HomeMy WebLinkAbout990742.tiff RESOLUTION
RE: APPROVE CHILD HEALTH PLAN PLUS SATELLITE ELIGIBILITY DETERMINATION
SITE AND COMMUNITY HEALTH PLAN ENROLLMENT PROJECT SERVICES
AGREEMENT AND AUTHORIZE CHAIR TO SIGN - CHILD HEALTH ADVOCATES
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 Child Health Plan Plus Satellite
Eligibility Determination Site and Community Health Plan Enrollment Project Services
Agreement between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Weld County Health Department, and
Child Health Advocates, commencing March 1, 1999, and ending June 30, 1999, with further
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 Child Health Plan Plus Satellite Eligibility Determination Site
and Community Health Plan Enrollment Project Services Agreement between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Weld County Health Department, and Child Health Advocates 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 7th day of April, A.D., 1999, nunc pro tunc March 1, 1999.
BOARD OF COUNTY COMMISSIONERS
f D COUNTY CO DO
ATTEST: i
�✓rI Dale K. Hall, Chair
Weld County lerk he BpardG /_
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Barbar J. Kirkmeyeo-Tem
BY: / /Y
Deputy Clerk Ozt Bgerd
��� George axter
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M. J. e e
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990742
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CHILD HEALTH ADVOCATES
CHP+ SATELLITE ELIGIBILITY DETERMINATION SITE AND
CHP+ COMMUNITY HEALTH PLAN ENROLLMENT PROJECT
SERVICES AGREEMENT
MANUAL AND ELECTRONIC S.E.D. SITE
This Agreement, made this 1st day of March 1999, by and between the CHILD HEALTH
ADVOCATES, hereinafter referred to as "ADVOCATES," and the Weld County Health
Department, in Greeley, Colorado, hereinafter referred to as the CONTRACTOR.
WHEREAS, The Children's Health Plan Act establishes a program called the Colorado
Child Health Plan (hereinafter called "CCHP") for the provisions of outpatient and inpatient
medical services to children under age nineteen in medically indigent families;
WHEREAS, The Children's Basic Health Plan Act (Colorado Revised Statutes, Sections
26-19-101 through 26-19-112), creates the Children's Basic Health Plan (hereinafter called the
"CBHP" or"Chile. Health Plan Plus" CHP+), provides for the coordination of the CCHP and
CBHP, and provides funding therefor;
WHEREAS, CONTRACTOR provides health programs which serve its clientele,
including Childrer. with Special Needs, Weld Child Health Clinic, EPSDT program clients who
are not eligible for Medicaid, and the like, and CONTRACTOR would like to handle the CHP+
Application and E igibility determination process for CONTRACTOR's clientele;
WHEREAS, ADVOCATES would like for CONTRACTOR to provide the CHP+
Application and Eligibility determination process for CONTRACTOR's clientele;
WHEREAS, authority exists in the Law and Funds have been budgeted, appropriated and
otherwise made available and a sufficient uncommitted balance thereof remains available for
encumbering and subsequent payment of this Agreement through CCHP funding sources;
WHEREAS, ADVOCATES is authorized to enter into Agreements in performance of its
responsibilities under funding cited above;
WHEREAS, required approval, clearance and coordination has been accomplished from
and with appropriate agencies;
NOW THEREFORE, in consideration of the mutual promises contained herein, the
parties agree as follows:
I. DEFINITEONS
For the purposes of this Agreement, the following definitions shall apply:
Application Transmittal Worksheet. That document, which may be amended from time
to time, that shall be used to summarize the information collected during the application process
by the eligibility technician.
Hatching and Invoicing Form. That document, which may be amended from time to time,
that shall be completed in full and accompany each weekly batch of complete CHP+
Applications.
Contact P.rson. That person or persons designated by the CONTRACTOR as the
individual(s) whc shall answer all questions and concerns regarding the application process from
the applicant and the ADVOCATES.
Eligibility Determination. That process which reviews and measures all financial and
demographic information provided for the purpose of determining if the applicant is within the
financial perimeters to be eligible for the CHP+program.
Electronic Internet CHP+ Application. The electronic processes by which Contractor will
access, determine eligibility, and submit Applications for the CHP+ applicant.
CHP+ Application. That document prepared by the ADVOCATES, which may be
amended from time to time, and will reflect what is required by statute, acts to capture required
financial, and demographic information for the purpose of determining eligibility for the CHP+
program for the applicant.
Procedure Manual. That policy and procedure manual prepared by the ADVOCATES, which
may be amended from time to time, will govern the terms of actual eligibility determination and
will reflect what is required by statute setting forth the basic policies and procedures to be
followed by Satellite Eligibility Determination Sites and Community Health Plan Enrollment
Sites in carrying out the terms and conditions of this Agreement.
