HomeMy WebLinkAbout981818.tiff RESOLUTION
RE: APPROVE LIFE PLANS BENEFITS PRODUCTS AND SERVICES CARE
MANAGEMENT AGREEMENT AND AUTHORIZE CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Life Plans Benefits Products and
Services Care Management Agreement 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 Life Plans/Family Caring Network, with terms
and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Life Plans Benefits Products and Services Care Management
Agreement 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 Life Plans/Family Caring Network be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 28th day of September, A.D., 1998.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
kiATTEST: .� L'% ( r�/a� eery'/'
rA Constance L. Harb rt, Chair
Weld County Clerk to thy B �� )
/ ♦ • W. H. ster, Pro-Tem
BY: fr
Deputy Clerk to the� � / / —e��� e . Baxter
ED FORM:
a e K. Hall
MAttn j _ off
arbara J. Kirkmeyer
981818
e('. N.S HR0069
LIFEPLANS
BENEFITS PRODUCTS AND SERVICES CARE MANAGEMENT
AGREEMENT
This Agreement is made as of the 233t day of Sgntet^hnr 19Jn ,,
between LifePlans, Inc. (hereinafter collectively referred to as LifePlans), its subsidiary
The Family Caring Network and
Weld County Division or Haman Services Area Anency nn ;aging (Provider).
SERVICE PROVISION
LifePlans provides a full range of risk and care management services to long term care
insurers and their claimants. LifePlans wishes to make use of Provider's services and
Provider is willing to make such services available as set forth in this Agreement.
Therefore, the parties agree as follows: -
1. Right to Use Materials, Products and Trademarks
LifePlans hereby grants to Provider the right to utilize, on an exclusive basis,the
materials developed for use by LifePlans and all products and trademarks related
thereto (Materials), including,but not limited to, all forms, manuals, assessment
instruments, training materials, documentation and other systems used or useful in
fulfilling Provider's obligations under this Agreement. The Materials shall be
used solely for the purpose of performing Care Management activities in strict
accordance with this Agreement, as amended from time to time, from the
commencement until the end of the term hereof, unless sooner terminated. No
materials other than LifePlans approved Materials shall be used by Provider in
carrying out services under this agreement. Provider brochures/materials may not
be distributed to applicants except, when required, during the benefit
determination & care management process.
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All rights, title and interest in the Materials, including any intellectual property
rights associated with the Materials,under any applicable federal or state statutory
or common law shall at all times remain vested in LifePlans, Inc. or one or more
of its affiliates. LifePlans disclaims any express or implied warranty that the
materials or their use will be free from claims of interference or infringement of
the patents, copyrights or other proprietary rights of any third party or claims of
impermissible use of proprietary information of any third party or any warranty,
express or implied, of the accuracy, reliability, technological or commercial value,
comprehensives or merchantability of the Materials.
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2. Definitions
2.1 Care Management. The term Care Management as it relates to LifePlans means
specifically a focus in geriatrics for Care Management in Long-Term Care
Insurance. Care Management is a service with three distinct components as
defined for purposes of this Agreement.
(a) Functional/Cognitive Assessment - Is a face to face evaluation utilizing a
standardized assessment tool to determine the claimant's daily care needs
and service requirements. The assessment provides some or all of the
following information regarding the claimant:
(I) functional level;
(2) cognitive status;
(3) health status;
(4) current living arrangement;
(5) use of formal and informal support systems.
(b) Care Plan- Determining with the claimant the appropriate available and
affordable mix of formal and informal services and resources to meet the
claimant's long-term care needs, and developing a Plan of Care to meet
those needs;
(c) Ongoing Care Management - Is the monitoring, reassessment, and
discharge or termination component of Care Management. More
specifically this includes:
(1) monitoring the service delivery, quality of care provided and status
of the claimant;
(2) reassessing the claimant's cognitive status, health status, and
functional level as they relate to the care provided and making
appropriate changes as needed, and;
(3) closing the case once a claimant no longer requires Care
Management due to depletion of insurance coverage, death, or
improved health, whereby Care Management services are no
longer required.
