HomeMy WebLinkAbout20240575.tiffRESOLUTION
RE: APPROVE AMENDMENT #3 TO INTERGOVERNMENTAL AGREEMENT FOR
2023-2024 COUNTY INCENTIVES PROGRAM AND AUTHORIZE CHAIR TO SIGN
AND SUBMIT ELECTRONICALLY
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 Amendment #3 to the Intergovernmental
Agreement for the 2023-2024 County Incentives Program 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, and the Colorado Department of Health Care Policy and
Financing, commencing July 1, 2020, and ending June 30, 2024, with further terms and conditions
being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that Amendment #3 to the Intergovernmental Agreement for the 2023-2024
County Incentives Program 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,
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 and submit said amendment electronically.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 6th day of March, A.D., 2024, nunc pro tunc July 1, 2020.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, �.OF�CLQ
ATTEST: dditt4m) ( x/04
Weld County Clerk to the Board
BY U 't • Gdu t 'i c --k .
Deputy Clerk to the Board
APPROVE
County A torney
3113Z
Date of signature:
7L 0
K • Ross, Chap
Perry L. f ck, Pro-Tem
Mike Feman
2024-0575
HR0096
ConFvac-1- tD la0Z
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Department of Health Care Policy and Financing County Incentives Amendment #3 for
Fiscal Year 2024
DEPARTMENT: Human Services DATE: February 27, 2024
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: In 2020 the Department entered into an Intergovernmental Agreement
with the Department of Health Care Policy and Financing (HCPF) for the County Incentives Program regarding
Medical Assistance Eligibility performance, known as Tyler ID 2020-2389. The State has now issued Amendment
#3 for Fiscal Year 2024 which creates and revises performance -based benchmarks and deliverables for the
County. The amendment includes one new Performance Incentive and the removal of two other Performance
Incentives.
The term of this agreement is from the date of the last signature on the Cover Page through June 30, 2024,
unless sooner terminated.
What options exist for the Board?
• Approval of Amendment #3 with the Department of HCPF.
• Deny approval of Amendment #3 with the Department of HCPF.
Consequences: An Amendment #3 with the Department of HCPF will not be executed.
Impacts: The Department will not receive incentive funds.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
• If FY 2024 benchmarks are met, Weld County may earn $466,727.65.
Pass -Around Memorandum; February 27, 2024 — CMS 7862
2024-0575
Recommendatlo :
• Approval of the Amendment and authorize the Chair to sign electronically.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Iffr
Perry L. Buck, Pro Tem
Mike Freeman
Scott K. James
Kevin D. Ross, Chair
Lori Saine
Pass -Around Memorandum; February 27, 2024 - CMS 7862
DocuSign Envelope ID: 24EDF1A9-025E-4C36-6195-D384BEE2B21D
CONTRACT AMENDMENT #3
SIGNATURE AND COVER PAGE
State Agency
Department of Health Care Policy and Financing
Original Contract Number
2021 CMIP063
Contractor
Weld County
Amendment Contract Number
2021CMIP063A3
Current Contract Maximum Amount
Initial Term
State Fiscal Year 2021 $275,695.31
Extension Terms
State Fiscal Year 2022 $275,695.31
State Fiscal Year 2023 $452,087.23
State Fiscal Year 2024 $466,727.65
Total for All State Fiscal Years $1,470,205.50
Contract Performance Beginning Date
July 1, 2020
Current Contract Expiration Date
June 30, 2024
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment
and to bind the Party authorizing his or her signature.
CONTRACTOR
Weld County
�—DocuSigned by:
O 6
By: \---2D8EA09BACOC4B3...
3/6/2024 111:43 PST
Date:
By:
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care Policy and Financing
p-DocuSigned by:
3 X6/06064 84792 E5 9 4M5
In accordance with §24-30-202 C.R.S., this Amendment is not valid until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
DocuSigned by:
By: 76160541272043A...
3/6/2024 I 15:19 MST
Amendment Effective Date:
Amendment Contract Number: 2021CMIP063A3 Page 1 of 1
a20-24 DO
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I. PARTIES
This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover
Page for this Amendment (the "Contract") is entered into by and between the Contractor and the
State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract.
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date
shown on the Signature and Cover Page for this Amendment. The State shall not be bound
by any provision of this Amendment before that Amendment Effective Date, and shall have
no obligation to pay Contractor for any Work performed or expense incurred under this
Amendment either before or after of the Amendment term shown in §B of this Amendment.
B. Amendment Term4.3
The Parties' respective performances under this Amendment and the changes to the Contract
contained herein shall commence on the Amendment Effective Date shown on the Signature
and Cover Page for this Amendment and shall terminate on the termination of the Contract
or June 30, 2024.
4. PURPOSE
The purpose of this Amendment is to create and revise performance -based benchmarks and
deliverables for county departments of human/social services to achieve certain performance
standards related to County Administration, Medical Assistance Eligibility and cooperation with
other Medical Assistance -related entities. This Amendment includes one new Performance
Incentive and the removal of two other Performance Incentives.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page
is hereby deleted and replaced with the Current Contract Expiration Date shown on the
Signature and Cover Page for this Amendment.
B. The Contract Maximum Amount table on the Contract's Signature and Cover Page is
hereby deleted and replaced with the Current Contract Maximum Amount table shown
on the Signature and Cover Page for this Amendment.
C. Exhibit A-1 STATEMENT OF WORK, is hereby deleted in its entirety and replaced with
Exhibit A-2, STATEMENT OF WORK, attached below. All references to Exhibit A and
A -1 shall now reference Exhibit A-2.
D. Exhibit B -1, RATES, is hereby deleted in its entirety and replaced with Exhibit B-2,
RATES, attached below. All references to Exhibit B and B-1 shall now reference Exhibit
B-2.
Amendment Contract Number: 202ICMIP063A3 Page I of 2
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E. Exhibit D, Review Sample Size Exemption Process Flow, is hereby deleted in its entirety
and replaced with Exhibit D-1, Review Sample Size Exemption Process Flow, attached
below. All references to Exhibit D shall now reference Exhibit D-1.
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments or other modifications to the Contract, if any, remain in full force and effect except as
specifically modified in this Amendment. Except for the Special Provisions contained in the Contract,
in the event of any conflict, inconsistency, variance, or contradiction between the provisions of this
Amendment and any of the provisions of the Contract or any prior modification to the Contract, the
provisions of this Amendment shall in all respects supersede, govern, and control. The provisions of this
Amendment shall only supersede, govern, and control over the Special Provisions contained in the
Contract to the extent that this Amendment specifically modifies those Special Provisions.
Amendment Contract Number: 2021CMIP063A3 Page 2 of 2
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EXHIBIT A-2, STATEMENT OF WORK
1. TERMINOLOGY
1.1. The following list is provided to assist the reader in understanding acronyms, abbreviations and
terminology used throughout this document.
1.1.1. Applicant - An individual for whom the Contractor is performing a Medical Assistance
Eligibility Determination.
1.1.2. Average Speed to Answer (ASA) - A key Call Center metric measuring the average amount
of time it takes to answer a phone call from a customer, from the point of call connection to
being connected to a live agent, including the time waiting in queue. ASA does not include
calls that can be answered through automated means and do not require a live agent.
1.1.3. Benchmark - degrees of performance between undesired current performance and target
performance (example: current timeliness 90%, benchmark for next month = 93% until we
reach 95%)
1.1.4. Business Day - any day in which the State is open and conducting business, but shall not
include Saturday, Sunday, or any day which the State of Colorado observes one of the
holidays listed in C.R.S. §24-11-101(1).
1.1.5. Call Center - A Call Center is defined as having one dedicated line for contacting the
Contractor; when members and individuals call in, they are automatically assigned to the next
available Contractor agent. This dedicated line should also have technology in place to
provide data, at a minimum, on the number of calls received, the average wait time and the
number of abandoned calls. Call Centers can be as small as 2 Contractor staff and as large as
100 or more Contractor staff answering calls.
1.1.6. Child Health Plan Plus (CHP+) - public low-cost health insurance for certain children and
pregnant women. It is for people who earn too much to qualify for Health First Colorado
(Colorado's Medicaid program), but not enough to pay for private health insurance.
