HomeMy WebLinkAbout20001358.tiff RESOLUTION
RE: APPROVE SINGLE ENTRY POINT AGENCY CONTRACT FOR LONG TERM CARE
AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, purs iant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Single Entry Point Agency Contract
for Long Term Care between the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, on behalf of the Department of Human Services,
Area Agency on Aging, and the Colorado Department of Health Care Policy and Financing,
commencing upon full execution of said contract, and ending June 30, 2001, with further terms
and conditions being as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said contract, ti copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners jf
Weld County, Colorado, that the Single Entry Point Agency Contract for Long Term Care
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency
on Aging, and the Colorado Department of Health Care Policy and Financing be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 5th day of June, A.D., 2000.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COJ/LORADO
ATTEST: '-C i/
Far Liej
Barbara J irkmeyer; Chair
Weld County Clerk to t B �o
M. J. Gei e,�ro-Terry
BY: -iL • Ri .:
Deputy Clerk to the u ' /'-' 7ce
iI eorge E. Baxter
APPROVED AS TO FO :
Dale K. Hall
ounty Attorney %Ltirf
—
Glenn Vaa
C C_' /147 2000-1358
H R0071
MEMORANDUM
„ao ((,16:,
Barbara J. Kirkmeyer, Chair, Weld County Board ot
D) ic)(-1 Commissioners
Walter J. Speckman, Executive Director, Weld
)c)tie County Division of Human Services
May 30, 2000
, , , -: � , CT: Options for Long Term Care Contract -
Department of Health Care Policy and
Financing
ie annual Options for Long Term Care Contract between
L„C LICFJCItIII IIL L, I 'CCILII Vale Policy and Financing and the Weld County Divis on of
Human Services'Area Agency on Aging. The contract time period is July 1, 2000 th nuyh
June 30, 2001. The maximum contract reimbursement will be $406,980.00.
If you have questions, you may reach me at 353-3800, extension 3317.
241 1 ;58
x 7 .
Agency or Department Name
Health Care Policy&Financing
Department or Agency Number
UHA
Contract Routing Numb r
SINGLE ENTRY POINT AGENCY CONTRACT
THIS CONTRACT,made this 30th day of June,2000,by and between the State of Colorado for the use and ben(fit of the
Department of Health Care Policy and Financing, 1575 Sherman Street,Denver, Colorado 80203-1714 hereinafte referred
to as the State or the Department and Weld County Board of Commissioners by and through the Weld County Division of
Human Services' Area Agency on Aging, 1551 North 17th Avenue, Greeley, CO 80631 , hereinafter referred to as the
contractor.
WHEREAS, authority exists in the Law and Funds have been budgeted, appropriated and otherw se made
available and a sufficient unencumbered balance thereof remains available for payment in Contract Encumbrance number
and for the Single Entry Point program, COFR's codes: Fund 100,Agency UHA,Appropriation Code 175;and
WHEREAS, required approval, clearance and coordination has been accomplished from and with appropriate
agencies;
WHEREAS,the contractor was selected in accordance with State law;
WHEREAS, the Department is the designated single Colorado agency responsible for the administration of the
Medicaid program,pursuant to 26-4-104,Colorado Revised Statutes(C.R.S.),as amended, and
WHEREAS, the State has established a Colorado Medical Assistance Program in order to participate in fide
XIX of the Social Security Act(Medicaid),and
WHEREAS, the Department is authorized, pursuant to Sections 26-1-103(7) and 26-4-521, et. seq., :3,R.S. as
amended,to contract with designated Single Entry Point agencies to serve as independent contractors for the administration
of long term care programs,and
WHEREAS, Section 26-4-522, C.R.S., as amended, provides that the Single Entry Point agency shad be
recommended by the Board of County Commissioners,and considered for approval by the Department in accord ince with
the authorizing legislation,and
WHEREAS, the Board(s) of County Commissioners of Weld has (have) designated the Contractor to be the
district Single Entry Point agency,and
WHEREAS,the Department has approved certification of the Contractor as a Single Entry Point agency, and
WHEREAS,the Department desires to enter into this Contract with the Contractor herein for the adm nisitation
of the Single Entry Point program,as set forth in greater detail below,and
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WHEREAS, as of the date of the execution of this Contract, the Contractor meets all statutory and regulatory
requirements for entering into this Contract,
NOW THEREFORE,it is hereby agreed that:
2(a) Scope of Work
A. Contractor shall perform the functions of single entry point agencies as defined by sections 264-507 and 25-4-{22,
C.R.S., as amended, and the rules and regulations applicable to the Department and the single entry poim- system
(hereafter referred to as "state regulations"). These state regulations may be found in the Code of Colorado
Regulations (C.C.R.) at 10 C.C.R. §2505-10, and may also be found in Volume 8 of the staff manual titled Medical
Assistance.
B. Contractor agrees to perform its obligations hereunder in conformity with the provisions of Title XIX of the Social
Security Act,other relevant federal and state laws and all pertinent federal and state regulations promulgated pursuant
thereto; including, without limitation, the Colorado Human Services Code, Section 26-1-101, et. seq., C R_S.. as
amended, and those applicable portions of the Staff Manuals of the Colorado Department of Human Services and the
Colorado Department of Health Care Policy and Financing: Volume 3, entitled "Income Maintenance," 't C.C.R.
§2503-1; Volume 5, entitled "Finance and Accounting," 11 C.C.R. §2508-I; Volume 8, entitled "Medical Assistance,"
10 C.C.R. §2505-10; and Volume 10, entitled "Services for the Aging," 12 C.C.R. §2510-1, as all the foregoing
provide on the date this Contract is executed,and as they may later be amended.
C. Contractor shall perform the functions of case management for eligible persons as defined in the state statutes and
regulations, including but not limited to intake/screening/referral, assessment of client need, development and
implementation of a care plan,on-going case management,monitoring of clients,reassessment,and case closue.
D. Contractor shall perform all necessary administrative functions for the operation of Single Entry Point agencies, as
defined in the state statutes and regulations,including but not limited to such matters as the following:
(1) establishing a community advisory committee for the purpose of providing public input and guidance Mr single
entry point agency operation;
(2) administering a personnel system for recruiting,hiring,evaluating, and terminating employees;
(3) performing accounting tasks in compliance with all rules and regulations for accounting practices set forth by the
state department;
(4) maintaining adequate liability insurance to meet the state department's minimum requirements for contract
agencies;
(5) information management: collecting and reporting of summary and client specific data pertaining to information
and referral services provided by the agency,program eligibility determination,financial eligibility determination,
care planning, service authorization,resource development,and fiscal accountability;
(6) record keeping: maintaining client records in accordance with program requirements, including the
documentation of all case activities,the monitoring of service delivery,and service effectiveness;
(7) resource development: facilitating the development of local resources to meet the long term care needs of
individuals who reside within the single entry point district served by the Contractor;
(8) protecting the confidentiality of all applicant and recipient records;and
(9) protecting the client's rights as defined by the state department under applicable programs.
(10) compliance with a signed letter of agreement with the state,a model of which is made part hereof as Exhibit D, in
the use of the Options for Long Temi Care Data System if contractor is using this automated system.
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E. Contractor shall comply with the standards as outlined in the state statutes and regulations, staff manual olume 8:
sections 8.390 through 8.539, for the operation of the Single Entry Point agency which include,but are not '.invited to
the following:
(1) Contractor shall afford appropriate and timely access to services for all clients and will facilitate the application
process for potentially eligible individuals and respond in a timely manner to all referrals of eligible cherts:
(2) Contractor shall provide thorough assessments of care needs and resources to assure the most appropriate
targeting of all private and public long term care resources to the needs of the clients. Such targeting shall not
supplant but shall support self care, family care and other informal community care. Contractor shall ass Ire
through the prior authorization review process that long-term care clients, who receive case management
services under the Contractor,receive types and amounts of Medicaid-funded skilled and non-skilled
Community-Based Services that do not exceed the types and amounts medically and/or functionally required
by each client and in compliance with Medicaid rules.
(3) The Contractor shall provide to the State by August 1,2000, a brief Single Entry Point District plan th it
describes plans and efforts that Contractor is implementing to assure that, for clients served by the Contractor,
Medicaid-funded Home Health and Home and Community-Based Services do not exceed the types an]
amounts medically and/or functionally required by each client and are in compliance with Medicaid n les. the
plan shall address subjects to be specified in a Dear Administrator Letter provided to the contractor no late,
than April 30, 2000. The State shall provide technical consultation to Contractors in the writing of these plans
as requested by the Contractors.
(4) During the period from October 15, 2000 through December 31, 2000,the State shall monitor a representative
sample of clients who are receiving Home and Community-Based Services non-skilled care services.Basetl on
standards set by the State and communicated to the contractor in training materials,the State will monitor to
ascertain that clients are being approved by Contractor to receive only those types and amounts of Me licaid-
funded Home Health services and Home and Community-Based services that do not exceed the types and
amounts medically and/or functionally required by each client and in compliance with Medicaid rules
(5) Contractor shall process paperwork in a timely and accurate manner to promote timely service to clients:
(6) Contractor shall provide accurate and timely documentation of client and agency activities;and
(7) Contractor shall not provide direct services unless a waiver is approved by the State Department based on criteria
set forth in the state regulations for single entry point agencies.
F. Contractor shall certify adult foster care facilities within the single entry point district in accordance with the
Department rules for adult foster care(staff manual volume 8, section 8.483).