II. OBLIGATIONS OF CONTRACTOR
A. In handling the Application and Eligibility determination process for CON'TRACTOR's
clientele, CONTRACTOR shall abide by all applicable federal and state laws and regulations in
effect during the term of this Agreement, and CONTRACTOR acknowledges that the applicable
federal and state laws and regulations are hereby incorporated into this Agreement.
CONTRACTOR shall further abide by any reasonable subsequent amendments of CBHP
(CHP+) with advance written notice.
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B. CONTRACTOR has read, understands, and agrees to abide by all provisions of the
Satellite Eligibility Determination and Community Health Plan Enrollment Project Procedure
Manual prepared by the ADVOCATES for the CHP+program. From time to time
CONTRACTOR will be made aware of changes in writing set forth by changes in Statutes.
CONTRACTOR agrees to be bound by the most recent version of the Procedure Manual as these
changes occur.
C. CONTRACTOR agrees to designate a contact person for all CHP+communication,
correspondence and eligibility processing inquiries. The Contact person shall respond to
questions and concerns from the inquiring party within two (2) business days.
D. CONTRACTOR shall, upon receipt of paper application by personal delivery or the U.S.
Postal Service, date stamp or staple original envelope to the application to validate date of
application. Date 'validation for applications obtained during a personal interview will be the
date that the applic ation is submitted to the ADVOCATES electronically.
E. CONTRACTOR shall subsequently obtain all required financial or other documentation
from the applicant within ten (10) business days.
F. CONTRACTOR shall determine eligibility for first time applicants only.
G. Quality Assurance.
CONTRACTOR shall:
1. Have 120 days from date of submission of first application to achieve 90%
accuracy for eligibility determination and gathering required documentation for CHP+ applicants
as outlined in the procedure manual.
2. Receive additional training by ADVOCATES to correct procedural errors if
90% accuracy is not reached within 120 days.
3. Have an additional 60 days after training to comply with 90% accuracy rate.
H. CONTRACTOR shall provide information regarding CCHP and CHP+to its clientele
and to the public by providing brochures and applications, which the ADVOCATES shall make
available to CONTRACTOR upon request at no charge, and CONTRACTOR shall refer any
applicants from the general public who are not CONTRACTOR's clientele to one of the nearest
in proximity eligibility sites.
I. Records and Reports.
CONTRACTOR shall:
1. For a minimum of two (2) years, maintain paper copies of such records and
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provide, without additional charge, financial and administrative information to the
ADVOCATES as may be necessary for compliance by ADVOCATES with state and federal law
and administrative regulation, as well as for the CBHP (CHP+) program management purposes.
The ADVOCATES shall have access, at reasonable times upon demand and reasonable notice, to
the books, records and papers of CONTRACTOR relating to the eligibility determination
services provided to applicants.
2. Submit to the ADVOCATES, CHP+Applications with all required
documentation as described in the Procedure Manual under "Electronic S.E.D. Enrollment Site
Procedures."
3. Attach a completed individual Application Transmittal Worksheet to each
application with submission of the application to the ADVOCATES.
4. Submit to the ADVOCATES a Batching and Invoicing Form with each batch
of applications on a weekly basis.
5. Submit to the ADVOCATES all CHP+Applications received at
CONTRACTOR's site within thirty (30) calendar days from receipt of the application from the
applicant.
6. Submit a duplicate of the Batching and Invoicing Form including the
CONTRACTOR's Federal Tax Identification Number for reimbursement on a weekly basis.
7. These reports shall be submitted to:
Ha Hoang
Manager, Eligibility and Enrollment
CHILD HEALTH ADVOCATES
P.O. Box 469022
Glendale, CO 80246
8. Provide own computer equipment, Internet access with the most current
version of Microsoft Internet Explorer. Further, CONTRACTOR shall provide their own
technical hardware support.
9. Hold in confidence any data or information pertaining to the financial,
demographic or other information obtained by the CONTRACTOR or the ADVOCATES about
the applicant and shall not disclose to any third person except in connection with quality
assurance and peer review, or unless an appropriate release has been obtained, or to the extent
required or permitted by law, or as described in the Procedure Manual.
10. Hold in confidence user log on name and password used to access the
eligibility system.
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III. OBLIGATIONS OF THE CHILD HEALTH ADVOCATES
ADVOCATES shall:
A. Provide training for processing applications, submitting applications, accessing
the CCHP Web site and downloading completed applications electronically. ADVOCATES will
further provide training on invoicing for work completed by the CONTRACTOR.
B. Provide Procedure Manual outlining Application processing requirements.
C. Enroll members on CHP+ effective the date of a complete application with
required documentation.
D. Provide CONTRACTOR 30 days prior written notice of any material changes in
the Procedure Manual. ADVOCATES further states and agrees that applicable federal and state
law and regulations are hereby incorporated into this Agreement.
E. Provide CONTRACTOR with necessary forms to complete application process.
F. Finalize incomplete applications that are submitted by the CONTRACTOR.
G. Provide each Member with an identification card.
H. Discourage retroactive cancellation or addition of any Member after the applicable
monthly billing is calculated.