1.1.7. Compliance Measures - Performance measures tied to contracts to ensure Colorado does not
fall below expected federal or state performance standards.
1.1.8. COGNOS/Decision Support System 01 (DSS01) - the Department's data reporting systems
that use information from the Colorado Benefits Management System (CBMS).
1.1.9. Colorado Benefits Management System (CBMS) - the State's eligibility determination
system.
1.1.10. Colorado interChange (interChange) - the State's claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collect and analyzes data related
to those payments.
1.1.11. Corrective Action Plan (CAP) - A formal plan submitted by the County and in collaboration
with the Department who will provide technical assistance to address non-compliance and/or
performance in accordance with 10 CCR 2505-5 1.020.11.
1.1.12. County Administration website - the Department's public -facing website where contract
documentation is kept for the County Incentives Program
(http://www.colorado.gov/hcpf/county-admin).
Exhibit A-2, SOW Page 1 of 22
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1.1.13. County Financial Management System (CFMS) - the accounting system utilized by the
Contractor to record expenditures against county administration funding for Colorado's
Medical Assistance Program. The system is also used to issue Performance Incentive
Payments to eligible Contractors.
1.1.14. County Incentives Program - program that provides specific funding to county departments
of human/social services for meeting Medicaid -related Performance Incentive Standards in
their counties. Also referenced as Performance Incentive Standard Program throughout this
Agreement.
1.1.15. Determination - The act of using CBMS to determine if an Applicant is eligible for the
Colorado Medical Assistance Program based on information submitted on a new application,
a redetermination or a change in member circumstance.
1.1.16. Disenroll or Disenrollment - The act of processing a change in circumstance that affects a
member's eligibility and makes them ineligible for coverage within Health First Colorado or
Child Health Plan Plus.
1.1.17. Eligibility Quality Assurance (EQA) Program - EQA conducts monthly case reviews to
monitor the accuracy and timeliness of eligibility determinations for Medical Assistance
made by the Contractor, with cases pulled monthly for quality review. Results of the EQA
reviews are displayed on the MAP Accuracy Dashboard.
1.1.18. HCPF Memo Series - The Department's policy, operational and informational
communications that are utilized to provide contract clarifications, provide data and
operational guidance and share information pertaining to the County Incentives Program
(https://hcpf.colorado.gov/memo-series).
1.1.19. Health First Colorado — the member -facing name for Colorado's Medical Assistance
Program, which includes all programs that use the Modified Adjusted Gross Income (MAGI)
and Non -MAGI Methodology.
1.1.20. Home and Community -Based Services (HCBS) - HCBS waiver programs provide additional
benefits and services to eligible populations in addition to the standard benefit package
offered to all members.
1.1.21. Improvement Action Plan (IAP) - An informal plan submitted by the County to address non-
compliance and/or performance in accordance with 10 CCR 2505-5 1.020.11.
1.1.22. Key Performance Indicator — KPI, a specific, measurable and quantifiable measure of
performance metrics used to track progress over time toward a specific objective or goal. Call
Center KPIs definitions and terminology were shared with Tier 1 counties in FY 2022-23 and
will be issued as an attachment in Operational Memo.
1.1.23. Long Term Care (LTC) - Long -Term Care is a Medical Assistance program that provides
nursing -home care, home -health care, personal or adult day care for individuals of any age
with a chronic or disabling condition.
1.1.24. Management Decision Letter (MDL) -A formal notification issued by the Department,
through a letter that details areas and findings of noncompliance by the Contractor. An MDL
can be issued for not meeting performance targets on the MAP Dashboard.
1.1.25. MCC — Health First Colorado Member Contact Center
Exhibit A-2, SOW Page 2 of 22
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1.1.26. Member — An individual who is eligible for the Colorado Medical Assistance Program. Also
known as a Client.
1.1.27. Medical Assistance Performance (MAP) Dashboards - a graphic representation of essential
information regarding performance measures, targets and benchmarks and the county's actual
performance. The MAP Dashboards highlights each county's performance and quality.
1.1.28. Performance Measure - A quantification that provides objective evidence of the degree to
which a performance result (goal) is occurring over time.
1.1.29. Program for the All -Inclusive Care for the Elderly (PACE) — Program provides
comprehensive medical and social support services to certain frail individuals 55 years of age
and over. The goal of PACE is to keep individuals in their homes and communities through
comprehensive care coordination.
1.1.30. PuMP - Performance Measurement Process developed by Stacey Barr.
1.1.31. Reporting Period - The period of time for each performance standard used to measure whether
the Contractor is meeting the requirements of each specific Performance Incentive Standard,
including performance targets and/or deliverables.
1.1.31.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1.31.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and end on
.dune 30 of that SFY.
1.1.32. Redetermination - A Determination as defined under 10 C.C.R. 2505-10 8.100.3.P.
1.1.33. State Fiscal Year (SFY) - The period beginning July 1 of each calendar year and ending on
Juno 30 of the following calendar year. Also referred to as fiscal year in this Exhibit.
1.1.34. Status Report - a communication to the Contractor those details which Performance Incentive
Standards were met for each Reporting Period.
1.1.35. Tableau — is an interactive data visualization software focused on business intelligence;
provides a graphic representation of essential information regarding performance measures,
targets and benchmarks and the county's actual performance.
1.1.36. Timely Determination - Any initial Determination that is completed within the timeliness
requirements set forth in 10 C.C.R. 2505-10 8.100.3.D.
1.1.37. Timely Disenrollment - Processing a change in a member's circumstance resulting in
disenrollment within fifteen (15) calendar days.
1.1.38. Timely Redetermination - Any Redetermination completed by the last day of the month prior
to the month in which the member's new annual enrollment period begins.
1.1.39. Targrt - Degree of performance we are continuously striving to achieve (i.e., 95%
Timeliness)
1.1.40. Untimely Determination — Any initial Determination that is not completed within the
timeliness requirements set forth in 10 C.C.R. 2505-10 8.100.3.D.
1.1.41. Untimely Redetermination — Any Redetermination that is not completed by the last day of
the month prior to the month in which the member's new annual enrollment period begins.
This is based on the CBMS RRR Due Date.
Exhibit A-2, sow Page 3 of 22
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1.1.42. Voice of the Customer - Voice of the Customer (VoC) is a series of different methods that is
used to collect customer feedback. A VoC program can help the Contractor capture how
customers feel about the experience of accessing services at the Contractor and can produce
insights that can help the Contractor create a stronger customer experience.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility -related work within the Contractor's
County, required under C.R.S. §25.5-1-101 el seq. The Department and the Contractor share the
costs of this work performed by the Contractor as defined in those statutes and this Contract shall
not impact the allocated amount of that cost sharing.
3. SYSTEMS USED TO DETERMINE COMPLIANCE WITH PERFORMANCE
INCENTIVES STANDARDS
3.1. Systems Utilized to Determine Compliance
3.1.1. To determine whether the Contractor met any or all the Performance Incentives Standards
when completing determinations and redeterminations within the Contractor's County, the
Department will utilize the COGNOS/DSS01 and MAP Dashboard systems to pull data
tracking and reports that track the Contractor's compliance with certain Performance
Incentive Standards. This data will be visualized on each county's MAP Dashboards.
3.1.2. To determine whether the Contractor met any or all the Performance Incentives Standards
when working with Medicaid populations within the Contractor's County, the Department
may utilize data from the Colorado interChange system.
3.1.3. The above list of systems is not all-inclusive, and the Department will, at its discretion, utilize
additional data and reports from the COGNOS/DSS01, interChange, and/or other systems to
determine whether the Contractor met any or all the Performance Incentives Standards.
3.1.4. The date the data or reports will be pulled from the COGNOS/DSS01, interChange, and/or
other systems published on the MAP Dashboard will be defined in each applicable
Performance Incentive Standard and/or the PUMP template for those performance measures.
3.1.5. The Contractor shall utilize policy, operational and informational guidance provided in this
Exhibit and through the HCPF Memo Series for each Performance Incentives Standard to
assist with implementing the Performance Incentives Standard and pulling applicable data
and reports to determine the Contractor's compliance with any or all the Performance
Incentives Standards.