G. Contractor shall provide case management functions to recipients of publicly funded long term care programs,
including, but not limited to Medicaid nursing facility care, Home and Community-Based Services for the Elderly,
Blind and Disabled (HCBS-EBD), Home and Community-Based Services for Persons Living with AIDS (HCBS-
PLWA), Home and Community-Based Services for Persons with Brain Injury (HCBS-BI), Home Care Allowance,
Adult Foster Care, and certain in-home services available under the federal "Older Americans Act of 1965, as
amended". The authorization and administration of services through a publicly funded program shall be in accordance
with the program's eligibility criteria, as defined by applicable state and federal statutes and regulations, as they exist
on the date this Contract is executed, and as they may later be amended. Contractor shall cooperate with the state and
the community center boards in the admission of clients with developmental disabilities to the Home and Community
Based Services for the Elderly,Blind and Disabled Program.
H. In accordance with staff manual section 8.392.4, entitled "PRIVATE PAY CLIENTS," the Contractor shall provide
case management services to persons able to pay privately for such services within two years of contractor
implementation.
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I. Contractor shall develop procedures for the transfer of clients from one county to another within the Single Entry Point
district and from one district to another in accordance with the state statutes and regulations.
.1. Contractor shall provide staff who meet the qualifications set forth in the state statutes and regulations,
to perform the following functions:administrative/supervisory,and case management.
K.Contractor shall arrange for a licensed medical professional to be available to staff for consultation regarding
medical and diagnostic concerns.
L. Contractor shall be considered for certification by the Department in accordance with standards and requirenenis set
forth in the state statutes and regulations. Decisions about certification shall be based upon but not limited to on-site
visits and other evaluation of agency performance in the following areas: quality of services provided;compliance with
program requirements, including case management standards adopted by the Department; timeliness; performance of
administrative functions, including reasonable cost per client, timely responses, managing program: in one
consolidated unit, on-site visits to clients, community coordination and outreach, and client monitoring; tai geting of
populations served;and financial accountability.
M. In accordance with procedures set forth in applicable state statutes and regulations,Contractor performance
shall be reviewed by the Department or its designee on an ongoing basis. Contractor will be notified within 0 days of
the outcome of such reviews, which may result in approval, provisional approval, denial, or temtinatio❑ of
certification. For the purpose of monitoring the Contractor and making certification recommendations,the Department
may designate an agent such as(but not limited to)the Colorado Department of Human Services.
2(b) Scope of Work in Regard to Deinstitutionalization Activities:
A. Contractor must show a good faith effort to identify appropriate State clients who may be deinstitutional zed from
nursing facilities and who are determined to be appropriate to be served under community based care.
B. The Deinstitutionalization Project is a research oriented project used to identify the characteristics of nursing facility
clients who can most successfully be deinstitutionalized into a community based setting and to identify financial
impacts of this work on the State long term care expenditures. Contractor will provide data and information as
required by the State which will permit the State to identify this information.
C. Contractor shall perform the following activities and functions as required under the Deinstitutionalization project
(1) From among eligible clients housed in nursing facilities, and who shall be designated by the State. Contractor
shall select clients for whom they determine a reasonable potential for Deinstitutionalization from tl e nursing
facility and into the community.
(2) Contractor shall conduct on-site visits to selected residents and/or families of residents of nursing facilities in
order to provide information regarding community based services and to assess the appropriateness of relocation
from the nursing facility into community based options.
(3) If the client elects to leave the nursing facility and enter the community, Contractor shall guide the client and/or
client's family and facilitate completion of the administrative and programmatic requirements to enter community
based care.
(4) In a form and manner to be selected by the State, Contractor shall collect and report summary and client specific
data and information sufficient to enable the State to complete research requirements under this project. This will
entail collection of data and information in regard to:
a. clients to whom informational visits are made in nursing facilities
b. clients who elect not to leave the nursing facility
c. clients who elect to leave the nursing facility
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(5) Collection and reporting of additional research oriented information related to deinstitutionalization,that is above
information which is normally reportable to the State under Single Entry Point requirements for those clients who
enter community based care from a nursing facility under this project.
D. Contractor agrees to perform its obligations hereunder in conformity with the provisions of Title XIX of the
Social Security Act, other relevant federal and state laws and all pertinent federal and state regulations
promulgated pursuant thereto; including, without limitation, the Colorado Human Services Code Section
26-1-101, et. seq., C.R.S., as amended, and those applicable portions of the Staff Manuals of the Colorado
Department of Human Services and the Colorado Department of Health Care Policy and F nancing:
Volume 3, entitled "Income Maintenance," 9 C.C.R. §2503-1; Volume 5, entitled "Finance and Accounting,"
11 C.C.R. §2508-1; Volume 8, entitled "Medical Assistance," 10 C.C.R. §2505-10; and Volume 10, entitled
"Services for the Aging," 12 C.C.R. §2510-1, as all the foregoing provide on the date this Contract is
executed, and as they may later be amended.
3. Performance Period
The contract shall be effective upon approval by the State Controller, or designee, or on July 1, 2000,whichever is later.
The contract performance contemplated herein shall commence as soon as practicable after the effective date of this
contract and shall be undertaken and performed in the sequence and manner set forth in the scope of work identified in
paragraph 2 and extend through June 30, 2001.
4. Price/Cost
The State shall reimburse the contractor's reasonable, allowable costs,as defined herein,not exceeding$406,91',0 for
work associated with the Scope of Work described under paragraph 2(a)above. Payment to the contractor for icily ides
associated with deinstitutionalization, described under paragraph 2(b)above is described and established for th
contractor in Exhibit B,hereby made a part of this contract.The statewide liability of the State for payment associated
with deinstitutionalization, described under paragraph 2(b)above is limited to the unspent amount remaining of$X 1 527
during the term of this contract.
Payment pursuant to this Contract will be made as earned, in whole or in part, from available state and fed.:ral Funds
encumbered in an amount not to exceed $406,980 for the purchase of the within-described services described ender
paragraph 2(a) above during the period,July 1,2000 through June 30, 2001. The specific methodology for calculating the
payment to the contractor is described in Exhibit A and Exhibit E which are attached to this contract and in(otpc'rated
herein by reference. The liability of the State, at any time, for such payments shall be limited to the unspe it amount
remaining of such encumbered funds.
S. Payment Terms
The State shall pay reasonable, allocable, allowable costs of performance as provided in Exhibit A, Exhibit B and
Exhibit E to this contract. Unless otherwise provided, and where appropriate:
A. The State shall establish billing procedures and pay the contractor the reasonable, allocable, and allowable costs for
work performed under this contract,based on the submission of monthly statements in the format prescribed by the
State. To be considered for payment,billings for payment pursuant to this contract must be received with n 30 days
after the period for which payment is being requested and final billings on the contract must be recei\ed by the
State within 30 days after the end of the contract term. All goods and services purchased under this Single Entry
Point contract must be received by the Contractor by the last day of the contract period, C.R.S. 24-75-102, or as
required by State policies and regulations.
B. Payments pursuant to this contract shall be made as earned, in whole or in part, from available funds ei cumbered
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.
C. In the event this contract is terminated, final payment to the contractor may be withheld at the discre'ion of the
State until completion of final audit.
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D. Incorrect payments to the contractor due 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 Stale and the
contractor, or by the State as a debt due to the State. The contractor shall submit requests for reimbursement
monthly,stating in the invoice a detailed description of the amounts of services performed and description of
reimbursable expenses.The Uniform Administrative Requirements for Grants and Cooperative agreement: to
State and Local Governments (the "Common Rule"), and the applicable OMB Circulars cited therein, shall govern
the allowability and allocability of costs under this contract. The State and federal government reserves rte right to
audit the contractor's books and records for a period of three years after contract expiration or termination in order
to validate the allowability of costs paid under this contract, and any costs not allowable under the State
procurement rules shall be reimbursed by the contractor, or offset against current obligations due by the State to the
contractor, at the State's election. 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 resolved after a three (3) year
period, the materials shall be retained until the resolution of the audit findings. Contractors and sub-contractors- will
retain automated and manual records in a condition and manner which will enable transfer or transmission to other
organizations. In the eventuality that a contract and/or sub-contract are terminated, the contractor and/or sub-
contractors will cooperate with the state in the transmission or transferring of records as necessary to a cesignated
organization.
E. Contractor is subject to and agrees to honor and abide by single entry point regulations in regard to :ettlement
required of differences between payments by the State to the contractor and allowed expenditures inured by the
contractor for the Contractor's operation of the single entry point contract.
F. The contractor must submit in writing to the State all proposed capital expenditures in excess of$500 that arc made
using funds from this contract. The State must approve these purchases in writing prior to orders being placed and
expenditures being made. Capital expenditures include office furniture, copying equipment, faxing equips lent.
vehicles, computers,printers and other automation related equipment as well as any other durable carpet,furniture,
equipment or construction or building alteration expenditures.
G. The State shall establish billing procedures and reimburse the Contractor in such amounts as may from time Lo time be
specified by the State pursuant to applicable federal and state statutes and regulations, including the Colorado Medical
Assistance Act Section 26-4-W1 et. seq., CRS, as amended, and the State Rules for the Long Term Care Single Entry
Point System, as such statutes and rules currently exist or may hereafter be amended. State funds shall be al located to
each Single Entry Point agency based on the number of counties in a district and the average number of clients served
in community-based care programs in that district during each quarter of the contract term. The specific methodology
for calculating the payment to the contractor is described in exhibit A and exhibit E which is are attaci ed to this
contract and incorporated herein by reference.
H. The Contractor shall submit monthly expenditure statements, using forms, procedures and within tit ne frames
prescribed by the State. Failure to submit the expenditure statements or to enter expenditures in the County Fiscal
Management System (CFMS) within the time frames established by the state may result in the withholding of
payments by the state until the statements are received.Total compensation to the Contractor under this contract shall
not exceed the limitation contained in the General Provision entitled"Price/Cost".
I. The Contractor shall receive state and federal funds in monthly payments from the State. Allowat le agency
expenditures are set forth by Federal rules, CFR Title 45, Part 74, Appendix G; Office of Management aid Budget
Circular A-87 or A-122, whichever is applicable; and the U.S. Department of Health and Welfare, December 1976,
Cost Principles and Procedures for Establishing Cost Allocation Plans and Indirect Cost Rates for Grants and
Contracts with the Federal Government as indicated presently or amended in the future.
