HomeMy WebLinkAbout20241535.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #1 TO INTERGOVERNMENTAL AGREEMENT
FOR CASE MANAGEMENT AGENCY (CMA) SERVICES AND AUTHORIZE CHAIR TO
SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with Contract Amendment #1 to the
Intergovernmental Agreement for Case Management Agency (CMA) Services 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 March 1, 2024, and ending June 30, 2025, 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 the Contract Amendment #1 to the Intergovernmental Agreement
for Case Management Agency (CMA) Services 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 said amendment.
CC HSD
ov0q /A4
2024-1535
HR0096
CONTRACT AMENDMENT #1 TO INTERGOVERNMENTAL AGREEMENT FOR CASE
MANAGEMENT AGENCY (CMA) SERVICES
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 12th day of June, A.D., 2024, nunc pro tunc March 1, 2024.
BOARD OF COUJuP SIONERS
WELD COUNT
ATTEST: ,,,,/
Weld County Clerk to the Board
. UJahu0 > .
Deputy Clerk to the Board
APVED
County A .•tee
Date of signature: (.1 n
Key' D moss, Chair
Perry L. B k, Pro-Tem
Mike Freeman
t K. James
i Saine
2024-1535
HR0096
Con-ket- Mil Zq9 (p
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Case Management Agency Contract Amendment #1 for State Fiscal Year (SFY)
2024-2025
DEPARTMENT: Human Services DATE: June 4, 2024
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: On January 17, 2024, the Department entered into an
Intergovernmental Agreement with Colorado Department of Health Care Policy and Financing (HCPF) to serve
as a Case Management Agency, know to the Board as Tyler# 2024-0121. The Department's Home and
Community Supports Division (HCSD) receives funding annually from HCPF to provide long-term care
information, initial intake, screening, referral, assessment of need, determination of functional eligibility, care
planning, case management, reassessment, and case closure for older adults and individuals of all ages with
disabilities in Weld County. These services provide individuals the opportunity to remain in the community as
an alternative to entering an institutional setting such as a nursing home.
The Colorado Department of Human Services (CDHS) has now issued Amendment #1 (C24 -188034A1), that
extends the contract to June 30, 2025, modifies Exhibit B, Exhibit C, and Exhibit E, and adjusts rates.
What options exist for the Board?
• Approval of the Case Management Agency Contract Amendment #1 for SFY 2024-2025.
• Deny approval of the Case Management Agency Contract Amendment #1 for SFY 2024-2025.
Consequences: WCDHS HCSD will not be able to accept the funds from CDHS.
Impacts: _WCDHS HCSD will not be able to provide these services to older adults and individuals with
disabilities in Weld County.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
• Total allocated = $1,579,756.82 for SFY 2024-2025 to cover administrative cost of contract work.
• Funded through Colorado Department of Human Services (CDHS)
Pass -Around Memorandum; June 4, 2024 - CMS ID 8296 2024-1535
•/,,
01200c1 0
Recommendation:
• Approval of the Case Management Agency Contract Amendment #1 and authorize the Chair to sign
electronically.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L Buck, Pro -Tern
Mike Freeman
Scott K. James
Kevin D. Ross, Chair
Lori Saine
rnf
Pass -Around Memorandum; June 4, 2024 - CMS ID 8296
DocuSign Envelope ID: 883B3D7D-3D94-40DA-BD53-0BF5B5C47232
CONTRACT AMENDMENT #1
SIGNATURE AND COVER PAGE
State Agency
Department of Health Care Policy and Financing
Original Contract Number
C24-188034
Contractor
Weld County Department of Human Services
Amendment Contract Number
C24 -188034A1
Contract Maximum Amount
Medicaid Programs
No Maximum for any SFY
State General Fund Programs
State Fiscal Year 2024-25 $21,693,981.00
Estimated Contractor Shared $1,579,756.82
Contract Performance Beginning Date
March 1, 2024
Current Contract Expiration Date
June 30, 2025
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 Department of Human Services
Kevin D. Ross, Chairman
STATE
Jared
Department of
OF COLORADO
S. Polis, Governor
Health Care Policy and Financing
'-DocuSigned by:
DocuSigned by:
By: '- 0B6A84797EA8493_..