3.1.6. To determine whether the Contractor met any or all the Call Center Performance Standards,
the Department will review county call center systems data for tracking and reports that track
the Contractor's compliance with Customer Service Incentive Performance standard.
3.2. Communications Utilized to Determine Compliance
3.2.1. The Contractor shall utilize and comply with guidance issued through the HCPF Memo Series
and shall fulfill the requirements in Exhibit A Statement of Work thereby enabling Contractor
to earn a Performance Incentive Payment.
3.2.2. The Contractor shall utilize the HCPF Memo Series to find any forms, templates, program
contacts or additional information needed to operationalize the Performance Incentives
Standard Program referenced throughout this Agreement.
Exhibit A-2, SOW Page 4 of 22
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3.2.3. If additional guidance or contract clarification is needed, the Department shall release
additional guidance to the Contractor through the HCPF Memo Series.
3.2.4. The Department reserves the right to request written documentation from the County to
include but not limited to the following: (1) any and all documentation generated by various
software and/or systems; (2) written policies and procedures; (3) standard operating
procedures; (4) Internal directives and/or communications to staff related to processing or
performance guidelines.
3.2.4.1 If the Department requests any documentation outlined in 3.2.4, the County shall
respond within five calendar days from the date of the request. If, for reasons outside of the
County's control, the County is unable to respond within the five calendar days, the County
will notify the Department immediately and request an extension. The request for an
extension must be received by the Department within the five -calendar day timeframe as
outlined above. The County must provide a reason for the extension. If the request for the
delay is not received within the five -calendar day timeline, the request will be denied.
3.2.4.2 The Department reserves the right to extend the deadline or to deny the request
for an extension.
4. PERFORMANCE INCENTIVES STANDARD PROGRAM
4.1. The Contractor has the ability to earn Performance Incentive Payments to reimburse a portion of
cost sharing as described in Section 2 by meeting targets, benchmarks and/or deliverables as
outlined in each Performance Incentive Standard.
4.2. Accuracy Performance Incentive Standard
4.2.1. The Contractor may earn the Accuracy Performance Incentive Payment by meeting the
Accuracy targets at the end of the Second Reporting Period. To earn the entire Accuracy
Performance Incentive Payment, the Contractor must meet both targets as specified in section
4.2.1.1, which includes (1) Target for Inaccurate Eligibility Determination Rate, and (2)
Target for Errors That Do Not Impact Eligibility. If the Contractor only meets one target, the
Accuracy Performance Incentive Payment will be 50% of the total amount for this
Performance Incentive.
4.2.1.1.
4.2.1.1.1.
4.2.1.1.2.
4.2.1.1.3.
4.2.1.1.4.
Accuracy Targets
Accuracy targets are set based on the county size of the Contractor. There are two
tiers.
Tier 1 target percentage (%): Contractors with twenty (20) or more cumulative quality
assurance case reviews conducted over a twelve-month period. This is the target
reported on the MAP Accuracy Dashboard.
Tier 2 target percentage (%): Contractors with fewer than twenty (20) cumulative
quality assurance case reviews conducted over a twelve-month period. This is not
reported on the MAP Accuracy Dashboard and used for County Incentives purposes
only.
Based on EQA sampling, large Contractors will exceed twenty cumulative quality
assurance reviews over the twelve-month period, resulting in no Tier 2 target for large
counties
Exhibit A-2, SOW Page 5 of 22
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4.2.1.2. The Inaccurate Eligibility Determination Rate target is used to determine how many
individuals in the sample had an incorrect determination.
4.2.1.2.1. The Inaccurate Eligibility Determination Rate is calculated as the number of
individuals that were incorrectly approved, denied, or terminated divided by the total
number of individuals in the sample (%), monthly (includes applications,
redeterminations, and case changes).
4.2.1.2.2. Target Percentages for Incorrect Eligibility Determination Rate
County Size
Tier 1 Target %
Tier 2 Target %
Large
5.5%
N/A
Medium
6.6%
13.2%
Small
7.3%
14.6%
4.2.1.3. The Errors That Did Not Impact Eligibility target is used to determine how many
individuals in the sample had a correct determination with errors that did not impact
eligibility (procedural errors).
4.2.1.3.1. The Errors That Did Not Impact Eligibility is calculated as the number of individuals
with error(s) that did not impact eligibility divided by number of individuals in the
sample, monthly (includes applications, redeterminations, and case changes).
4.2.1.3.2. Target Percentages for the Errors That Did Not Impact Eligibility Rate
County Size
Tier 1 Target %
Tier 2 Target %
Large
17.9%
N/A
Medium
16.9%
20.9%
Small
23.2%
27.2%
4.2.1.4. HCPF Eligibility Quality Assurance (EQA) Program and Medical Assistance
Performance (MAP) Accuracy Dashboard
4.2.1.4.1. The Contractor shall comply with the HCPF Eligibility Quality Assurance Program,
per 10 CCR 2505-5 1.020.10.2 and HCPF Operational Memo (OM) 21-057, or
whichever later Operational Memo supersedes OM 21-057, which specifies the
Contractor's role in the state quality assurance (QA) case review process.
4.2.1.4.1.1. The EQA case review process is to monitor the accuracy and quality of eligibility
determinations for Medical Assistance made by the Contractor, and EQA case
reviews occur monthly.
4.2.1.4.1.2. The Contractor must respond to documentation requests and error findings within
ten (10) business days of the request to ensure EQA case reviews are completed
timely.
Exhibit A-2, SOW
Page 6 of 22
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4.2.1.4.1.3. The Contractor must respond to the Department's EQA case review error findings
by using the two options, 1) Agree/Concur or 2) Disagree/Rebut within ten (10)
business days.
4.2.1.4.1.4. If additional or revised guidance relative to the HCPF EQA process is issued
through the HCPF Memo Series, the Contractor shall disregard the previous
guidance and comply with the new guidance offered through the HCPF Memo
Series.
4.2.1.4.1.5 Th e Department shall utilize the Medical Assistance
Performance (MAP) Accuracy Dashboard to publish the results of the quality
assurance case review findings each month and sends the results to the County
Directors and Board of County Commissioners.
4.2.1.5. Determining Compliance with the Accuracy Performance Incentives Standards
4.2.1.5.1. The MAP Accuracy Dashboard will be available monthly to the Contractor to
determine the Contractor's performance over the fiscal year. To determine
compliance with the Accuracy Performance Incentive, the Department shall utilize
the most recent twelve (12) consecutive months of cumulative MAP Accuracy
Dashboard data, to determine whether the Contractor met or exceeded the specified
Accuracy target.
4.2.1.5.2. The Department shall use the Contractor's final actual performance on the MAP
Accuracy Dashboard in comparison to the Contractor's Accuracy targets at the end
of the fiscal year to determine if the Contractor's actual performance has met and/or
exceeded the Accuracy targets to earn an Accuracy Performance Incentive Payment.
The percentage calculation has one (1) decimal place and will not be rounded.
4.2.1.6. Review Sample Size Exemptions
4.2.1.6.1. If the Contractor has a review sample size, as defined in section 4.2.1.6.2, performed
by HCPF EQA, the Contractor may be eligible for the Review Sample Size
Exemption.
4.2.1.6.2. Definition of Review Sample Size
4.2.1.6.3. The Contractor with twenty (20) or fewer quality assurance case reviews per fiscal
year would qualify for a Review Sample Size Exemption. The Contractor with a
review sample size that does not meet one, or both, of the Accuracy Incentive targets
as defined in section 4.2.1.1 may be eligible for the Review Sample Size Exemption:
i. Inaccurate Eligibility Rate and/or,
ii. Errors That Did Not Impact Eligibility.
4.2.1.6.4. Determining Targets percentage (%) for Potential Review Sample Size Exemptions
4.2.1.6.5. HCPF shall have two separate tiers with different target percentages for the Accuracy
Targets:
4.2.1.6.5.1. Tier 1 target percentage (%): The Contractor with twenty (20) or more quality
assurance case reviews completed within the 12 -month rolling average.