J. The Contractor shall be reimbursed an amount to equal the "annual rate"per client calculated as specified in exhibits
A and E for each client for whom assessment has occurred, and who selects and is enrolled in the Total Long Term
Care program. This will be achieved by the Contractor continuing to include the referred client in their monthly client
count through the remainder of the Performance Period of the contract year in which the referral is made.
6. Legal Authority
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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, bylaws, and/or applicable law 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.
7. Inspection and Acceptance (Services)
The State reserves the right to inspect services provided under this contract at all reasonable times and places (Tiring the
term of the contract "Services" as used in this clause includes services performed or tangible material procuced 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.
8. Confidentiality of Records
In the event the contractor shall obtain access to any records or files of the State in connection with agreement, or in
connection with the performance of its obligations under this agreement, the contractor shall keep such records and
information confidential and shall comply with Section 8-72-107, CRS, Section 24-72-201 et. seq. and all otter laws
and regulations concerning the confidentiality of such records to the same extent as such laws and regulations apply to
the State. The contractor shall notify its employees, agents and sub-contractors that they are subjec to the
confidentiality requirements as set forth above, and shall provide each employee with a written explanation O1 the
confidentiality requirements before the employee is permitted access to confidential data.
9. 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 obligation 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 contractor. These remedial actions
are as follows:
A. Suspend contractor's performance pending necessary corrective action as specified by the State without cor tractor'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 sate.factorily
completed; and/or
C. Request the removal from work on the contract of employees or agents of 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. Denial of the amount of payment must be reasonably related to the
value of work or 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.
10. Termination for Convenience
The State may terminate this contract at any time the State determines that the purposes of the distribution of State
moneys under the contract would no longer be served by completion of the project. The State shall effect such
termination by giving written notice of termination to the contractor and specifying the effective date thereof, at least
sixty(60)days before the effective date of such termination.Either party may terminate this contract by giving the other
Page 7 of 17
party sixty (60) days written notice of its intent to terminate the Contract. In that event, all finished or ur finished
documents, data, studies, 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 by either party as provided by Paragraph 10 of this agreement, the contractor will be paid
for those services that were satisfactorily performed prior to the date of termination, less any payments that were
previously made for services not completed.However, if the contract is terminated, and 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 for that portion of the actual out-of-pocket expenses that are not otherwise reimbursed wider this
contract incurred by the contractor during the contract period which are directly attributable to the uncompletec 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 the contractor, the Termination for Cause or Default
provision shall apply.
11. Termination for Default/Cause
If, through any cause, the contractor shall fail to fulfill, in a timely and proper manner, its obligations under this
contract, or if the contractor shall violate any of the covenants, agreements, or stipulations of this contract, he State
shall thereupon have the right to terminate this contract for cause by giving written notice to the contractor of is 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, 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 not expended for
purposes set forth herein.
Notwithstanding the above, the contractor shall not be relieved of liability to the State for any damages sustained b) the
State by virtue of any breach of the contract by the contractor, and the State may withhold any payment to the c miractor
for the purposes of mitigating its damages until such time as the exact amount of damages due to the State Cron. the
contractor is determined.
If after such termination it is determined, for any reason, that the contractor was not in default, or that the coitractor'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 ierein.
12. 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, ncluding
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 pc licy shall
include an endorsement, certificate, or 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 curing 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.
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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 7 workin;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. The
contractor shall show proof of such insurance or certify that they are self-insured.
13. Independent Contractor Relationship
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 MONEYS PAID
PURSUANT TO THIS CONTRACT. CONTRACTOR ACKNOWLEDGES THAT THE CONTRACTOR AND
ITS EMPLOYEES ARE NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS THE
CONTRACTOR OR A THIRD PARTY PROVIDES SUCH COVERAGE AND THAT THE STATE DOES
NOT PAY FOR OR OTHERWISE PROVIDE SUCH COVERAGE. CONTRACTOR SHALL HAVE NO
AUTHORIZATION,EXPRESS OR IMPLIED,TO BIND THE STATE TO ANY AGREEMENTS,LIABILITY,
OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH HEREIN. CONTRACTOR SHALL
PROVIDE AND KEEP IN FORCE WORKER'S COMPENSATION (AND SHOW PROOF O1' SUCH
INSURANCE) 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.
14. Representatives and Notice
A. Representatives. For the purpose of this contract, the individuals identified below are hereby d.sigiated
representatives of the respective parties. Either party may from time to time designate in writing new or substitute
representatives:
For the State:
Barbara Prehmus Assistant Manager,Health Care Benefits
Name Title
For the Contractor:
Name Title /�
'/or �I-Ca2 '-/ eHc/ ov' /Thy
Page 9 of 17
•
B. Notices. All notices required to be given by the parties hereunder shall be hand delivered or given by certified or
registered mail to the individuals at the addresses set forth below. Either party may from time to time des gnate in
writing substitute addresses or persons to whom such notices shall be sent.
For the State:
Name : Barbara Prehnms
Department and Division: Colorado Dept. of Health Care Policy and Financing
Health Care Benefits
Address: 1575 Sherman Street
Denver, Colorado 80203-1714
For the contractor:
<fry c/a %i2rFL
t✓�=gin Arra /4yesa7 rn 49•^Y
, SOX /fc'T
G, /rr e6ej
15. 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. Except as herein otherwise
provided, this agreement shall inure to the benefit of and be binding only upon the parties hereto and their respective
successors and assigns.
16. Changes
The State may prospectively increase or decrease the amount payable under this contract through a "Change Order
Letter," approved by the State Controller or his designee, in the form attached hereto as Exhibit C and provided for in
Exhibit A, subject to the following conditions.
A. The Change Order Letter("Letter")shall include the following:
1) Identification of contract by contract number and affected paragraph number(s);
2) Types of services or programs increased or decreased and the new level of each service or prograr r;
3) Amount of the increase or decrease in the level of funding for each service or program and the tot.l;
4) Intended effective date of the funding change;
5)A provision stating that the change shall not be valid until approved by the State Controller or such assistant
as he may designate;
B. Upon proper execution and approval, such letter shall become an amendment to this contract and, except for the
general terms and conditions and Special Provisions of the contract, the letter shall supersede the contract in the
event of a conflict between the two. It is understood and agreed that the letter may be used only for increased or
decreased finding, and corresponding adjustments to service levels and any budget line items. The process to
increase or decrease the level of funding under this contract is as specified in Exhibit A, Paragraph 11, to this
contract.
C. Increases or decreases in the level of contractual funding made through the letter process during the term of this
contract maybe made under the following circumstances:
I) If necessary to fully utilize Colorado State appropriations and/or non-appropriated federal grant a wards.
Page 10 of 17
2) Adjustments to reflect current year expenditures.
3) Supplemental appropriations or non-appropriated federal funding changes resulting in an inc-ease or
decrease in the amounts originally budgeted and available for the purposes of this program.
4) Closure of programs and/or termination of related contracts.
5) Delay or difficulty in implementing new programs or services.
6) Other special circumstances as deemed appropriate by the State.
17. Options: Performance Extension
The State may require continued performance for a period of one year of any services within the limits and at the rates
specified in the contract. The State may exercise the option by written notice to the contractor deposited in the mail
before the end of the performance period of the contract using a form substantially equivalent to Exhibit F. The State
shall give the contractor 60 days preliminary written notice of its intent to execute the option. Preliminary nonce does
not commit the State to an extension. 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 five (5) years. 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. No option shall be
effective unless executed by the Contractor. Financial obligations of the Contractor payable after the current focal year
are contingent upon funds for that purpose being appropriated,budgeted and otherwise made available.
18. 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 fire, explosion, action of the elements, strike, interruption of transportation, rationing,
court action, illegality, unusually severe weather, or any other cause which is beyond the control of the party affected
and which,by the exercise of reasonable diligence,could not have been prevented by the party affected.
19. 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 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.
20. Sovereign 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 or the negligence of Contractor, their departments, institutions, agencies, boards, officials, and
employees and its political subdivisions 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.
21. Severability
To the extent that this contract may be executed and performance of the obligations of the parties may be acco nplisbed
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
Page 11 of 17
22. 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.
23. Entire Understanding
This contact 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 :hall have
any force or effect unless embodied in a writing executed and approved pursuant to the State Fiscal Rules.
24. 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 th State as
provided herein in the event of such failure to perform or comply by the contactor.
25. Modification and Amendment
This contact 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 pint of this
contact on the effective date of 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.
26. Federal Funding
This contract is subject to and contingent upon the continuing availability of Federal funds for the purposes he.eof. The
parties hereto expressly recognize that the contactor is to be paid, reimbursed, or otherwise compensated with funds
provided to the State for the purpose of contacting for the services provided for herein, and therefore, the contractor
expressly understands and agrees that all its rights, demands, and claims to compensation arising under this ccntract are
contingent upon receipt of such funds by the State. In the event that such funds or any part thereof are not received by
the State.the State may immediately terminate this contact without liability, including liability for termination costs.
27. Litigation Reporting
Unless otherwise provided, the contactor shall promptly notify the State in the event that the contractor learns of any
actual litigation which is related to the Single Entry Point Program 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 set vices
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 contact, or in absence of such designation, to
the chief executive officer of the department,agency,or institution executing this contact on behalf of the Staie.
28. 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 contact, and shall maintain such
records for a period of three (3) years after the date of termination of this contact or final payment hereunder,
whichever is later, or for such further period as may be necessary to resolve any matters which may be pending. 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 contactor shall be custodian on behalf of the State. 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 resolved after a three(3)year period, the materials shall be retained until the resolution of the
audit findings. Contractors and sub-contractors will retain automated and manual records in a condition and mai mer which
will enable transfer or transmission to other organizations. In the eventuality that a contract and/or sub-contract are
terminated,the contractor and/or sub-contractors will cooperate with the state in the transmission or transferring of records
as necessary to a designated organization.