2.2. Competitor. In the event Provider has entered or enters into an agreement with
any agency or organization providing, offering or seeking to provide or offer
Long Term Care Insurance Assessment and/or Care Management services in more
than one state, either directly or through coordinating activities, management
agreements, affiliation or contracting with organizations or individuals shall
notify LifePlans (Exhibit A)
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3. Confidentiality
As part of your working relationship with LifePlans, Inc., you will be furnished with
materials developed by LifePlans which are confidential and non-public. With respect to
these materials; you and your staff agree to: keep secret and not disclose, reproduce or
remove from your or our premises, nor use for your benefit or the benefit of others, any
confidential or proprietary materials unless expressly authorized in writing by one of our
executive officers.
4. Schedule of Services To Be Provided
4.1. Services Provided by LifePlans. LifePlans will provide national coordination,
operational management and network development services.
4.2. Services Provided by Provider. Provider is responsible for providing Care
Management services using LifePlans approved protocols as specified in
agreements with insurance clients including, without limitation, when specified:
(a) conducting FunctionaUCognitive Assessments;
(b) developing Care Plan;
(c) performing Ongoing Care Management;
(d) following agreed upon policies, procedures and protocols in
provisions of Care Management services by LifePlans and
detailed in Exhibit B;
(e) maintaining standards and turnaround time in provision of
Case Management services;
(f) complying in all respects with applicable federal, state and
local regulations, including such regulations, if any, which
may require licensure;
(g) ensuring that the Care Management services shall be
conducted only by Registered Nurses, Licensed Practical
Nurses, Licensed Vocational Nurses or practitioners
holding a minimum of a Bachelor's Degree in social work.
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5. Term
The Term of this Agreement shall begin as of the date hereof and continue in force for
twelve months unless otherwise terminated pursuant to the terms of this Agreement. At
the expiration of each term, this Agreement will automatically renew for an additional
twelve month period unless a party sends written notice of termination via receipted mail
to the other party sixty (60) days prior to the expiration of the then current term.
6. Territory
The Network Provider's Territory shall be a geographical area described in Exhibit C
which is attached to this Agreement and incorporated herein by reference, in which the
Provider has the right to use the LifePlans Materials, and in which the Provider agrees to
provide Care Management and related services as a designated representative of
LifePlans, either directly or through sub-contracts.
Territory may be amended by Provider following 60 day written notice, via certified mail
to LifePlans.
7. Service Referrals
7.1. General. LifePlans is responsible for making available the services of the
Provider organizations to individuals and groups such as national and regional
insurance companies, employers, and unions. LifePlans, Inc. will develop and
manage the group contracts for Care Management services, and all referrals will
be coordinated through a centralized national intake center which receives calls,
collects identifying and accounting information, conducts a preliminary needs
screen and makes referrals to the appropriate Provider organization.
7.2. Overlapping Territories. In the event Territories overlap, or if there are multiple
Providers within a Territory, referrals will be made as determined by LifePlans,
on the basis of the following criteria:
(a) Geographic proximity;
(b) Cost of service;
(c) Quality of service.
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8. Fees and Payments
8.1 Fees. For each Care Management service provided and submitted to LifePlans,
Provider will be reimbursed at a rate of:
• $55 per hour of service provided to LifePlans
• $25 per hour of travel
• $.30 per mile of travel
8.2 Payments
8.2.1. Billing. Providers will be responsible for maintaining separate service
documentation and accounting for all individuals referred to the Provider
by LifePlans. Providers will use LifePlans forms and procedures to
submit the required service documentation and accounting information on
a monthly basis.
8.2.2. Payments. The Provider will submit the billing to LifePlans for payment
and LifePlans will pay the Provider for all services rendered and
documented according to the requirements specified. Payment will be
made within 30 days of receipt of accurate billing.
