due Date to inform pregnant client of HMO
regulations or PCP regulations, and Department of Human Services (DHS)
regulations regarding appropriately reporting birth to receive medically
necessary, timely care for the newborn; and
• Follow-up recorded in IRIS client chart as needed to assure appropriate and
timely medical care, removing barriers to appropriate care as necessary.
• Plans submitted to The Department to describe relationships with partners
who are doing EPSDT inform. This plan will include training provided,
including samples of tools used; agreed upon expectations of the role the
partner agency will provide in regards to the inform process and format in
which partner agency will communicate client contact information with
EPSDT; and partner agency will provide client contact information to EPSDT
to allow for IRIS data entry of encounter, concerns, referrals and outcomes.
ii. Contact 90% of families of newborns to ensure notification of EPSDT
benefits and services, documented through the following means, by June 30,
2004.
Documentation shall include:
• Contractor contact recorded in IRIS client chart within 30 days of
EDC or birth, informing family of services and benefits of EPSDT,
assuring that child has been reported and added to Medicaid, and/or
the offer to report if needed;
• Contact shall also include assistance in locating a physician within the
available HMO or PCP options. Included in the recorded encounter
must be the current physician or provider if known;
• Acceptable forms of outreach are face-to-face or phone contact with
parent or guardian. Initial attempt to notify client should be face-to-
face or phone contact. Second contact should reflect the EPSDT
attempt to locate the client through community partners. Only after
two unsuccessful attempts to locate and inform a parent, may a
notification letter may be sent. All attempts shall be recorded in IRIS
client chart. Appropriate outcome must be included to show
completion of inform process
• Follow-up as needed, recorded in IRIS client chart, to assure
appropriate and timely medical care is received, removing barriers to
appropriate care as necessary;
• Follow-up, recorded in IRIS, including, but not limited to, the
Medicaid Rules and Regulations surrounding the need for a
`Redetermination' by the county DHS office before the clients first
birthday; and
• Additional information on other programs, such as CHP+ for which
the child may be eligible, if Medicaid eligibility ends at 1st birthday,
must be included.
• Plans submitted to The Department to describe relationships with
partners who are doing EPSDT inform. This plan will include training
provided, including samples of tools used; agreed upon expectations of
the role the partner agency will provide in regards to the inform
process and format in which partner agency will communicate client
contact information with EPSDT; and partner agency will provide
client contact information to EPSDT to allow for IRIS data entry of
encounter, concerns, referrals and outcomes
iii. Contact 90%of families of Children with SSI eligibility to ensure
notification of EPSDT benefits and services, documented through the
following means, by June 30, 2004
Documentation shall include:
• Contractor introductory contact recorded in IRIS client chart within 60
days of client eligibility into IRIS Database;
• Acceptable forms of outreach are face-to-face or phone contact with
parent or guardian. First attempt should be by face-to-face or phone,
and the second contact should reflect the attempt to locate and inform
the client through community partners. Only after two unsuccessful
attempts to locate and inform a parent/client, may a notification letter
may be sent. Appropriate outcome must be included to show
completion of inform process;
• Encounter shall also include assistance in locating a physician within
the available HMO or PCP options, including any primary insurance
options. Included in the recorded encounter must be the current
physician or provider, if known;
• Encounter shall also include appropriate collaborations with and
referrals to the Health Care Program for Children with Special Needs.
• Follow-up as needed, recorded in IRIS client chart, to assure
appropriate and timely medical care is received, removing barriers to
appropriate care as necessary; including documentation of appropriate
medical home.
• Plans submitted to The Department to describe relationships with
partners who are doing EPSDT inform. This plan will include training
provided, including samples of tools used; agreed upon expectations of
the role the partner agency will provide in regards to the inform
process and format in which partner agency will communicate client
contact information with EPSDT; and partner agency will provide
client contact information to EPSDT to allow for IRIS data entry of
encounter, concerns, referrals and outcomes
b) Provider outreach to local Medicaid providers
Report on the following measurable objectives:
i. Physically contact 50% of Medicaid providers at least once a year, including but
not limited to: PCPs (Family Practice, Pediatrics, Internal Medicine and
OB/GYN), hearing aid providers, vision providers and dental providers including
orthodontist and Presumptive Eligibility sites, documented through the following
means, by June 30, 2004;
Documentation shall include:
• The Contractor agencies shall document these visits in IRIS under the
Community Outreach. Documentation shall include, name of agency or
practice, name of person contacted, date, reason for visit, outcome of visit,
and a brief account; and
• The State shall be notified of all provider changes within 10 days of
provider contact through IRIS Provider Request Screen.
ii. Maintain an accurate list of local community resources that offer Medicaid-
covered and non-covered services that are provided free or at a reduced rate.
List shall include basic eligibility guideline and program rules and regulations to
assure appropriate client referrals.