Page 12 of 17
29. Audit, Inspection of Records, and Monitoring
The contractor shall permit the State,Federal Government,or any other duly authorized agent of a governmenta t 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 term; 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 check, or any other
reasonable procedure. If an audit by or on behalf of the federal and/or state government has begun but is not complete 1 at
the end of the three (3) year period, or if audit findings have not been resolved after a three (3) year period, the r late]ials
shall be retained until the resolution of the audit findings. Contractors and sub-contractors will retain automated and
manual records in a condition and manner which will enable transfer or transmission to other organizations. In the
eventuality that a contract and/or sub-contract are terminated,the contractor and/or sub-contractors will cooperate with the
state in the transmission or transferring of records as necessary to a designated organization.
30. Federal Examination of Records Clause
Contractor, and its subcontractors and subgrantees, will give the State, the awarding Federal agency, and the
Comptroller General of the United States, through any authorized representatives, access to and the right to examine all
records,books,papers, or documents related to the award and contract; and will establish a proper accounting s istere in
accordance with generally accepted accounting standards.
31. Federal Audit Provisions
All state and local governments and non-profit organizations receiving more than $300,000 from all funding sources,
that are defined as federal financial assistance for single audit purposes, shall comply with the audit requirements of
OMB Circular A-128 (Audits of State and Local Governments) or A-133 (Audits of Institutions of Higher Education
and Other Non-profit Organizations),whichever applies.
32. Conflict of Interest
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, ar 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.
During the term of this contract, 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 cor tract.
Additionally, Contractor acknowledges that, in governmental contracting, even the appearance of a conflict of interest is
harmful to the interests of the State. Thus,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.
In the event that the Contractor is uncertain whether the appearance of a conflict of interest may reasonably exist,
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.
Page 13 of 17
33. 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. 1.2101,et seq.
of 1990(ADA)
- 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
- Medicaid Law 42 U.S.C. 1396a
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 tie 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 Al] S-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, o activities
performed by the Contractor,or be subjected to any discrimination by the Contractor.
C. The Contractor shall take all necessary affirmative steps, as required by 45 CFR 92.36(e) and(Colorado Ex.
Order, Procurement Rules), to assure that small and minority businesses and women's business tinterprises
are used, when practicable, as sources of supplies, equipment, construction, and services purchased under
this Contract.
Page 14 of 17
34. Drug Free Workplace
The undersigned certifies that to the best of his or her knowledge and belief the contractor is in compliance with the
requirements of the Drug-Free Workplace Act(Public Law 100-690,Title V,subtitle D,41 USC 701 et seq.).
35. Lobbying
The undersigned certifies to the best of his or her knowledge and belief that:
1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned. to any
person for influencing or attempting to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with th.s Federal
contract, grant,loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with it instructions.
3) The undersigned shall require that the language of this certification be included in the award documents
for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans_ and
cooperative agreements)and that all subrecipients shall certify accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction wai made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
Section 1352, title 31, United States Code. Any person who fails to file the required certification shall be subject to a
civil penalty of not less than$10,000 and not more than$100,000 for each such failure.
By his/her signature to this contract the authorized signatory certifies that the above specified certifications are true
Page 15 of 17
SPECIAL PROVISIONS
CONTROLLER'S APPROVAL
1. This contract shall not be deemed valid until it shall have been approved by the Controller of the State of Colorado or such assist ter as he may designate.
- This provision is applicable to any contract involving the payment of money by the State.
FUND AVAILABILITY
2. Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being _cpropnatcd, budeeted,
and otherwise made available.
BOND REQUIREMENT
3. If this corm-act involves the payment of more than fifty thousand dollars for the construction,erection, repair, maintenance,or impmvcm:ct of any building.
road, bridge. viaduct, tunnel, excavation or other public work for this State, the contractor shall, before entering upon the performance of an/ such work
included in this contract,duly execute and deliver to the State official who will sign the contract, a good and sufficient bond or other ac-ptabic surety :o be
approved by said official in a penal sum not less than one-half of the total amount payable by the terms of this contract. Such bond tihall be din executed
by a qualified corporate surety conditioned upon the faithful performance of the contract and in addition, shall provide that if the c occzceor of is subcon-
tractors fail to duly pay for any labor, materials, team hire, sustenance, provisions,provendor or other supplies used or consumed by ;u-h contractor cr his
subcontractor In performance of the work contracted to be done or fails to pay any person who supplies rental machinery, tools, or esui,tment n the prose-
cution of the work the surety will pay the same in an amount not exceeding the suns specified in the bond, together with interest at he rite of e flirt per cent
per annum. Unless such bond is executed, delivered and filed, no claim in favor of the contractor arising under such contract sha 1 be -rudder, allowed or
paid. A certified or cashier's check or a bank money order pavaule to the Treasurer of the State of Colorado may be accepted in lie r c f. bond. T.v_ provi-
sion is in compliance with CRS 38-26-106.
INDEMNIFICATION •
4. To the extent authorized by law,the contractor shall indemnify,save,and hold harmless the State.its employees and agents,against my and all claims, dam-
ages. 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.
DISCRIMINATION AND AFFIRMATIVE ACTION
5. The contractor agrees to comply with the letter and spirit of the Colorado Antidiscrimination Act of 1957, as amended, and other applicable law respecting
discrimination and unfair employment practices (CRS 24-34-402), and as required by Executive Order, Equal Opportunity and Affirmative Action, dated
April 16, 1975. Pursuant thereto,the following provisions shall be contained in all State contracts or sub-contracts.
During the performance of this contract,the contractor agrees as follows:
(a) Tne contractor will not discriminate against any employee or applicant for employment because of race,creed,color,national o igin,sex,marital status,
religion,ancestry,mental or physical handicap,or age. The contractor will take affirmative action to insure that applicants are employed,and that employ-
ees are treated during employment,without regard to the above mentioned characteristics. Such action shall include,but nor be limited to the following:
employment upgrading, demotion,or transfer, recruitment or recruitment advertisings; lay-offs or terminations; rates of pay or other forms of compen-
sation; and selection for training,including apprenticeship. The contractor agrees to post in conspicuous places. available to e nployees and applicants
for employment,notices to be provided by the contracting officer setting forth provisions of this non-discrimination clause.
(b)Tae contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will
receive consideration for employment without regard to race,creed,color,national origin,sex,marital status,religion, ancestry, mental or physical hand-
icap, or age.
(c)The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement o other contract or under-
standing, notice to be provided by the contracting officer, advising the labor union or workers' representative of the contractors cony itmrni under :he
Executive Order,Equal Opportunity and Affirmative Action,dated April 16, 1975,and rules,regulations. and relevant Orders of tie Oovenor.
(d)Tne contractor and labor unions will furnish all information and reports required by Executive Order,Equal Opportunity and A:5n-tative Actioc of April
16. 1975, and by the rules,regulations and Orders of the Governor,or pursuant thereto,and will permit access to his books, red'r:;. and ac:::wnts by :he
contracting agency and the office of the Governor or his designee for purposes of investigation to ascertain compliance with s tcs rues re;rs'atons and
orders.
(e)A labor organization will not exclude any individual otherwise qualified from full membership nehs in such labor organizado expel sty such :rdi-
vodual from membership in such labor organization or discriminate against any of its members in the full enjoyment work opro c t y be:sus race.
creed.color, sex, national origin, or ancestry.
(O A labor organization. or the employees or members thereof will not aid, abet,incite, compel or coerce the doing of any act def ned:n this contract to be
discriminatory or obstruct or prevent any person from complying with the provision of this contract or any order issued riser:urde r, or ate tempt cheer
directly or indirectly, to commit any act defined in this contract to be discriminatory.
Form 6-AC-029
Revision 5/97
615-62-50-6038 - page 1 F, of_LI._pages
ce the ation auses of this ct or with of such rules. ns.or s,this con-
(g) Introt may be`the canceled, terminated or suspended in whole or inand thelcon:racct r may beadecclared ineligible for further State ccontracs�i racce dance
d
sed and remedies as may be invoked as provided in Executive Orders,Equal Op❑onumty and
with procedures,authorized in Executive Order,Equal Opportunity and Affirmative Action of April 16, 1975 and the rules, regulations,or orders promulgate
A accordance therewith,and such other sanctions as may be smpo in ce therewith, as law.
Affirmative Action A of oral 16, 1975,or by tilts,regulations,ohro orders
n evcrydsubcona'actnand subconvacrtor purchase eorder provided
by excmf ice b+ pules
(h)The contractor ll include u pursuant
provisions oc tiveagr (a)
regulations, or orders issued pursuant to Executive Order, Equal Opportunity and Affirmative Action o(Aprl 16, 1975, so that such provisions w II 7..C amdinc
coon each subcontractor or vendor.roe contractor .will take such action with respect to any subcontracting or purchase order as the contractin
direct, as a means of enforcing such provisions,including sanctions for noncompliance;provided,however,that in the event the contractor bectmeslivolveh
In. or is threatened with, litigation,with the subcontractor or vendor as a result of such direction by the contracting agency the contractor r._} 12CtICSL th'
State of Colorado to enter into such litigation to protect the interest of the State of Colorado.
COLORADO LABOR PREFERENCE
6a'rovisions of CRS 317101 & 102 for?reference of Colorado labor are applicable to this contract if public works within the State are under:a. r hcreunocr
and are financed in whole or in pan.be State funds.