4.2.1.6.5.2. Tier 2 target percentage (%): The Contractor with fewer than twenty (20) quality
assurance case reviews completed within the 12 -month rolling average.
Exhibit A-2, SOW Page 7 of 22
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4.2.1.6.6. Review Sample Size Exemption Process
4.2.1.6.6.1. The Department shall follow Exhibit D-1 for the Review Sample Size Exemption
Process.
4.2.1.6.6.2. Definition of Similar Error(s)
4.2.1.6.63. The MAP Accuracy Dashboard identifies the accuracy rates for each Contractor;
HCPF EQA provides the Contractor with those errors caused by the Contractor
that impact accuracy rates. This allows the Contractor to address the root cause of
errors to prevent similar errors going forward. If errors are not addressed by the
Contractor and the same errors repeat in future months, the errors will be
considered similar errors.
4.2.1.6.6.4. If the Contractor meets only one target with less than twenty (20) reviews, the
Review Sample Size Exemption Process will be applied only to the one target not
met by the Contractor.
4.2.1.6.6.5. The Contractor that does not meet both targets with less than twenty (20) reviews,
exemption will be applied to both targets.
4.2.1.6.6.6. Notification of Review Sample Size Exemption
4.2.1.6.6.7. If the Contractor does not meet the Accuracy Incentive Targets per sections
4.2.1.2.2 and 4.2.1.3.2, the Contractor will be notified through the Status Report
of the Second Reporting Period.
4.2.1.6.6.8. The Contractor that does not meet the Accuracy Incentive Targets but qualifies
for the exemption process per section 4.2.1.6, the Contractor will be notified
through the Status Report of the Second Reporting Period.
4.2.1.6.6.9. If the Contractor qualifies for the Review Sample Size Exemption Process, the
Department shall review previously submitted documentation from the Contractor
based on their MAP Accuracy Dashboard and may request additional
documentation as specified in section 4.2.1.6.7.
4.2.1.6.6.10. The Contractor shall submit any additional documentation requested for the
exemption process to the County Relations webform
(https://hcpfdev.secure.force.com/HCPFCountyRelations) within ten (10)
business days from the day of notification (Ticket Type = County Incentives).
4.2.1.6.7. Review Sample Size Exemption Process and Accuracy Performance Incentive
Payment
4.2.1.6.7.1. The Contractor shall earn the entire Accuracy Performance Incentive Payment if
both Accuracy Targets defined at sections 4.2.1.2.2 and 4.2.1.3.2 are met after
eligible exemption(s) are applied. If only one target is met, 50% of the Accuracy
Performance Incentive Payment will be earned. If both targets are not met, no
Accuracy Performance Incentive Payment is earned.
4.2.2. BENCHMARKS: Contractor -size specific accuracy targets for Inaccurate Eligibility
Determinations and Errors That Did Not impact Eligibility as detailed in 4.2.1.2.2 and
4.2.1.3.2
4.3. Performance Compliance Performance Incentive Standard
Exhibit A-2, sow Page 8 of 22
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4.3.1. The Contractor may earn a Performance Compliance Performance Incentive Payment in
Reporting Period 2 when the Contractor meets at least three (3) out of the four (4) following
benchmarks:
• Application Timeliness of Determinations, 45 Days
• Application Timeliness of Determinations, 90 Days
• Pending Exceeding Processing Guidelines (EPG) 45 Determinations (EPG 45)
• Pending Exceeding Processing Guidelines (EPG) 90 Determinations (EPG 90)
4.3.2. Department Monitoring of MAP Dashboards
4.3.2.1. HCPF updates the MAP Dashboards monthly, which are accessible to the Contractor
through the MAP Dashboard Tableau site; copies of these Dashboards are also emailed
monthly to Contractor directors, secondary directors and Board of County
Commissioners.
4.3.2.2. If HCPF determines that the Contractor has not met specified performance benchmarks,
a Management Decision Letter (MDL) will be issued. The MDL will require the
Contractor to create an Improvement Action Plan (IAP) or Corrective Action Plan (CAP)
that will improve the Contractor's performance.
4.3.2.2.1. The Contractor shall refer to HCPF OM 21-078 for guidance on MDLs, IAPs and
CAPs, or whichever later Operational Memo supersedes HCPF OM 21-078.
4.3.2.3. The MDL and associated IAP or CAP shall address the root causes of not meeting
performance benchmarks and will support the Contractor in achieving future performance
compliance.
4.3.3. Contractor Monitoring of MAP Dashboards
4.3.3.1. The Contractor shall monitor the monthly published MAP Dashboards to ensure targets
are met.
4.3.3.2. The Contractor shall designate Contractor staff to be MAP Dashboard performance
owners. Performance owners will have access to the MAP Dashboards and follow the
Standard Operating Procedure (SOP) or HCPF Memo Series guidance. The Contractor
shall use the MAP Dashboard to ensure targets are met and to take the necessary action(s)
to mitigate ongoing errors when necessary.
4.3.3.3. The Contractor shall review and investigate the root causes for not achieving the target(s)
and, if issued an MDL, shall submit the requested IAP or CAP by the required due date
listed on the notice.
4.3.3.3.1. If additional guidance or clarification pertaining to MDLs, IAPs and CAPs is issued
by the HCPF, the Contractor shall comply with the most current guidance, issued
through the HCPF Memo Series.
4.3.4. Determining Compliance with Performance Compliance Performance Incentives Standard
4.3.4.1. Timeliness of Determinations
4.3.4.1.1. The Contractor shall complete at least ninety-five percent (95%) of Application
Timeliness of Determinations, 45 Days as Timely Determinations. Application
Timeliness of Determinations, 90 Days shall be calculated separately (see 4.3.4.2).
Exhibit A-2. Sow Page 9 of 22
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4.3.4.1.2. The Department will total all Timely Determinations the Contractor completed within
the Reporting Period and divide that by the total number of Determinations the
Contractor completed during that Reporting Period to determine the timeliness
percent. The Department will round these calculated percentages to two (2) decimal
places.
4.3.4.1.2.1. The Department will utilize the MAP Applications Dashboard to determine
compliance with timeliness benchmark.
4.3.4.1.2.2. The MAP Applications Dashboard data will be pulled the 20`h of each month and
after the end of each Reporting Period to determine the Contractor's performance
over the entire six-month Reporting Period.
4.3.4.2. Application Timeliness of Determinations, 90 Days
4.3.4.2.1. The Contractor shall complete at least ninety-five percent (95%) of all Application
Timeliness of Determinations, 90 Days as Timely Determinations.
4.3.4.2.1.1. The Department will total all Timely Determinations for Application Timeliness
of Determinations, 90 Days the Contractor completed within the Reporting Period
and divide that by the total number of Application Timeliness of Determinations,
90 Days completed during that Reporting Period to determine the timeliness
percent. The Department will round these calculated percentages to two (2)
decimal places.
4.3.4.2.2. Determining Compliance with the Application Timeliness of Determinations, 90
Days
4.3.4.2.2. The Department will utilize the MAP Applications Dashboard to determine
compliance with the timeliness benchmarks.
4.3.4.2.2. The MAP Applications Dashboard will be pulled the pulled the 20th of each
month and after the end of each Reporting Period.
4.3.4.3. Pending Exceeding Processing Guidelines (EPG) Determinations
4.3.4.3.1. The Contractor's Pending EPG Determinations average at the end of each Reporting
Period 2 shall be at or below the targets described in the following table:
4.3.4.3.2. Contractor Targets Pending EPG Table
County Size
Pending EPG 45
Pending EPG 90
Large
<25
<10
Medium
≤5
<3
Small
<3
<1
4.3.4.3.3.
4.3.4.3.3.1.
Exhibit A-2, SOW
To determine the Pending EPG Determinations average, the Department will total the
Pending EPG Determinations of each month of the Reporting Period and divide by
the number of months in the Reporting Period.
The MAP Applications Dashboard, Pending EPG 45 and 90 measure, will be used
to determine the Contractor's amount of Pending EPG 45 and 90 Determinations
for each month of each Reporting Period.