Documentation shall include:
• Contractor will contact community resources one time per year to assure the
accuracy of referrals given to the client or provider. All contacts shall be
recorded in IRIS under Community Contacts and shall include name of
agency or practice, name of person contacted, date, and reason for visit,
outcome of visit, and a brief account;
• All Community referrals given to clients shall be entered into IRIS client
chart. The Department shall pull referral reports no later than January 10,
2004 and July 10, 2005 to assure that Contractor agencies have working
relationships with, but not limited to, the following agencies: Part C, Part B,
WIC, School Based Health Centers, Prenatal Plus,Nurse Home
Visitor/Nurse Family Partnership, Presumptive Eligibility and HCP;
• All referrals received from the above agencies shall be recorded in IRIS
client chart; and The Department shall pull reports no later than January 10`h
2004 and July 10, 2004 to assure Local Agencies have working relationships
with community partners.
5. Consequences of non-adherence to the above required EPSDT outreach and case
management activities:
a) Written Notification from the Department will be sent to the Contractor Nurse
Manager and/or Nursing Director as to contract deficiencies. Contractor shall have
15 days to reply and/or schedule up to eight hours of Shadowing/Training Sessions
with Department employees. Attendees in the shadowing sessions will include the
Contractor EPSDT program manager, regional team leader or Contractor lead
worker and can include the Nurse Manager or Nursing Director; and
b) If the Local Agency has not reached compliance with this contract 15 days
following the Shadow Session Training, the Department, may exercise remedial
actions. Remedial actions are as follows:
i. Withhold a percentage of total contract payment from date of initial
compliance request letter. Percentage of payment will continue to be withheld
until the necessary service or corrections in performance are satisfactorily
completed and the Department has notified Local Agency in writing;
ii. Recover reimbursements for those services or deliverables, which have not
been performed in compliance with the contract; and
iii. If the contractor cannot meet compliance after 120 days from the initial
deficiency letter, the Department will cancel the contract giving a 30 day
notice.
ATTACHMENT B
PREVENTION,INTERVENTION AND TREATMENT SERVICES FOR CHILDREN AND YOUTH
FINAL EXPENDITURE REPORT FORM
APPLICANT:Board of County Commissioners of Weld County FOR THE PERIOD:.July 1,2003-June 30,2004
PROJECT:EPSDT
Annual #of Total SOURCE OF FUNDS
Salary months .Amount Requested
Rate Budget FTE Required OTHER" from HCPF
PERSONAL SERVICES:
ContractuafFee for Service
Supervising Personnel
Fringe Benefits: Rate
Total Personal Services $ $ $
OPERATING EXPENSES
Total Operating $ $ $
Equipment
Total Equipment $ $ $
TRAVEL(Specify Mileage Reimbursement Rate x number miles X$)
Total Travel $ $ $
Contractual
Total Contractual $ $
Total Direct Costs(Personal Services+Operating+Travel+Contractual) $ $ $
ADMJNISTRATIVE/INDIRECT COST
Total Administrative/Indirect Costs $ $ s
TOTAL PROJECT COST $ $
'Source of funding for"Other"(Match or In-kind)
$
$
$
TOTAL$
May the NON FEDERAL funds be used as match? YES NO
Signature of Authorized Representative Date
Rwst 0103 BUOGETAPPLFORM.XLS 8Sm"n
OPTION LETTER
Exhibit A
Date: State Fiscal Year: Option Letter No.
SUBJECT: Option to Renew
In accordance with Paragraph(s) 4 of contract routing number 2104-0118, UHA, between the State of Colorado
Department of Health Care Policy and Financing, and
Board of County Commissioners of Weld County
covering the period of[ July 1, 20 through June 30, 20 ] the state hereby exercises the option for [an
additional one year's performance period at the (cost ) (price) specified in Paragraph .] and/or
[increase/decrease the amount of goods/services at the same rate(s) as specified in Paragraph/Schedule/Exhibit
.]
The amount of funds available and encumbered in this contract is [increased/decreased ] by [ $ amount of
change] to a new total funds available of [ $ ] to satisfy services/goods ordered under the
contract for the current fiscal year [ FY 0 ]. The first sentence in Paragraph is hereby modified
accordingly. The total contract value to include all previous amendments, option letters, etc. is [ $
]•
APPROVALS:
State of Colorado:
Bill Owens, Governor
By: Date:
Karen Reinertson, Executive Director
Department of Health Care Policy and Financing
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 Controller
Arthur L. Barnhart
By:
Date:
Page 1 of 1
F
0° . Memorandum 1 it 5 TO: David E. Long, Chair
Wlip Q Board of County Commissionbi$ I- _'
•
COLORADO FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health a
Environment A ./1 �t� (�`
DATE: June 3, 2003 �'�11
SUBJECT: Contract for the EPSDT Program
Enclosed for Board review and approval is a contract between the State of Colorado, Department
of Health Care Policy and Financing (HCPF) and Weld County Board of Commissioners for the
Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) Program.
Previously this program was administered by the Colorado Department of Public Health and
Environment. However, effective July 1, 2003, HCPF will be overseeing it and has designated
Weld County as the regional administrator for the program in northeast Colorado. The funding
will be used to provide case management, outreach, and support services for children ages 0 to
21 who are on Medicaid. Emphasis is on educating families about age appropriate well child
services and helping them utilize these services that are available in our community. For these
activities, Weld County will be reimbursed a sum not to exceed $119,850 for the time period
July 1, 2003 through June 30, 2004.
I recommend your approval of this contract.
Enclosure
2003-1482
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