6'o When a construction contract for a public project is to be awarded to a bidder a resident bidder shall be allowed a preference against a Door s f bidder
from a state or foreign county equal to the preference given or required by the state or foreign country in which the nonresident bidder is a r)sicerth if t
determined by the officer responsible for awarding the bid that compliance with this subsection .06 may cause denial of federal funds which would other
wise be available or would otherwise be inconsistent with requirements of Federal law, this subsection shall be suspended,but only to the ex tent,c_essa-t
to prevent denial of the moneys or to eliminate the inconsistency with Federal requirements(CRS 8,9101 and 102).
GENERAL execution, and enfo m at of t is
7.The, laws of the State of Colorado and rules and regulations sued pursuant thereto shall be applied in the interoremtion, or
contract.Any provision of this contzct whether or not incorporated
herein
e eil na consideredreference
null and void.ch providesN for a bcoation nebyinany any orajud,iciainbo body
r r.soon sT
,jc
which is otherwise in purports
portst wto negate
said laws.rules, regulations
by'whether by reference which
iof complaint,defense,or fs or any otherwisee.ther.Anyspecial proviisiono rendered null and pan
the olperation of this valid or forceable provision or available
not inal dare ashen at I ernam'rs:
of this contract to the extent that the contract is capable of execution.
8. At all times during the performance of this contract,the Contractor shall strictly adhere to all applicable federal and state laws,rules,and regu'tabcn. that hip)),
been or may hereafter be established.
9.Pursuant to CRS 2430202.4 (as amended), the state controller may
balance witholdadde is owed toestatest.or other charges the
vendor
specified offset f ante l ri.us 3c r for: �I a i
unpaid child su to lest or child tosuppon nr the de, (b) unpaid
thereof, the amount of which is found to be owing as a result of final agency ce�rmina�ca
unpaid loans due to the student loan division of the department of higher education;(d)owed amounts required to be pare to the unempioyme it pnpensa i.,,
fund; and (e) other unpaid debts owing to the state or any agency
or reduced to judgment as certified by the controller.
1QTne signatories aver that they are familiar with CRS 18-8-301,et. seq., (Bribery and Corrupt Influences) and CRS 188 401,et. seq., (Abuses f l'gelid Off cc.,
and that no violation of such provisions is present.
II:fhe signatories aver that to their laiowledge,no state employee has any personal or beneficial interest whatsoever in the service or property resHt'ed her::r:
IN WITNESS WEERFOF, the parties hereto have executed this Contract on the day first above written.
Weld County Board of Commissioners by and through the TAl E OF COLORADO
Weld County Division of Human Services' Area Agency on Aga Bill Owens, Governor
[Full Legal Name)_
QO R / � Bn.
oocai xc_nfy Number or.EIh Sa e$T._R/
-- Sieramrc o:.Aumorizco 0nrr ,
Tutc of.va',homxa Cncio _ _._ _
DEPARTMENT OF
if Corporation:Auest(Seal)By
Corporate Scnrary or Fgur:aem.Town/Cr/County Oct IC
APPROVALS STATE CONTROW:2--------__
ATTORNEY GEC=RSL
B ——-----
By _
Perm 6-AC-02C
aovlcar, ?/99 Drtoo t 7 of 17 Paces
Exhibit A
Methodology for Calculating Total Compensation and Monthly Payments to Contractor:
(1) Total compensation for the one-year term of the contract will be subject to adjustment in accordance with the
average number of community-based clients served by the Contractor during each of the first three quarters of the
contract term (7/1/00 - 9/30/00, 10/1/00 - 12/31/00, and 1/1/01 - 3/31/01). Payment to the Contracto- will be
made in monthly installments, but the amounts contained in those monthly payments will be subject to adjustmem in
accordance with the procedures described below.
(2) The "average number of community-based clients" shall be calculated as follows: A census of clients will be taken
each month by the state. The categories to be included in this census are:
(a) "HCA ONLY (Home Care Allowance Only)",
(b) "HCA-KING", (Home Care Allowance, Client sought services due to King lawsuit,
(c) "HCA + HCBS" (Home Care Allowance with Home and Community Based Services),
(d) " HCA PLUS HCBS - KING" (Home Care Allowance and Home and Community Based Services, client
sought services due to the King lawsuit)
(e) "AFC ONLY" (Adult Foster Care Only),
(f) "AFC + HCBS" (Adult Foster Care with Home and Community-Based Services),
(g) "HCBS-EBD ONLY" (Home and Community-Based Services for the Elderly, Blind, and Disabled Only),
(h) "HCBS-EBD-KING" (Home and Community Based Services for the Elderly, Blind and Disabled, client sought
services due to the King lawsuit)
(i) "HCBS-PLWA ONLY" (Home and Community-Based Services for Persons Living with AIDS Only), and
(j) "HCBS-BI ONLY" (Home and Community-Based Services for Persons with Brain Injury Only).
(k) Clents referred to the Total Longterm Care Program during the remainder of the first contract year in which
the referral is made.
These categories are mutually exclusive and each case shall appear in only one category. Cases which may be
counted in these categories are those clients who have received at least one service which is eligible for
reimbursement under the program indicated, and who have not been terminated from the program. For each
quarter of the contract term, the Contractor's "average number of community-based clients" will be detetmined by
averaging the census for the three months in that quarter.
(3) In the event that the average number of community-based clients served by the Contractor during each cf the first
three quarters of the contract term is between 417, the "Case Loss Threshold", and 439 clients, total compensation
to the Contractor for the entire contract term shall be in the amount of 367,882, which shall be known as the "base
contract amount." The figure of 439 clients shall be known as the "base client figure."
(4) During the first four months of the contract term (7/1/00 - 10/31/00), the Contractor shall be paid 122,627.33,
divided into four equal monthly payments. The compensation for the first four months is equal to one-third of the
base contract amount and assumes that the average number of community-based clients served by the Contractor
during the first quarter will equal the base client figure.
(5) Actual compensation to the Contractor during the second, third and fourth quarters of the contract term shall be
determined by comparing (1) the actual, average number of community-based clients served during the preceding
quarter with (2) the base client figure for the Contractor. Contractor may qualify for additional compensation as
indicated in the second paragraph below.
(6) If the average number of community-based clients served by the Contractor exceeds the base client figure during
any of the first three quarters of the contract term, total compensation to the Contractor shall be increased by $838
(Annual Rate)for each additional client beyond the base client figure.
Page 1 of 3
Exhibit A
The following examples illustrate the foregoing principle:
(A) If the Contractor's base client figure is 100 and the Contractor's average case count is 103 in each of the
first three quarters of the contract term, total compensation will be increased above the base contract
amount by 3 times $838 = $2,514.
(B) If the Contractor's base client figure is 100 and the Contractor experiences an average case court of 106,
106, and 108 during the first three contract quarters, total compensation will be increased above the base
contract amount by 8 times $838 = $6,704.
(C) If the Contractor's base client figure is 100 and the Contractor experiences an average case court of 102,
99, and 105 during the first three contract quarters, total compensation will be increased above the base
contract amount by 5 times $838 = $4,190.
(7) However, total compensation for the contract term shall not be increased under this mechanism by more than
39,098 above the base contract amount, i.e., to a maximum total compensation of 406,980. The maximum increase
above the base contract amount under this mechanism represents 37 clients above the base client figure; -he figure
of 476 clients shall be known as the "maximum reimbursable client figure." Payment of the rdditional
compensation shall be made in equal installments over the number of months remaining in the contract term.
(8) The State has incorporated an adjustment of the payment per client, based upon a performance based payment
component to the single entry point payment methodology. Under this payment methodology, if the contractor does
not meet the performance objectives as specified in Exhibit E to this contract, the effective rate per client for the
period July 1, 2000 through June 30, 2001 will be reduced to $818 per client and commensurate adjustment of
payments will be made. All other terms of the SEP payment methodology will remain the same with the exception
that the effective per client payment will be reduced to $818 per client for the entire contract period with
commensurate payment adjustments being made by the State. Exhibit E provides also for an incentive payment of
$17 additional payment per client as set forth in this payment methodology for implementation of Prior
Authorization Procedures that achieve a standard set forth in Exhibit E.
(9) In the eventuality of an occurrence which will foreseeably cause rapid growth of the number of clients be ng served
by the Contractor, the State and the Contractor may mutually agree to compensation of the Contractor based on a
number of clients which exceeds the present quarterly average and which does not exceed the maximum
reimbursable client figure. If the average quarterly number of clients for which the Contractor is paid under this
type of agreement is not reached during the first, second or third quarters, the Contractor shall reimburse the State
for the difference in compensation between that average client count for which payment has been made and the
highest average client count which has occurred during the first, second or third quarters. If the Contractor has not
reimbursed the State, the State may also recoup the amount of reimbursement from any payments due under this
contract.
(10)If the average number of community-based clients served by the Contractor falls below 417 clients during any of the
first three quarters of the contract term, payment to the Contractor during the following quarter shall be decreased.
The amount of the decrease shall equal $209.50 times the figure obtained by subtracting (1) the average number of
community-based clients served during the preceding quarter from (2)the base client figure.
(11)After the client counts for the third quarter are reported (i.e., for months through March 2001), no later client.
counts will be used in calculating the compensation for the contract term. It is possible that, following the third
quarter, some additional funds will become available to compensate SEP agencies which have experbnced high
growth in their client case counts, such that they exceed the "maximum reimbursable client figure", during the first
three quarters of the contract term. Such additional funds, if any, would become available if one or store of the
SEP agencies does not reach its maximum reimbursable client figure during the first three quarters. In that event,
any excess available funds may be proportionately distributed among those SEP agencies which, during am oil the
Page 2 of 3
Exhibit A
first three quarters, have experienced average client counts in excess of the maximum reimbursable client figures
stated in their current contracts. As part of its calculations for distributing such excess funds, the State shall
compute the largest difference between(a) each agency's average client case count in each of the first three quarters
and (b) that agency's maximum reimbursable client figure.