Page 10 of 22
VVI:V Jil�ll CIIYCIU�JC IV. G4CV1' IA.9-VG:JC"4liJV'OIJJ-UJO4OGGGOC 14
4.3.4.3.3.2. The MAP Applications Dashboard data will be pulled on the 20th of each month,
or the next business day thereafter.
4.3.4.3.3.3. The Department will round the Pending EPG 45 and 90 Determinations average
to the nearest whole number.
4.3.5. Small County and Sample Size Exceptions
4.3.5.1.1. If the Contractor processes a total of one hundred (100) or fewer Application
Timeliness of Determinations, 45 Days per month, the Contractor shalt be deemed to
have met the timeliness percentage benchmark so long as they had ten (10) or fewer
Untimely Determinations during that Reporting Period.
4.3.5.1.2. If the Contractor processes a total of ten (10) or fewer Application Timeliness of
Determinations, 90 Days per Reporting Period, the Contractor shall be deemed to
have met the Application Timeliness of Determinations, 90 Days percentage
benchmark so long as they had four (4) or fewer Application Timeliness of
Determinations, 90 Days during that Reporting Period.
4.3.5.1.3. There are no Small County or Sample Size Exceptions for either Pending EPG 45 or
EPG 90 Determinations.
4.3.6. Exemptions for Unusual Circumstances
4.3.6.1. The Contractor may request an exemption for unusual circumstances for failure to meet
the Timeliness of Determinations benchmark as described in section 4.3.4.1 and 4.3.4.2,
failure to meet Pending EPG Determinations benchmark as described in section 4.3.4.3.
4.3.6.2. The exemption process for unusual circumstances is described in section 6, Exemptions.
4.3.7. BENCHMARK: Three (3) out of the following four (4) benchmarks are met:
95.00% timeliness average over each Reporting Period for Application Timeliness
of Determinations, 45 Days as described in section 4.3.4.1
95.00% timeliness average over each Reporting Period for Application Timeliness
of Determinations, 90 Days as described in section 4.3.4.2
< Pending EPG 45 Determinations average over Reporting Period 2 at or below target
based on Contractor size as described in section 4.3.4.3
< Pending EPG 90 Determinations average over each Reporting Period below limit
based on Contractor size as described in section 4.3.4.3
4.3.8. Customer Service Performance Incentive Standard
4.3.8.1. The Contractor may earn one Customer Service Performance Incentive Payment at the
end of the Second Reporting Period in which the Contractor submits the required
deliverable(s) as outlined for each Contractor Customer Service Tier relating to
improving customer service through the monitoring of metrics and the development of
improvement plans that demonstrate the Contractor is actively implementing the rule 10
CCR 2505-5 1.020.3.4, which requires the county director to have a documented
policy/process outlining the administrative internal controls that ensure the Contractor
provides timely, respectful and culturally -appropriate customer service to Medical
Assistance applicants and members.
Exhibit A-2, SOW Page 11 of 22
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4.3.8.2. Contractor Customer Service Tier
4.3.8.3.
4.3.8.4.
4.3.8.4.1.
4.3.8.4.2.
4.3.8.4.3.
4.3.9.
4.3.9.1.
4.3.9.1.1.
4.3.9.1.1.1.
The Department assigned the Contractor to a Customer Service Tier during Fiscal Year
2022-23. The Customer Service Tier determines which customer service metrics,
benchmarks and deliverables the Contractor must meet and/or submit to earn a Customer
Service Performance Incentive Payment.
Customer Service Tier Reclassification
The Department may, in consultation with the Contractor, amend its initial
classification and reclassify the Contractor to a different Customer Service Tier.
Any reclassification approved by the Department, in consultation with the Contractor,
shall take effect the following Reporting Period.
Contractor reclassifications from either Tier 2 option to Tier 1 are allowable.
Customer Service Tier 1
If the Contractor is assigned to the Customer Service Tier 1 category, the Department
shall classify the Contractor as Tier 1 to determine what the Contractor's required metrics,
benchmarks and deliverables are.
Customer Service Tier 1
If the Contractor is classified as Tier 1, the Contractor is understood to have an
active call center operation, which can be as small as two Contractor staff or as
large as 100 or more Contractor staff members answering calls, with a dedicated
line which has the technology in place to provide data, at a minimum, on the
number of calls received, the average wait time and the number of abandoned
calls.
4.3.9.1.1.2. If the Contractor is classified as Tier 1, the Contractor shall complete the each of
the following benchmarks and deliverables to earn a Customer Service
Performance Incentive Payment:
4.3.9.1.1.3. Submit to the Department monthly Call Center reporting from the Contractor's
available data that complies with the Call Center data reporting requirements
determined by Department.
4.3.9.1.1.4. Monthly reporting will be due on the 10th of each month and sent electronically
to the County Relations webform
(https://hcpfdev.secure.force.com/HCPFCountyRelations).
4.3.9.1.1.5. To meet fiscal year end requirements, monthly reporting for June 2024 data is due
by July 3, 2024.
4.3.9.1.1.6. Data elements required to be submitted by the Contractor shall be issued via
HCPF Memo Series.
4.3.9.1.1.7. Meet and/or exceed a service -level performance target for the Contractor's Call
Center Average Speed to Answer (ASA) by the Second Semi -Annual Due Date,
July 5, 2024.
4.3.9.1.1.8. The service -level performance target for the Contractor's ASA was jointly
determined by HCPF and the Contractor at the end of FY 2022-23. This occurred
during the second technical assistance meeting in June 2023 as required during
Exhibit A-2, SOW Page 12 of 22
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that fiscal year. ASA targets shall he average for the six-month period of January
to June 2024. Targets shall be issued via HCPF Memo Series.
4.3.9.1.1.9. Attend, at a minimum two, half-hour technical assistance (a learning and support
session) with the Department's MCC Operations staff before June 14, 2024.
4.3.9.1.1.10. At a minimum, one technical assistance will occur during each of the reporting
periods.
4.3.9.1.1.11. The Contractor can request additional support, beyond the required session
detailed 4.3.9.1.1.9, from the MCC Operations staff to improve its ASA
performance by contacting the County Relations webfonn.
4.3.9.1.1.12. The Department can require additional technical assistance in addition to the two
required technical assistance meetings if the Contractor's data indicates additional
support is necessary to meet the ASA benchmark.
4.3.9.1.1.13. The Contractor assigned to Customer Service Tier 1 must comply with the
provisions in sections 4.3.9.1.1 to earn a Customer Service Performance Incentive
Payment.
4.3.10. Customer Service Tier 2
4.3.10.1. If the Contractor is assigned to the Customer Service Tier 2 category, the Department
shall classify the Contractor as Tier 2A or Tier 2B to determine what the Contractor's
required metrics, benchmarks and deliverables are.
4.3.10.2. If the Contractor is classified as Tier 2A or 2B, the Contractor is understood to be small
enough in operations and workload where a call center (defined as at least two or more
staff members answering a dedicated line and to not have the technology in place, at a
minimum, on the number of calls received, the average wait time and the number of
abandoned calls) is cost -prohibitive or not supportable tinder existing funding or staffing
allocations.
4.3.10.3. If the Contractor is classified as Tier 2A, the Contractor shall complete each of the
following benchmarks and deliverables to earn a Customer Service Performance
Incentive Payment:
4.3.10.3.1. Implement the Customer Service Survey Outreach Plan submitted at the end of FY
2022-23 and submit a report in Reporting Period 2 updating the Department on the
implementation of the Customer Service Survey Outreach Plan. A template will be
provided to Tier 2A Contractors by the Department
4.3.10.3.1.1. If the Contractor classified as Tier 2A did not submit a Customer Service Survey
Outreach Plan in FY 2022-23, the Contractor is required to submit a Customer
Service Survey Outreach Plan in FY 2023-24 and to meet all other Tier 2A
benchmarks and deliverables to earn the Customer Service Incentive.
4.3.10.3.1.2. The Customer Service Survey is managed by HCPF and does not require any
action from the Contractor. The Customer Service Survey is sent by HCPF to all
members who have an email address on file in PEAK each calendar quarter.
4.3.10.3.1.3. The Contractor's baseline was determined at the end of FY 2022-23 and is used
to determine what percentage of survey participation rate must be increased
during FY 2023-24.