8.2.3. Documentation and Record Keeping. LifePlans will develop the necessary
documentation and reporting systems and supports (e.g. forms, etc.) to
implement the billing system. The Provider will be responsible for
maintaining all service documentation in accordance with the terms of any
Agreement. Individual billing records shall be kept for a minimum of five
(5) years, and LifePlans, having given reasonable notice, shall have the
right at any time during that period to audit, at its own expense, the service
records and all related accounting records for individuals referred to the
Provider by the Network.
9. Default and Termination
9.1. By Provider. The Provider may terminate this Agreement, on the first day of the
month following at least 60 days written notice of termination, via receipted mail.
9.2. By LifePlans. LifePlans may terminate the Agreement on the first day of the
month following written notice, via receipted mail. LifePlans may terminate for
any of the following:
(a) If Provider fails to follow agreed upon protocols in provision of Care
Management services;
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(b) If Provider fails to meet agreed upon standards of excellence in provision
of Care Management services;
(c) If Provider shall attempt to assign this Agreement or otherwise sell, assign,
transfer or encumber the Materials without the written consent of
LifePlans as herein above provided;
(d) If Provider or any of its employees fails to conduct the Provider's activities
in substantial compliance with any applicable law or regulation, local or
national;
(e) If Provider or a person or entity controlling, controlled by, or under
common control with Provider becomes insolvent (as revealed by its
records or otherwise); or if an involuntary petition is filed against it and
such petition is not dismissed within thirty(30) days, or if it shall make an
assignment for the benefit of creditors; or if a receiver or trustee in
bankruptcy or similar officer, temporary or permanent, be appointed to
take charge of any of its affairs or any of its property; or if-dissolution is
commenced;
(f) If Provider, by the conduct of its activities materially impairs the value of
the Materials, in the reasonable judgment of LifePlans.
9.3 Termination without Cause. Either party may terminate the Agreement without
cause by sending written notice via certified mail return receipt requested. The
Agreement will terminate 60 days after receipt of such notice.
LifePlans reserves the right to request the Provider agency cease using a trained
professional if such employee does not follow the protocols or fails to continually
meet the protocols established under this Agreement in the provision of Care
Management services. Upon receipt of such request the Provider shall cease
using the trained professional and shall make necessary arrangements to provide
Care Management services, with no interruption in service in the Territory
described in Exhibit C.
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10. Liability; Indemnity
The relationship between LifePlans and the Provider is that of independent contractors,
and neither shall be considered an agent or representative of the other for any purpose.
Each party shall be responsible for action and services separately attributable to itself and
to its employees and staff. This paragraph shall survive termination of this agreement.
At all times the Provider shall keep in force a general liability insurance policy issued by
a company authorized to transact business in the Provider's state of business. Limits of
liability shall be in the amount of$1,000,000 per incident$3,000,000 aggregate. The
Provider agrees to indemnify and hold harmless LifePlans and its insurance company
customers, employees and agents for any losses or damages resulting from the wrongful
acts, omissions or negligence of the Provider, its employees, or agents under this
Agreement.
11. Notices
All notices, requests, demands, and other communications hereunder shall be in writing
and delivered or mailed, with postage prepaid, to the party intended, at its address as
set forth on the signature page of this Agreement or such different address as may be
furnished by written notice.
12. Assignment
This Agreement may not be assigned by either party without the prior written consent of
the other, except that it may be assigned by LifePlans without Provider's consent to any
corporation affiliated with it by stock ownership or any successor to the operations of the
Network.
•
13. Binding
This Agreement shall inure to and bind the successors, assigns and representatives of
r the parties.
14. Entire Agreement
This Agreement contains the entire agreement between the parties hereto; no
representations, inducements, promises, or agreements, oral or other, between the parties
not embodied herein, shall be of any force or effect.
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15. Amendment of Agreement
This Agreement may be amended only by a written instrument signed by the parties
hereto.