For example: consider agency A which has a maximum reimbursable client figure of 115 and experiences
average case counts of 110, 115, and 120 during the first three quarters of the contract term; and agency B,
which also has a maximum reimbursable client figure of 115 and experiences average case counts of 120, 120
and 120 during the same time period. Each of these agencies would be entitled to the same proportionate share
of excess SEP funds, if any, which become available through funds released from agencies which do not teach
the maximum reimbursable client figure after the third quarter of the contract term.
Notification to the Contractor by the State of changes in the maximum reimbursable client figure and the maximum
total compensation under the provisions of this paragraph shall be made to the Contractor by means of a letter of
notification of the average number of clients of record at the State during the first three quarters of the contract
period. Contractor shall notify the State by a deadline date, not less than fourteen days from the date of
notification, set forth in the letter of notification of discrepancies in the number of clients served during the first
three quarters and the parties shall set the amended "maximum reimbursable client figure" and the amended
"maximum total compensation". Failure to respond to the letter of notification by the deadline date shall constitute
agreement by Contractor with the amended "maximum reimbursable client figure" and the amended "naximum
total compensation" contained in the letter of notification. Commensurate with this process the State shall issue a
change order letter that amends the "maximum reimbursable client figure" and the "maximum total compensation",
made part hereof as Exhibit C. Such change order letter shall not be valid until approved by the State Controller or
such assistant as he may designate.
(12)If adjustments occur in the state and/or federal funds through supplemental funds which are appropriated for this
program, the funding available to the contractor for client caseload growth may be adjusted in proportion to the
overall change in appropriation. Adjusted funding shall be made available by notification to the contractor by the
state and shall not require amendment of this contract.
(13) The Contractor shall be reimbursed an amount equal to the "Annual Rate" for each client for whom assessment has
occurred, and who selects and is enrolled in the Total Long Term Care program. This will be achieved by the
Contractor continuing to include the referred client in their monthly client count through the remainder of the
Performance Period of the contract year in which the referral is made.
(14)The payment to the Contractor of the annual case management fee for clients who are de-institutionalized ander
Scope of Work Paragraph 2(b) shall be made to the contractor from a separate fund made available to the State in an
amount not to exceed $81,527 for all Single Entry Point contractors statewide.
Page 3 of 3
Exhibit B
Payment Methodology for Deinstitutionalization Activities
Billing/Payment Procedure
(1) The State shall establish billing procedures and reimburse the Contractor in such amounts as may from time to time be
specified by the State pursuant to applicable federal and state statutes and regulations Total compensation to the
Contractor under this contract shall not exceed the limitation contained in the General Provisior entitled
"C ompensation/MaximumPayab le."
(2) The Contractor shall receive state and federal funds in monthly payments from the State as set forth in paragraph 3 of
this exhibit. Allowable agency expenditures are set forth by Federal rules, CFR Title 45, Part 74, Appendix G; Office
of Management and Budget Circular A-87 or A-122, whichever is applicable; and the U.S. Department of Health and
Welfare, December 1976, Cost Principles and Procedures for Establishing Cost Allocation Plans and Indirect Cost
Rates for Grants and Contracts with the Federal Government as indicated presently or amended in the future.
(3) The Contractor shall be reimbursed$270 per client for each nursing facility client for whom Contractor pe-fomts an
informational interview and a deinstitutionalization potential evaluation. The Contractor shall be reimbursed an
additional sum of$200 per client for each client who elects to leave a nursing facility, receive care in a community
setting, and for additional required research related to client monitoring and reporting of client specific and summary
information as required by the deinstitutionalization project.
(4) State payments to Contractor for deinstitutionalization activities are not subject to reimbursement to the State based on
contractor cost to provide the services.
(5) The Contractor shall be reimbursed as specified in paragraph 3 of this exhibit, as long as funding remains available for
this purpose. In the eventuality that the annual funding available for this service has been expended, the state will
notify, through the"Dear Administrator Letter"system,all Single Entry Point Contractors that payment will no longer
be available. These payments are on a fee for service basis and are not encumbered as a part of this contract.
Page 1 of 1
Exhibit C
Change Order Letter
Date:
State Fiscal Year 2001
Change Order Letter No. 1
In accordance with Paragraph 11 of Pages 2 and 3 of Exhibit A of contract routing number between
the State of Colorado Department of Health Care Policy and Financing and
covering the period of July 1, 2000 through June 30, 2001 the
undersigned agree the first sentence of Paragraph 4,Page 5,Price/Cost is hereby amended to read:
The State shall reimburse the contractor's reasonable, allowable costs, as defined herein,not exceeding,$
for work associated with the Scope of Work described under paragraph 2(a) above.
This constitutes a(n) (increase or decrease) in the maximum compensation to be made to the Contractor bri
the State under this contract of$
The sentences on Page 2 of Exhibit A to the contract which now read:
However,total compensation for the contract term shall not be increased under this mechanism by more
than$ above the base contract amount, i.e.,to a maximum total compensation of$ .The maximum
increase above the base contract amount represents_ clients above the base client figure; the figure of
shall be known as the"maximum reimbursable client figure".
are amended to read:
However, total compensation for the contract term shall not be increased under this mechanism by more
than$ above the base contract amount, i.e.,to a maximum total compensation of$ .The maximum
increase above the base contract amount represents_ clients above the base client figure; the figure of
_shall be known as the "maximum reimbursable client figure".
This amendment to the contract is intended to be effective as of but in no event shall it be
deemed valid until it shall have been approved by the State Controller or such assistant as he may
designate.
State of Colorado
Bill Owens, Governor
By:
For the Executive Director
Colorado Department of
Health Care Policy and Financing
APPROVALS:
By: By:
For Provider Rates and Financing Division State Controller or Authorized Designee
Page 1 of 1
Exhibit D
OPTIONS FOR LONG TERM CARE DATA SYSTEM
LETTER OF AGREEMENT
Purpose:This letter of agreement for the installation and testing of the Options for Long Term Care Data System
(OLTC-DS), training of the OLTC staff and supervisors, helping with the conversion of OLTC staff to automated
processing, problem identification and resolution and ongoing maintenance, between the Options for Long Term
Care Agency (OLTC), the Colorado Foundation for Medical Care (CFMC)and the Colorado Department of Health
Care Policy and Financing (HCPF) must be signed by all parties prior to installation.
This agreement is made by and between the Colorado Department of Health Care Policy and Financing
(referenced as DHCPF or State), the Colorado Foundation for Medical Care (referenced as CFMC) and
(referenced as Agency).
The goal of this agreement is to foster an environment of cooperation, mutual assistance, and self-reliance. It is
understood that this agreement is subject to modification, revision or termination due to changes in federal or
state laws and regulations pertaining to Medicaid and other State funded Medical Service programs and is subject
to available appropriations.
The Options for Long Term Care Data System (OLTC-DS) includes electronic formats of the OLTC Intake and
Care Plan forms, the ULTC-100 (also known as the Assessment form) and the Discontinuation form. The ULTC-
100 is uploaded to the Colorado Foundation for Medical Care for review and approval. In order to automate these
tasks, the Data System provides several processes such as"End of Day" and "Start of Day." One feature of the
Data System is the tracking module for use by the OLTC agency to identify due dates, CSRs, etc. There are also
management reports associated with the system.
A. The State will:
1. Contract for the provision of the Options for Long Term Care Data System (OLTC-DS), including the software
development, modification, and enhancement.
2. Purchase one personal computer, modem, and printer for the use of each agency.
3. Work with both the OLTC agency and the Colorado Foundation for Medical Care to assure the Data System
meets the functional and quality needs of the agencies.
4. Test all software, including enhancements and modifications, prior to release to the OLTC.
5. Approve all software and related documents (such as user manuals) prior to release to the OLTC agency.
6. Mediate any disputes between CFMC and the OLTC agency.
7. Schedule and conduct regular meetings of the Data System's Users Group
8. Publish, in conjunction with CFMC, the Data System Update. These updates will be done quarterly, or more
often as needed
B. The Colorado Foundation for Medical Care (CFMC)will:
1. Be responsible for installation, testing, and maintenance of the hardware and software supplied by the State.
2. Develop, test, maintain, and install at the Agency, the Options for Long Term Care Data System and related
components.
3. Provide technical expertise and assistance to the Agency to resolve problems encountered with the OLTC-DS
or State-purchased equipment when requested by the Agency. Technical advice may be given regarding the
purchase of computer equipment, networking, and other software products.
Page 1 of 3
4. Respond to each problem or request for assistance from the Agency lead person within one working day of
notification of a problem. CFMC will resolve the problem within two working days if the problem is ceusirg the
OLTC Data System to be unusable or within seven working days if the problem is not disrupting service. If
the problem is major or on-going, CFMC will notify the State within two working days of the nature of the
problem and the plan for resolution.
5. Conduct on-site training on the OLTC Data System for all Agency staff and supervisors who will be using the
OLTC Data System.
6. Determine, with the Agency, the training schedule and format. CFMC will provide up-to-date procedure
manuals to each trainee. The manuals will be updated or replaced as changes are made in the Data System
or its related components.
7. Maintain a problem log which identifies each call for technical assistance or problem resolution. The log will
contain the nature of the problem or question, the date and time the Agency notified CFMC, the date and time
CFMC responded to the Agency, and the resolution of the problem.
8. Assist in identifying and resolving problems with other computer hardware, software or networks at the
Agency. CFMC will assist in resolving problems caused by the installation and operation of the OLT: Data
System to the Agency's computer network.
9. Consult with Agency's identified lead contact person and the Agency's network administrator or their designee
if any modification to the Agency's equipment, software or network is needed. CFMC will assist the agency in
their modification/maintenance efforts.