Exhibit A-2, SOW Page 13 of 22
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4.3.10.3.1.4. The Customer Service Survey Outreach Plan shall include the Contractor's
methodologies and strategies for increasing applicant and member participation
in the Department's Customer Service Survey in the following contract cycle.
4.3.10.3.1.5. The Customer Service Outreach Plan will include, at minimum, the following:
4.3.10.3.1.6. Who is responsible for the Contractor's Outreach Plan
4.3.10.3.1.7. What communications, methodologies and strategies will be used to engage with
applicants and members to increase participation in the survey
4.3.10.3.1.8. How the Contractor will ensure that negative action is not taken against applicants
and members who decline to participate in the Customer Service Survey
4.3.10.3.1.9. How the Contractor tracks and monitors its participation rate based on
Department -provided data
4.3.10.3.1.10. No template is provided to the Contractor for the Customer Outreach Plan; the
Contractor's Outreach Plan shall be detailed on the Contractor's letterhead.
4.3.10.4. If the Contractor is classified as Tier 2B, the Contractor shall complete each of the
following benchmarks and deliverables to earn a Customer Service Performance
Incentive Payment:
4.3.10.4.1. Implement the Customer Service Improvement Plan (CSIP) submitted at the end of
FY 2022-23 and submit a report in Reporting Period 2 updating the Department of
implementation of the Customer Service Survey Outreach Plan. A template for the
report will be provided to Tier 2B Contractors by the Department.
4.3.10.4.1.1. If the Contractor classified as Tier 2B did not submit a Customer Service
Improvement Plan (CSIP) in FY 2022-23, the Contractor is required to submit a
Customer Service Improvement Plan (CSIP) and to meet all other Tier 2B
benchmarks and deliverables to earn the Customer Service Incentive
4.3.10.4.1.2. The Customer Service Survey is managed by HCPF and does not require any
action from the Contractor. The Customer Service Survey is sent by HCPF to all
members who have an email address on file in PEAK each calendar quarter.
4.3.10.4.1.3. The Contractor's baseline was determined at the end of FY 2022-23 and is used to
determine what percentage of survey participation rate must be increased during
FY 2023-24.
4.3.10.4.1.4.
4.3.10.4.1.5.
4.3.10.4.1.6.
4.3.10.4.1.7.
The Customer Service Improvement Plan (CSIP) shall:
Does not require a standardized template, but must be written on the Contractor's
formal letterhead, approved by the Contractor's director and include each of the
required elements: Voice of the Customer, Complaints and Negative Feedback,
and Data Collection.
Voice of the Customer
Address how the Contractor hears from customers on a regular basis through
regular and ongoing data and information collection. If the Contractor does not
have active processes in place to integrate the Voice of the Customer, the CSIP
must include how the Contractor is rectifying the lack of information on customer
satisfaction.
Exhibit A-2, Sow Page 14 of 22
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4.3.10.4.1.15.
4.3.10.4.1.16.
4.3.10.4.1.8. Address how the Contractor is or isn't using data to determine customer
satisfaction
4.3.10.4.1.9. Include how the Contractor is actively implementing processes that integrate the
Voice of the Customer.
4.3.10.4.1.10. Include how the Contractor, through its customer service processes, provides
supports to underserved and/or at -risk populations and communities.
4.3.10.4.1.11. Complaints and Negative Feedback
4.3.10.4.1.12. Detail how the Contractor works to ensure timely responses and requests for
support from the customer, to avoid complaints where possible.
4.3.10.4.1.13. If a complaint is submitted, the CSIP shall include how the Contractor addresses
positive and negative feedback received through process improvement, training
and coaching, positive reinforcement with staff or other methods.
4.3.10.4.1.14. Prescribe how the Contractor's processes integrate or align with the Department's
centralized complaint process as issued in HCPF Memo Series.
Data Collection
Detail what data is collected, how the data is collected ongoing and what tracking
mechanisms areacc in place.
4.3.10.4.1.17. Include what steps the Contractor takes when actionable data on customer service
satisfaction is collected.
4.3.10.4.1.18. Describe what tools the Contractor uses, if any, to collect its data and inform its
process improvements.
4.3.11. Customer Service Performance Incentive Standard Exemptions for Unusual Circumstances
4.3.11.1. The Contractor may request an exemption for unusual circumstances for failure to meet
tie service -level performance targets as detailed in section 4.3.9.1.1.8, if the Contractor
was classified by the Department as Customer Service Tier 1 A or 1B.
4.3.11.2. No exemptions for unusual circumstances are allowed for deliverables for each Tier for
Contractors classified as Customer Service Tier 1, Tier 2A or 2B. Deliverables include
any required plans, reports, data, and technical assistance.
4.3.11.3. The exemption process for unusual circumstances is described in section 6, Exemptions;
only Contractor exemption requests that follow the process and meet the requirements as
outlined in section 6 will be considered by the Department.
4.3.12. PERFORMANCE BENCHMARK:
4.3.12.1. Tier 1: Meet or exceed customized Average Speed to Answer by end of Second Reporting
Period and complete required participation in technical assistance sessions with MCC.
Submit call center reporting data as detailed in 4.3.9.1.1.4 and 4.3.9.1.1.5.
4.3.12.2. Tier 2A and Tier 2B: Submit a report on implementation of each tiers identified customer
service plan (report template to be provided by the Department). Customer Service survey
response rates to increase as averaged over the course of the fiscal year when compared
to the initial survey sent May 2023 which established a baseline. Deliverable is measured
by increase in number of responses to be released in HCPF Memo Series. If Contractor
Exhibit A-2, SOW Page 15 of 22
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did not submit a Customer Service Outreach Plan or Customer Service Improvement Plan
(CSIP) in FY 2022-23, the Contractor shall be required to submit one in FY 2023-24 to
earn the Customer Service Incentive in addition to all other Tier 2 benchmarks and
deliverables.
5. SEMI-ANNUAL REPORTING
5.1. The Contractor shall submit documentation to the Department to verify the Contractor's
compliance with each Performance Incentive Standard and will submit such documentation on a
semi-annual basis as required. The Contractor must submit documentation to the County
Relations webform (https://hcpfdev.secure.force.com/HCPFCountyRelations) or email
HCPF CountyRelations@state.co.us, unless otherwise specified through the HCPF Memo
Series.
5.1.1. For the Second Reporting Period, the Contractor shall submit the following documentation:
5.1.1.1. Any Accuracy Performance Incentive Standard Review Sample Size Exemption Process
documentation for the fiscal year if the Contractor failed to meet specified target(s). The
Contractor shall only submit documentation upon the Department's request after the
release of the Report Period 2 Status Report.
5.1.1.1.1. Any Customer Service Performance Incentive Standard Plans, reports or other
documents listed as deliverables under this agreement or specified through the HCPF
Memo Series. A due date for any plans not submitted in FY 2022-23 will be provided
in HCPF Operational Memo.
5.1.1.1.1.1. DUE DATE: June 14, 2024
6. EXEMPTIONS
6.1. The Contractor may request an exemption for unusual circumstances for specific Performance
Incentive Standards by following the process as outlined in section 6.
6.1.1. Based on the Department's review of the Contractor's request, partial payment of the
Performance Incentive Standard Payments may be made at the Department's discretion,
which is not subject to exemption request or dispute. The Department's decision on partial
payment is final in addition to any Performance Incentive Payments made based on the
Department's determination.
6.2. Definition of Unusual Circumstances
6.2.1. Unusual circumstances are defined as uncommon, rare or sudden events such as ransomware
or other types of cybersecurity attacks, natural disasters, etc. The circumstance must have
been out of the Contractor's direct control, and which directly result in the failure to act in
accordance with or meet the requirements of the specific Performance Incentive Standard.
6.2.2. Unusual circumstances for which the Contractor can request exemption include the
anticipated end of the federal COVID-19 Public Health Emergency or other circumstances
that cause a large, sustained increase in workload.
6.2.3. Unusual circumstances do not include circumstances for which the Contractor had direct
knowledge or control over, including the Contractor's clear and demonstrated failure to act
in accordance with or meet the requirements of the specific Performance Incentive Standard
is evident.