16. Headings
The headings used in this Agreement are inserted only as a matter of convenience and
for reference and in no way define, limit, or describe the scope of this Agreement nor
the intent of any provision thereof.
17. Governing Law
This Agreement shall be construed under the laws of The Commonwealth of
Massachusetts.
18. Severability.
In the event one or more clauses of this agreement is/are deemed by a court of law to
be unlawful and/or unenforceable all other clauses of this Agreement shall continue in
full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first above written.
By: cl- a.., / /7s r\ BY( 2�.Li �,64'ic C. Constance L. �rt (09/28/98)
" 'Iwo University Office Park Title: Chair. Weld County Board of Commissioners
51 Sawyer Road, Suite 340
Waltham, MA 02453 Address : 915 10th Street
Greeley. CO 80631
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EXHIBIT A
Competitor Disclosure
(Provider) , provides Long-Term Care
Assessment services with the following organizations:
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EXHIBIT B
Established Protocols & Time Standards
LifePlans requires that established protocols be followed in the completion of each Care
Management service. These protocols ensure that LifePlans is able to provide the highest quality
service to its contracted insurance carriers.
It is necessary that all Care Management services are performed only by LifePlans trained
specialists.
It is necessary that all Care Management services be mailed utilizing a next day secured service
to LifePlans home office upon completion. LifePlans provides pre-paid postage to facilitate this
protocol.
Due to LifePlans' need for timely service, it is necessary that all phone calls placed from
LifePlans home office staff to the Provider are returned within 24 hours. It is also necessary that
the Provider make a contact call to the claimant within 24 hours of service request from
LifePlans.
Each LifePlans referral will have a section to note "Actual Time Spent On Case:
,"Travel Time: " and "Mileage: "on the Referral Service Order. It is
LifePlans' expectation that actual time spent on case, travel time and mileage will be accurately
noted for each case.
Each LifePlans referral will have a"Returned Completed Work By "due date on the
Referral Service Order. It is LifePlans' expectation that all work will be received at the home
office by the required service completion date.
When unexpected problems prevent adherence to the turn around time, it is Provider's
responsibility to notify LifePlans' home office by 1) calling with the problem and 2) completing
the"Exception Report".
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Adherence to LifePlans protocols and time standards is imperative.
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EXHIBIT C - TERRITORY
Please list the counties your agency will cover:
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Gheyet/N /1 c , "2y C' °lccv
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4i7ij\ MEMORAN � l.�M, _
1 I7u Ti' 25 23
Constance L. Harbert, Chair
'' ' }kTO: Board of County Commissioners DATJE ptember 25, 1998
TT((t T aV !?
FROM: Walter J. Speckman, Executive DiPectE or, iuman Services
COLORADO SUBJECT: Addendum to the Contract between the Weld County VVV
Division of Human Services' Area Agency on Aging and
Life Plans/Family Caring Network
Enclosed for Board approval is an addendum to the contract between the Weld County Division of
Human Services' Area Agency on Aging and the Life Plans/Family Caring Network.
The Area Agency on Aging provides assessment and ongoing case management services to Life
Plans/Family Caring Network. The attached addendum includes a change in the amount the Area
Agency on Aging will be reimbursed for services provided. The payment will change from a flat
reimbursement schedule to an hourly payment. This change will benefit our agency. The payment
change will take effect once the addendum has been signed by all necessary parties.
If you have questions, please feel free to telephone me at 353-3800, extension 3317.
981818
4
(a;
ct MEMORANDUM
' TO: Kim, Clerk to the Board DATE: December 3, 1998
CO . FROM: Susan Talmadge, Human Servic‘ jZt1 l!l
SUBJECT: Lifeplans Benefits Products and Services Care
COLORADO Management Agreement
Enclosed, please find the original Lifeplans Benefits Products and Services Care Management
Agreement that was approved by the Board on September 28, 1998.
If you have questions, please call me at extension 3310.
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