C. The Agency will:
1. Assign a lead contact person to work with CFMC and the State. This lead person will represent the Agency at
all User's Group meetings, identify problems or concerns about the OLTC Data System to both CFMC and
the State, and be the central contact for all staff at the agency regarding the OLTC Data System. This person
should have previous experience working with computers (more than novice skills in computer literacy and
Windows), the ability to communicate Data System problems in a clear and concise manner, and the ability to
document problems encountered with the system.
2. Provide adequate space, electricity, and ventilation for the State-purchased computer equipment. The space
will allow for easy access by all case managers and supervisors who need to use the machine. Hardware
and software documentation will be located with the equipment. The State-purchased equipment wi I he
returned to the State should the Agency cease to be an approved OLTC agency.
3. For any additional computers on which the Agency wishes to have the OLTC Data System installed, the
equipment must meet or exceed the minimum standards as published in the Data System Update. Purchase
of additional computers will be the Agency's responsibility
4. Ensure staff and supervisors of the Agency who will be using the computerized OLTC Data System attend the
training provided by CFMC. This includes but is not limited to: attending all sessions of training, being on
time for the training sessions, and staying for the full training. If staff have never used a computer before,
computer literacy and basic Windows training will be given to them through a supervisor, a co-worker, or
through other training resources (such as community schools, colleges, or other private training) prior to the
installation training.
5. Ensure that staff keep their computer skills active by using the Data System, and by providing refresher
sessions when skills have not been used consistently.
6. Train all new employees who will be using the computerized OLTC Data System. Training can be done by a
supervisor or a co-worker who is skilled with the Data System. CFMC will not be responsible for training new
staff.
7. Call CFMC immediately when any problems with the state-purchased hardware or the Data System software
occurs.
8. Maintain a problem log following installation of the OLTC Data System. The log should identify the natu-e of
the problem, the staff encountering the problem, the date and time that CFMC was notified of the problem, the
date and time that CFMC responded to the Agency, and the resolution of the problem. For the first three
months of implementation, the problem logs will be submitted to CFMC and the State at the end of each
month.
Page 2 of 3
9. Responsible for the installation, testing and ongoing maintenance of other hardware, software or networks
within the agency.
, HCPF Date
, CFMC Date
Page 3 of 3
Exhibit E
Performance Based Payment Methodology
(1) (a)The contractor will receive the full per client payment by achieving three of the four performance
standards, (2A), (2B), (2C), (2D), listed below and by attaining performance standard(2E). Attainment of the
minimum required number of performance standards must be achieved and certified by the State by January
15, 2001. Payments by the State prior to January 15,2001, shall be made at a rate of $838 per eligible client
as described in Exhibit A to this contract.
(b)If three of four performance standards(2A), (2B),(2C) and(2D)below as well as performance standard
(2E) are not achieved and certified by the State by January 15, 2001, the State will deduct from the remaining
payments a total amount that adjusts the rate per client to$818 for clients served throughout the period from
July 1, 2000 through June 30, 2001 under the payment methodology described in Exhibit A to this contract.
Payment adjustments shall be made for average quarterly caseload counts for the first, second and third
quarters of the contract year as encompassed in Exhibit A to this contract.
(c) If performance standard(3)is attained by State certification by January 2001, contractor shall receive
payment of an additional$17 per client for clients served throughout the period from July 1,2000 through
June 30,2001 under the payment methodology described in Exhibit A to this contract. Payment adjustments
shall be made for average quarterly caseload counts for the first, second and third quarters of the contract year
as encompassed in Exhibit A to this contract.
(2) PERFORMANCE STANDARDS AND QUALIFICATION
(2A) Obtaining qualifying training for single entry point case management staff:
(a) This performance standard is achieved by the contractor,individually or in conjunction with other single
entry point contractors,providing at least sixteen hours of training for case management staff within the
period January 1, 2000 through January 15, 2001. Contractors may also submit to the State copies of signed
contracts or other written and signed documentation of commitment for qualifying training scheduled
between January 1,2001 and March 31, 2001 for credit toward the meeting of this standard.
(b) The required training must qualify under the list attached as Attachment 1 to this Exhibit E.
(c) Training provided after January 1, 2001 shall become eligible to fulfill training requirements in the contract
for July I, 2001 through June 30, 2002.
(d) Contractor must obtain this training from qualified trainers as determined by the State. The qualifications of
the trainer(s)and a proposed training agenda of information to be provided must be submitted to and
approved by the State. Contractors may also submit medically oriented courses appropriate for case
management staff in long term care as indicated in the last item of Attachment 1 to this Exhibit E.
(e) Contractor staff who received more hours than those required under the FY 1999-2000 Single Entry Poi it
Contract can carry forward into the FY2000-2001 contract a credited"beginning balance"of eligible training
hours, not to exceed 6 hours as Contractor was pre-notified in Dear Administrator Letter dated January ,
2000.The eligible"beginning balance" shall be calculated by subtracting "Training Hours Required' tioni
"Approved Training Hours Obtained"on the final"Report of Compiled Training Hours"under the FY 1909
2000 contract. Eligible training hours in excess of those required by the training standard under the FY 999-
2000 can be carried forward only into the "beginning balance"under the FY2000-2001 contract and not wn
any training requirements in contracts beyond the FY2000-2001 contract.
(f) Qualifying training must be given to training coordinators and all staff who perform as direct case manager
supervisors or who interact with clients in a direct case management provision role.This includes case
manager supervisors, case managers, and training coordinators. The training requirement for case aides,
Page 1 of 3
Exhibit E
intake staff, clerical staff who provide quarterly utilization and review contact shall be one-half of the hours
required for case managers, direct supervisors and training coordinators and medical terminology and
interviewing courses are recommended. Support staff who only refer clients to direct case management staff
have no training hour requirement under this contract.
(g) Staff hired between July 1, 2000 and November 1, 2000 shall have a pro-rated training requirement as
follows:
• Persons with hiring dates between July 1, 2000 and August 30,2000 shall be required to be provided l2
hours of training.
• Staff hired between September 1,2000 and October 15, 2000 shall be required to be provided 6 hours of
training.
• Staff hired after October 15,2000 shall be required to be provided no hours of training until a new tn.inm:;
cycle begins on January 1, 2001.
(h) The training requirement for part-time staff to meet this standard shall be pro-rated as follows:
• Staff who participate in single entry point activities at the level of.01 FTE to .24 FTE shall be pro),ided
4 hours of qualifying training.
• Staff who participate in single entry point activities at the level of.25 FTE to .49 FTE shall be provided
with 8 hours of qualifying training.
• Staff who participate in single entry point activities at the level of.50 FTE to .99 FTE shall be provided
with 16 hours of qualifying training.
(2B)Completeness, accuracy and adequacy of client assessment using the ULTC-100:
(a) Contractors achieving this performance standard are required to submit an average of 90%of the assessments
and reassessments to CFMC over a ten-month period beginning February 1,2000 and ending November 30,
2000 as Contractor was pre-notified in Dear Administrator Letter dated January 21, 2000 in sufficient
completeness, accuracy and adequacy that a return call or fax for the purpose of obtaining additional ULIC-
100 encompassed information is not required from CFMC intake unit staff. Contractors who submit fewer
than 10 assessments or reassessments during a four month period shall qualify by having no more than 1 return
call or fax for the purpose of obtaining additional ULTC-I00 information for the CFMC intake unit staff
(b) Telephone calls or faxes by CFMC to obtain information not normally encompassed by the ULTC-100 are not
included for calculation of this standard.
(c) CFMC shall provide a monthly report to the State and to the contractor which calculates the number of client
assessments and reassessments being submitted and the number of clients for whom faxes or return calls wer
c
required for contractor's SEP district and which provides the names of clients, social security numbers and a
summary statement of the nature of the reason(s) for the return call or fax.
(d) Specific ULTC-100 information that must be submitted completely, accurately and adequately is listed im
Attachment 2 to this Exhibit E to this contract.
(2C) Qualifying Attendance at Home Health Training:
(a) Prior to August 15, 2000, the State shall provide training in relation to Home Health services for long tenn came
clients.
(b) Qualifying contractors under this standard will have 100%of direct case management supervisors,direct cast
management lead workers, and Single Entry Point training coordinators attend this training, or in the cast of
unavoidable absence view a video-taped recording of this training to be provided by the State. Contrac:toi v ill
have at least eighty percent of their case manager staff attend this training, and
(c) At least eighty percent of those staff who attend will pass the post test of a pre-post test to be provided.b.) the
state trainer(s).
Page 2 of 3
Exhibit E
(2D) Cross-disciplinary staff:
(a) Contractors qualifying under this standard shall employ or contract for services of nursing trained or social
sciences trained case manager personnel who are trained in the discipline not predominantly held by the current
case management staff Predominantly social sciences staffed single entry point contractors could qualify D
employing as a regular member of their staff or by contracting for services of persons possessing nursing
qualifications as registered nurses. Predominantly nursing staffed contractors could qualify by employing as a
regular member of their staff or by contracting for the services of at least one case manager possessing bachelor
level social sciences training.
(b) Staff employed or whose contract services are obtained must meet staffing requirements specified in the single
entry point regulations. Wavering of staffing qualifications under the regulations and this paragraph may be
submitted to and must be approved by the State on an individual agency basis. Contractors who have in
previous years begun the practice of employment of cross-disciplinary staff shall be considered qualified under
this standard as long as the cross-disciplinary staffing continues or service contract continues.
(c) Staff whose services are being obtained must possess experience in working with clients who require long tern-
care.
(d) For a contractor to qualify under this standard, they must submit to the State a description of the employment
or contractual relationship which is being proposed to obtain the cross-disciplinary staffing. The description
must include a description of how the relationship is perceived to be adequate to serve the needs of the
contractor's particular caseload size, the credentials of the person(s) whose services are being obtained.and a
background summary of each cross-disciplinary staff member's experience in working with clients who It quuc
long term care. The description must also indicate the proposed accessibility to the agency staff and must
specify a minimum number of hours the cross-disciplinary person(s) will be available in person per month for
staffing cases and/or to answer questions. For example the description may indicate that:
"the person(s)will attend staffings or other meetings with the single entry point case managers in which
client needs are being reviewed and decisions made in regard to their care and will be available by telephone
and fax for discussions in regard to individual clients. The person will be available on-site at the singb.
entry point agency at least eight hours per month."