Exhibit A-2, SOW Page 16 of 22
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6.2.4. The Department's determination of whether the Contractor's request for exemption meets the
definition of unusual circumstances is final.
6.3. Process for Unusual Circumstances Exemption Requests
6.3.1. The process for the Contractor to submit an exemption request shall be communicated via
the HCPF Memo Series for each Performance Incentive Standard.
6.3.2. Unusual circumstances exemption requests must include thorough supporting documentation
from the Contractor clearing outlining what unusual circumstance occurred and what
occurred as a result of the unusual circumstance. The Contractor shall be responsible for
timely submission of any additional documentation requested by the Department for the
exemption process determination.
6.3.3. General questions on unusual circumstances exemption requests should be submitted to the
County Relations webform (https://hcpfdev.secure.force.com/HCPFCountyRelations) or
email HCPF CountyReIations®state.co.us.
6.4. Department Review and Approval of Exemption Requests
6.4.1. Based on the Contractor's unusual circumstances exemption request and supporting
documentation, the Department will provide the Contractor with an approval or denial of the
request on the Final Status Report.
6.4.2. If the Department approves the unusual circumstances exemption request, partial payment
will be made to the Contractor. Partial payment will align with the Performance Incentive
Standard exemption request the Department ultimately approved.
6.4.2.1. The Department has the sole authority to determine the amount of partial payment, which
is not subject to dispute by the Contractor.
6.4.2.2. If partial payment is made based on the Contractor's unusual circumstances exemption
Bequest, the Department will provide the actual amount of the partial payment on the Final
Status Report.
6.4.3. If the Department denies the unusual circumstances exemption request submitted by the
Contractor, the Performance Incentives Payments issued are final and are not subject to
further dispute or appeal.
6.4.4. The Department has the sole discretion to approve or reject any request for unusual
circumstances exemptions and may limit the total number of approved exemptions for all
Performance Incentive Standards.
6.4.5. Non -Allowable Exemption Reasons
6.4.5.1. The Department will deny unusual circumstances exemption requests that are (1)
determined to be the fault of the Contractor; (2) unusual circumstances that did not exist;
(3) and/or any exemption requests based on the following but not limited to the following:
6.4.5.1.1. The Contractor failed to meet contractually specified requirements relating to the
content of submission of deliverables and the timely submission of deliverables.
6.4.5.1.2. The Contractor failed to meet contractually specified requirements relating to
performance benchmarks of any Performance Incentive Standards eligible for
exemption requests.
Exhibit A-2, SOW Page 17 of 22
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6.4.5.1.3. The Contractor's failure to review and utilize County Administration regulations at
10 CCR 2505-5 1.020 and County Incentives Program documentation, including
policy, informational, and operational guidance issued through the HCPF Memo
Series, that resulted in the Contractor failing to meet performance benchmarks and
deliverables relating to any Performance Incentive Standard.
6.4.5.1.4. The Department's final determination of the Contractor's exemption request(s) for
the Accuracy Performance Incentive Standard.
6.4.5.1.5. The Contractor's failure to use the MAP Dashboards for the purposes of fulfilling
Exhibit A, Statement of Work.
6.4.5.1.6. The Contractor's failure to use EQA case review results for the purposes of fulfilling
Exhibit A, Statement of Work. The reasons for denial of an exemption as stated in
section 6 are not all-inclusive and the Department reserves the right to deny any
exemption for reasons not stated in section 6.
6.4.6. Prior to denying an exemption for reasons beyond those stated in section 6, the Department
may, at its discretion, request further documentation from the Contractor to determine
whether the request for exemption meets the exemption standards as stated in Section 6,
Exemptions.
6.5. Performance Incentive Standards Eligibility for Unusual Circumstances Exemption Requests.
6.5.1. Unusual circumstances exemption requests will be considered for any Performance Incentive
Standard listed under section 6.5.1.
6.5.1.1. Customer Service Performance Incentive Standard
6.5.1.2. Accuracy Performance Incentive Standard
6.5.1.3. Performance Compliance Performance Incentive Standard
7. NOTIFICATIONS
7.1. After each Reporting Period, the Contractor will be provided a Status Report that outlines
Performance Incentive Standards that were met.
7.1.1. The Contractor's Reporting Period Status Report will only detail which Performance
Incentive Standards were met for the Reporting Period in question. Funding amounts will
not be provided until the conclusion of the fiscal year.
7.1.2. If the Contractor has more than one Reporting Period in the fiscal year to meet any
Performance Incentive Standards, the Reporting Period Status Report will not include the
Contractor's performance in those Performance Incentive Standards.
7.2. After the conclusion of the fiscal year, the Department will provide the Contractor a final Status
Report that details which Performance Incentive Standards were not met and met and how much
Performance Incentive Payments were earned by the Contractor.
7.2.1. The final Status Report cannot be disputed; if the Contractor disagreed with the Department's
determination of compliance with any Performance Incentive Standard, the Contractor must
have disputed that result based on the Reporting Period Status Report.
7.3. Each Reporting Period Status Report and the final Status Report will be sent to the county
human/social services director and will act as the official notification of the Contractor's
compliance with the Performance Incentives Standards.
Exhibit A-2, SOW Page 18 of 22
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7.4. Status Reports for each Reporting Period will be sent within ten (10) calendar days after the
Semi -Annual Reporting due date for each Reporting Period as found in Section 5, Semi -Annual
Reporting. The date on which the Status Report for each Reporting Period is sent to the
Contractor will be considered the Status Report Date.
7.4.1. If the Department experiences unusual circumstances resulting in a delay with sending the
Contractor's Reporting Period or final Status Reports, the Department will inform the
Contractor of the delay and an anticipated date of resolution during the ten (10) calendar days
after the Semi -Annual Reporting due date for each Reporting Period and provide an updated
timeline for sending the Contractor's Reporting Period or final Status Reports.
7.5. The final Status Report will be sent upon the Department's determination of final Performance
Incentive Payment amounts.
7.6. The Contractor will have the opportunity to dispute the Status Report results as defined in Section
8, Dispute Resolution.
8. DISPUTE RESOLUTION
8.1. Opportunity and Timeframe for Dispute Resolution
8.1.1. In the event the Contractor disagrees with the findings of the official notification as found in
section 7, Notifications, the Contractor will have the opportunity to dispute the Reporting
Period Status Report for the Reporting Period in question.
8.1.1.1. The final Status Report cannot be disputed per section 7.2.1.
8.1.1.1.1. The Contractor will have seven (7) calendar days from the Status Report Date to
review each Reporting Period Status Report and dispute the results.
8.1.1.1.1.1. If the Contractor fails to dispute the Reporting Period Status Report within seven
(7) calendar days from the Status Report Date, the Status Report results will be
deemed final. No further disputes will be allowed, and compensation will be made
per section 9 based on the results of the non -disputed Status Report.
8.2. Allowable Disputes
8.2.1. The Contractor will be allowed to dispute the results of the Status Report based on the
following reasons:
8.2.1.1. If the Department states supporting documentation was omitted in its entirety or if the
Department states the documentation was submitted outside of the time frames outlined
in the Contract and the Contractor refutes the claim, the Contractor must submit proof of
submission. The Contractor must show the documentation was in fact submitted in a
timely manner and in accordance with the contractually required due date. The Contractor
requests a re -review of the Contractor's submitted documentation that was used to
determine compliance with any Performance Incentive Standard.
8.2.1.2. The Contractor has available data, such as systems reports or other tracking
methodologies, that conflicts with the Department's available data that will utilized to
determine compliance with a Performance Incentive Standard.
8.2.1.2.1. The Contractor will be responsible for providing all necessary and relevant data to the
Department for the purposes of determining if the Contractor's data in fact conflicts
with the Department's data.
Exhibit A-2, SOW Page 19 of 22
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8.2.1.2.2. The Department will make the final determination when a conflict of data occurs and
will make Performance Incentive Standard Payments based on its final determination.
8.2.1.2.3. Any and all supporting documentation allowed under this sub -section must be
submitted to the Department within (3) three calendar days of said documentation
being determined relevant by the Department. If the documentation is not received by
the Department by the timeframe outlined, it will no longer be considered in the
Dispute Resolution process.