I. For Complete Applications submitted by CONTRACTOR hereunder,
ADVOCATES shall pay to CONTRACTOR the compensation set forth in Section 1V
Reimbursement.
J. Any data or information pertaining to the Diagnosis, treatment, or health of any
Member or applicant obtained by the CONTRACTOR or the ADVOCATES shall be held in
confidence and shall not be disclosed to any third person except in connection with quality
assurance and peer review, or unless an appropriate release has been obtained, or to the extent
required or permitted by law, or as described in the Procedure Manual.
K. ADVOCATES shall periodically provide CONTRACTOR with a current list of
Participating Providers.
L. Provide additional training as necessary.
IV. REIMBURSEMENT
A. Complete CHP+Applications submitted on paper with required documentation
shall he paid at the rate of six dollars, fifty cents ($6.50) per application.
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B. Electronic Internet submission of completed applications with required
documentation shall be paid at the rate of ten ($10.00) dollars per application.
C. All applications are subject to review for completeness and accuracy by the
ADVOCATES Manager of Eligibility and Enrollment.
D. Reimbursement checks will be distributed to the CONTRACTOR one (1) time per
month through the CHILD HEALTH ADVOCATES or its designee in accordance with their
regularly scheduled payment dates.
V. TERM AND TERMINATION
A. Term. The initial term of this agreement shall begin on March 1, 1999 and shall
continue through June 30, 1999. This Agreement shall be renewed automatically for successive
(12) twelve month periods unless either party notifies the other in writing not less than thirty (30)
days prior to the renewal date that it will not renew the Agreement.
B. Termination.
1. Either party may terminate this Agreement without cause with 30 days
advance written notice to the other party. Once notice has been given, CONTRACTOR will not
accept any new enrollment forms, but will continue to collect information for current
applications for submission to the ADVOCATES within that 30 days.
2. ADVOCATES may terminate this Agreement immediately if:
a. There is a finding, by any professional organization having recognized
jurisdiction or judgment, of professional misconduct by CONTRACTOR or employee of
CONTRACTOR.
b. CONTRACTOR becomes insolvent or files for bankruptcy, or if
CONTRACTOR's business shall come into the possession or control, even temporarily, of any
trustee in bankruptcy, or if a receiver is appointed for it or if CONTRACTOR makes general
assignment for creditors.
3. ADVOCATES may terminate this Agreement upon (30) thirty days prior
written notice if funds are not appropriated by the Colorado General Assembly, or if
ADVOCATES is unable to compensate CONTRACTOR because of insufficient funds.
4. ADVOCATES may terminate this Agreement upon (30) thirty days prior
written notice if CONTRACTOR is unable to comply with 90% accuracy requirement.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day first
above written.
ADVOCATES
;n C
Bonnie Sherman, Executive Director,
CHILD HEALTH ADVOCATES
CONTRACTOR
WELD COUNTY HEALTH DEPARTMENT
WELD COUNTY HEALTH DEPARTMENT
BY:
06.n c/a,. L. 0.r/SOn / HN S. PICKLE, M.S.E.H.
Print Name DIRECTOR
•
%J /J
Electronic S.E.D. Enrollment Site Administrator
84-6000-813
Federal Tax I.D. Number
WELD COUNTY BOARD OF COMMISSIONERS
R, 4
Chair, Dale K. a (04/07 93) --
111:ATTEST: .., 4I► 41 tiff,'i , '- -V
BY: S.,[ .1� =•
�� L .
Deputy Clerk to the Var.."
7
'r' MEMORAnDUM
Dale K. Hall, Chairman
T„ Board of County Commissioners Date April 2, 1999
COLORADO
From
John Pickle, Director, Health Departmc,rt'"
Subject:
Services Agreement with Child Health Advocates
Enclosed for Board review and approval is an agreement for services between the Weld County
Health Department(WCHD) and the Child Health Advocates.
Under the terms of this agreement WCHD will become a Satellite Eligibility Determination Site
for the Children's Basic Health Plan also called Child Health Plan Plus (CHP+). This plan
established by Colorado Revised Statutes, Sections 26-19-191 through 26-19-112, provides for
outpatient and inpatient medical services to children under age nineteen in medically indigent
families. As a Satellite Eligibility Determination Site, the Health Department will assist clients
in completing their applications for this insurance plan, will determine eligibility for first time
applicants only, and will submit each application with all required documentation to the Child
Health Advocates.
This program will enhance existing services to other child health programs at the Health
Department such as the Health Care Program for Children with Special Needs, the EPSDT
Program, and Well Child Health Program.
In exchange for these services, WCHD will be paid $6.50 for each completed paper application
and $10.00 for each completed electronic application submitted. The initial term of this
agreement is from March 1, 1999 through June 30, 1999 and it will be renewed automatically for
successive twelve month periods unless terminated by either party.
I recommend your approval of this agreement.
Enclosure
990742
NLx25
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