(2E) Utilization Monitoring of HCBS-EBD Services On-site utilization monitoring by the State during the period
October 15,2000 through December 31, 2000 shall demonstrate that the State determines that at least 90% of
monitored client Contractor-approved Prior Authorization Reviews(PARs) do not exceed those types anc
amounts of Medicaid-funded Home and Community-Based Non-skilled services that are medically and/'o-
functionally required by each client and in compliance with Medicaid rules.
(3) "Monitoring of Skilled Care Provider(Home Health) Service Utilization"The increase in cost of skilled
care services must be limited to 12.5%,not including the increase that occurs as a result of rate increases set by
the Department. The Medical Services Board of the Department of Health Care Policy and Financing wi,1 set
an average per client increase in the cost of services per client and effective September 1, 2000,that rate )f
increase shall become the standard against which this objective will be measured.For the contractor to qualify
under this standard, a data base which meets State requirements must be kept timely and accurately to within
seven days for all Prior Authorization Reviews(PARs)for clients who receive skilled care performed by the
contractor. A review of this data base by the State following entry of client PARs for Home Health skilled care
must demonstrate that the contractor has approved PARs for services that do not average more than the increase
amount set by the Medical Services Board over an average baseline PAR approval figure in dollars for tl at
contractor district that is provided to the contractor by the State.
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Attachment I to Exhibit E
Recommended List of Courses for
Performance Based Qualification
Qualification is sixteen hours per year for most staff(See Exhibit E for specific training
requirements) to encompass training as follows:
Course description and trainer credentials to teach course must be submitted in advance to the state
for qualification.
(A) Diabetes Management
(B) Progression and Management of Chronic Congestive Heart Failure
(C) Progression and Management of Chronic Lung Diseases
(D) An Overview of Radiation and Chemotherapy in Respect to the Physical and Emotional Impact
on the Client Receiving These Treatment Modalities
(E) An Overview of the Normal Aging Process with an Emphasis on Normal Functional Decline
(F) Assisting the Younger Disabled Client:
• Newly Disabled: Grieving and Adjustment to the Disability
• Chronically Disabled: Coping Skills in Regard to the Disability
(G) An Overview of Dementia
(H) A Brief Overview of the Major Psychiatric Disorders, i.e., Bipolar, Depression, Schizophren[a,
Borderline Personality Disorder and How Aging and/or Disability Impacts Them.
(I) Functional Evaluation of Cognitive Impairment from Brain Injury--Creating a Care Plan to
Address Care Needs
(J) Neurobehavioral Consequences of Brain Injury Treatment Planning and Management
(K) The Grieving Process
(L) Medical Terminology
(M)Interviewing Techniques
(N) Common Drug Interactions
(O) Topics, to include fraud and abuse training, associated with monitoring of utilization of client
Medicaid services.
(P) Other topics to be proposed by SEP(s) submitted with course description and trainer crecentals
to teach the course. Must be approved in advance by the State.
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Attachment 2 to Exhibit E
ULTC 100 Data Field Requirements
The process of submission of the ULTC 100 information is described as follows:
I. ULTC 100 faxes are received at the CFMC intake unit, reviewed for completion and logged into the
computer by the customer service representatives.
2. Missing data field requirements are identified and entered into the fax log.
3. A telephone call is made or a fax is sent to the OLTC agency informing them of the missing data field
requirements.
Legible handwriting must be used throughout the ULTC 100:
Contractor must submit ULTC 100 forms which include the following information:
(a) State Identification Number or Date and County of Application
(b) Date of Birth
(c) Social Security Number
(d) Sex
(e)Physician's Signature
(t)Physician's Printed Name
(g) Physician's License Number
(h)Physician's Telephone Number
(i)Date of Physician's Signature
(j)Diagnosis/es
(k)Pages 3a and 3b:
On page 3a and 3b of the ULTC 100, a number from 0 through 3 must be circled for each client functional
capacity measure. For client functional capacity scores from 1 to 3, entries must be made in the column
entitled "Describe Client Functioning". If no entries appear for scores I through 3, the CFMC intake unit
will telephone or fax the contractor agency for completion of this column and the return will be included m
the calculation of the index to be used for the performance based standard.
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Entries of a subjective nature as follow are queried to the contractor only by the CFMC nurse reviewers,
rather than the intake unit, and are not included in the calculation of the index to establish the performance
standard. These entries describe why the client requires services for each functional category. While they are
not included in the calculation of the index for the standard, they are important for rapid evaluation and to
reduce queries from the CFMC nurse reviewers.
Notes:
1. Please describe all safety issues related to any of the areas under Behavior. The behavior area. Page
5, Question 20, gives you a better chance than on page 3 to be more specific and leaves you room on the
page 3s to include more information.
2. If you need additional space to describe your clients needs, please use the comment section on page 6.
3. If you are going to utilize the wording "due to",please refer to a specific diagnosis if the diagnosis i
identifiable. This allows the nurse reviewer to understand which condition is causing a particular
functional deficit.
Transfers:
If the diagnoses shown on page 1 do not readily explain why the client requires transfer
assistance please explain why.
Does the client manage by himself/herself?
Type of assistance required?
How often is human assistance required?
Who assists the client?
Bowel and Bladder:
If the diagnoses shown on page l do not readily explain why the client requires bowel and/or
bladder care please explain why.
Is the client incontinent?
How many times per day/week is the client incontinent?
Is the client incontinent during the day, at night, or both?
Does the client manage the incontinence by himself/herself?
How often is human assistance required?
Who manages the incontinence?
If the client has an ostomy or catheter:
Who manages it?
Does the client require assistance to manage it?
How often is assistance required?
Mobility:
If the diagnoses shown on page 1 do not readily explain why the client requires mobility
assistance please explain why.
What is the client's level of mobility?
Does the client manage by himself/herself?
Does the client utilize any assistive devices? Please list them.
How often does the client require human assistance?
Who provides this assistance?
Does the client require assistance outside the home? If so,how often and what type?
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Dressing:
If the diagnoses shown on page 1 do not readily explain why the client requires dressing
assistance,please explain why.
Does the client require assistance? None,partial or complete?
What does he/she need assistance with?Everything, selection,buttons, tying shoes?
How often does the client require assistance?
Who provides the assistance?
Bathing:
If the diagnoses shown on page 1 do not readily explain why the client requires bathing
assistance,please explain why.
Does the client manage by himself/herself?
What type of assistance does he/she need?
Who assists him/her?
Hygiene:
If the diagnoses shown on page 1 do not readily explain why the client requires hygiene
assistance,please explain why.
Does the client manage by himself/herself?
What type of assistance does he/she require?
Who provides the assistance?
How often does he/she get help?
Eating:
If the diagnoses shown on page 1 do not readily explain why the client requires eating
assistance,please explain why.
Does the client manage by himself/herself?
What type of assistance does he/she require?
Who provides the assistance?
How often does he/she require assistance?
Meal Preparation/Housework/Laundry/Shopping:
If the diagnoses shown on page 1 do not readily explain why the client requires meal
preparation,housework,laundry and/or shopping assistance,please explain why.
Does the client manage by himself/herself?
What type of assistance does he/she require?
Who provides the assistance?
How often does he/she require assistance?
Medicine Management:
if the diagnoses shown on page 1 do not readily explain why the client requires medical
management assistance,please explain why.
Does the client manage by himself/herself?
What type of assistance does he/she require?
Who provides the assistance?
How often does he/she require assistance?
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Appointment/Money Management, Access Resources,Telephone:
If the diagnoses shown on page I do not readily explain why the client requires appointment,
money managements access resources and/or telephone assistance,please explain why.
Does the client manage by himself/herself?
What type of assistance does he/she require?
Who provides the assistance?
How often does he/she require assistance?
Pages 6 and 7 include further essential fields as follow which are included in the calculation of the incex f.pr
performance based payment purposes:
Page 6:
Name
Agency
Date
Phone Number
Include the specific services that the client needs in the comment section of page 6. This is most important
for both Admission and CSRs.The Nurse Reviewer utilizes this information when scoring and the physician
reviewer refers to it should the client be denied.
Page 7 (Admissions only)
Assessor Signature
Date of Birth
Social Security Number
Signature
The contractor shall contact the following persons in order to discuss issues of disagreement Jr
return due to oversight:
Step 1
Kristen Stone Customer Service Representative 303 695-3340 Ext. 3044
or
Wade Stiggins Customer Service Representative 303 695-3340 Ext. 3067
Step 2
Judy Helms LTC Manager 303 695-3340 Ext. 3112
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Step 3
Michael McGuire State Single Entry Point Program Administration 303 866-2694
Or, in his absence
Joan Bell State Single Entry Point Program Administration 303 866-2833
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Exhibit F
Example Option Exercise Letter
Date:
TO: [Contractor]
[Address]
SUBJ: Option Exercise Letter
In accordance with Paragraph of contract routing number FAA ADA ,between the
State of Colorado Depaztiuent of ( division) and
[Contractor]
covering the period of July 1,2000 through June 30, 2001 the State hereby exercises the option for
[an additional one year's performance period at the(cost) (price) specified in paragraph .]
The maximum amount payable by the State in Paragraph is (increased/decreased)by
($ amount of change) to a new total of($ ). The first sentence in Paragraph is hereby modified
accordingly.
State of Colorado:
, Governor
For the Executive Director
Colorado Department of
Title
APPROVALS: FOR THE STATE CONTROLLER
By: By:
State Controller or Designee
For Division
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