8.2.2. The Department reserves the right to add additional allowable dispute reasons on a case -by -
case basis based on new and relevant information made available to the Department from the
Contractor. The Department's determination of additional allowable dispute reasons are final
and not subject to the Dispute Resolution process as outlined in section 8.
8.3. Nonallowable Disputes
8.3.1. The Contractor will not be allowed to dispute the results of the Status Report based on the
following reasons:
8.3.1.1. The Contractor failed to meet contractually specified requirements relating to the content
of submission of deliverables and the timely submission of deliverables.
8.3.1.2. The Contractor failed to meet contractually specified requirements relating to
performance benchmarks of any Performance Incentive Standard.
8.3.1.3. The Contractor's failure to review and utilize County Incentives Program documentation,
including policy, informational, and operational guidance issued through the HCPF
Memo Series, that resulted in the Contractor failing to meet performance benchmarks and
deliverables relating to any Performance Incentive Standard.
8.3.1.4. The Department's final determination of the Contractor's exemption request(s) for the
Accuracy Performance Incentive Standard.
8.3.2. The Department reserves the right to deny a Contractor's dispute based on any reason not
included under section 8.3.1. The Department's determination is final and is not subject to
dispute or appeal.
9. COMPENSATION
9.1. Compensation
9.1.1. Performance Incentive Payment
9.1.1.1. The Department shall pay the Contractor, after the end of the state fiscal year in which
the work was performed, in addition to Performance Incentive Payments for each
Performance Incentive Standard met during the applicable Reporting Period as follows:
9.1.1.1.1. The Department shall pay the Contractor an Accuracy Performance Incentive
Payment, if applicable, as shown in Exhibit B-2 at the conclusion of the Second
Reporting Period if the Contractor meets the requirements for that Performance
Incentive Standard. (To earn the entire Accuracy Performance Incentive Payment, the
Contractor must meet both targets as specified in section 4.2.1.1, which includes (1)
Target for Inaccurate Eligibility Determination Rate and (2) Target for Errors That
Do Not Impact Eligibility. If the Contractor only meets one target, the Accuracy
Performance Incentive Payment will be 50% of the total amount for this Performance
Incentive.)
Exhibit A-2, SOW Page 20 of 22
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9.1.1.1.2. The Department shall pay the Contractor a Performance Compliance Performance
Incentive Payment as shown in Exhibit B-2 at the conclusion of the Second Reporting
Period if the Contractor meets the requirements for that Performance Incentive
Standard during the second Reporting Period.
9.1.1.1.3. The Department shall pay the Contractor a Customer Service Performance Incentive
Payment as shown in Exhibit B-2 at the conclusion of the Second Reporting Period if
the Contractor meets the requirements for that Performance Incentive Standard.
9.1.2. Remaining Funds Incentive Pool Payment
9.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
9.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
9.1.2.1.1.1. The total amount of all base Performance Incentive Payments allocated to any
Contractor that opted out of participation in the Performance Incentive Standards
Program for that SFY.
9.1.2.1.1.2. Each of the Performance Incentive Payments the Accuracy Performance Incentive
Standard, Performance Compliance Performance Incentive Standard, the
Customer Service Performance Incentive Standard and the Continuous Coverage
Performance Incentive Standard that were not earned by the Contractor during a
Reporting Period in that SFY.
9.1.2.1.1. The Contractor shall be eligible for Remaining Funds Incentive Pool
payments.
9.1.2.1.2. If the Remaining Funds Incentive Pool is zero dollars ($0.00) for any SFY, the
Contractor shall not receive a Remaining Funds Incentive Pool Payment for that SFY.
9.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
9.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds Incentive
Pool based on the dollar amount of Incentives met during that SFY.
9.1.2.2.2. Based on the proportion of total Incentive funds that the Contractor is eligible to be
paid in each SFY, the Contractor shall receive the same proportion of funds from the
Remaining Funds Incentive Pool.
9.1.2.2.3. The Contractor's payment of funds from the Remaining Funds Incentive Pool shall
never exceed the county's share of Medicaid expenditure, as specified in Section 2,
County Determinations.
9.2. Payment Procedures
9.2.1. The Contractor shall receive Performance Incentive Payments at the end of the Second
Reporting Period within ninety days (90) days following the end of the fiscal year in which
the Performance Incentive Standards were met. This allocation will reflect the maximum the
Contractor can earn for each Performance Incentive Standard per Reporting Period.
9.2.1.1. If the Contractor's County administration line item is over -expended during the county
administration closeout process, Settlement Accounting and the Department may utilize
the Contractor's earned Performance Incentive Payments during the closeout process.
9.2.2. Actual Performance Incentive Payment maximums are dependent on the Contractor's share
of Medicaid County administration expenditure. In no event shall the Contractor be paid more
Exhibit A-2, Sow Page 21 of 22
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than the Contractor's County share of Medicaid County administration expenditure in any
Reporting Period or fiscal year.
9.2.3. The Department may add any unearned funds from the First Reporting Period into the Second
Reporting Period allocation for any SFY.
9.2.4. The Contractor shall be paid the Performance Incentive Payment through the County
Financial Management System (CFMS).
9.2.5. The Department may use any unearned Second Reporting Period Performance Incentive
Payments during the county administration close out process.
9.2.5.1. The Incentive Payment earned is unrestricted, and the Contractor may utilize the fund per
the Contractors discretion.
Exhibit A-2, SOW Page 22 of 22
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EXHIBIT B-2, RATES
SFY 2023-24 Incentives Payment Table
To earn the entire Accuracy Performance Incentive Payment, the Contractor must meet both targets as specified in
section 4.2.1.1, which includes (1) Target for Inaccurate Eligibility Determination Rate and (2) Target for Errors
That Do Not Impact Eligibility. If the Contractor only meets one target, the Accuracy Performance Incentive
Payment will be 50% of the total amount for this Performance Incentive.
Incentive Payment Name
% Of
Funding
Payment
Amount
Accuracy Performance
Incentive Payment
40%
$186,691.06
Performance Compliance
Performance Incentive
Payment
30%
$140,018.30
Customer Service
Incentive Payment
30%
$140,018.30
Total
$466,727.65
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Contract Form
Entity Information
Entity Name *
COLORADO DEPT OF HEALTH
CARE POLICY & FINANCING
Entity ID*
@00007174
Contract Name*
HEALTH CARE POLICY & FINANCING (CONTRACT
AMENDMENT #3 COUNTY INCENTIVES)
Contract Status
CTB REVIEW
O New Entity?
Contract ID Parent Contract ID
7862 20202389
Contract Lead" Requires Board Approval
COBBXXLK YES
Contract Lead Email Department Project #
cobbxxlk@co.weld.co.us
Contract Description *
AMENDMENT #3 FOR FY 2024 COUNTY INCENTIVES. ORIGINAL CONTRACT TYLER ID: 2020-2389. AMENDMENT
INCREASING ELIGIBLE INCENTIVE DOLLARS TO $466,727.65 AND ADDS ONE NEW PERFORMANCE INCENTIVE AND
REMOVES TWO OTHER PERFORMANCE INCENTIVES.
Contract Description 2
TERM: DATE OF EXECUTION TO JUNE 30, 2024
Contract Type* Department
AMENDMENT HUMAN SERVICES
Amount*
$466,727.65
Renewable*
NO
Automatic Renewal
Grant
IGA
Department Email
CM-
HumanServices@weldgov.
com
Does Contract require Purchasing Dept. to be
Department Head Email included?
CM-HumanServices-
DeptHead@weldgov.com
Requested BOCC Agenda
Date*
03/06/2024
Due Date
03/02/2024
Will a work session with BOCC be required?*
NO
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date
04/30/2024
Committed Delivery Date
Renewal Date
Expiration Date*
06/28/2024
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CHERYL PATTELLI BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
02/29/2024 03/01/2024 03/01/2024
Final Approval
BOCC Approved Tyler Ref #
AG 030624
BOCC Signed Date Originator
COBBXXLK
BOCC Agenda Date
03/06/2024
Hello