P. rt'SS
6/12/2024 I 21:29 MDT
Date:
By: 2D8EA09BAC0C4B3...
6/12/2024 I 14:39 PDT
Date:
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
p -DocuSigned by:
tror 13or ot&4i,
By: `-079EB5B301 F5427...
6/13/2024 I 07:11 MDT
Amendment Effective Date:
1. 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 §3.B of this Amendment.
B. Amendment Term
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.
4. PURPOSE
To extend the Contract for the next State Fiscal Year and to modify Exhibit B, Exhibit C, and
Exhibit E to revise requirements and adjust rates.
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 B, Statement of Work is hereby deleted in its entirety and replaced with Exhibit B-1,
Statement of Work, which follows.
D. Exhibit C, Rates is hereby deleted in its entirety and replaced with Exhibit C-1, Rates, which
follows. Any references to Exhibit C now refer to Exhibit C-1.
E. Exhibit E, Contractor's Administrative Requirements is hereby deleted in its entirety and
replaced with Exhibit E-1, Contractor's Administrative Requirements, which follows.
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.
Exhibit B-1, Statement of Work
1. CASE MANAGEMENT OBLIGATIONS
1.1. Contractor's Obligations
1.1.1. Contractor shall provide case management activities outlined in this Contract for the
following Home and Community Based Services (HCBS) waivers, non-HCBS programs, and
State General Fund programs:
1.1.1.1. Family Support Services Program (FSSP)
1.1.1.2. HCBS Children with a Life Limiting Illness Waiver (HCBS-CLLI)
1.1.1.3. HCBS Children's Extensive Supports Waiver (HCBS-CES)
1.1.1.4. HCBS Children's Habilitation Residential Program Waiver (HCBS-CHRP)
1.1.1.5. HCBS Children's Home and Community Based Services Waiver (CHCBS)
1.1.1.6. HCBS Community Mental Health Supports Waiver (HCBS-CMHS)
1.1.1.7. HCBS Complimentary and Integrative Health Waiver (HCBS-CIH)
1.1.1.8. HCBS Developmental Disabilities Waiver (HCBS-DD)
1.1.1.9. HCBS Persons who are Elderly, Blind and Disabled Waiver (HCBS-EBD)
1.1.1.10. HCBS Persons with Brain Injury Waiver (HCBS-BI)
1.1.1.11. HCBS Supported Living Services Waiver (HCBS-SLS)
1.1.1.12. Hospital Back -Up Program (HBU)
1.1.1.13. Intermediate Care Facilities -Intellectual and Developmental Disabilities (ICF-IDD)
1.1.1.14. Long Term Home Health (LTHH)
1.1.1.15. Nursing Facilities (NF)
1.1.1.16. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS)
1.1.1.17. Program for All -Inclusive Care for the Elderly (PACE)
1.1.1.18. State Supported Living Services Program (State SLS)
1.1.2. Contractor shall abide by and perform its duties and obligations in conformity with relevant
federal law, all pertinent federal regulations, State law, rules and regulations of the
Department of Health Care Policy and Financing which include, but are not limited to:
1.1.2.1. Colorado Revised Statutes, Title 25.5, Article 6, Sections 104 through and including 107.
1.1.2.2. Colorado Revised Statute, Title 25.5, Article 10 et seq.
1.1.2.3. Colorado Department of Health Care Policy and Financing written communications.
1.1.2.4. Colorado Department of Public Health and Environment at 6 C.C.R. 1011-1 et seq.
1.1.2.5. Colorado Department of Human Services 12 C.C.R. 2509-8 7.700 et seq.
1.1.2.6. All State Medicaid regulations promulgated by the Department. These regulations
include, but are not limited to:
1.1.2.6.1. CHCBS 10 CCR 2505-10, Sections 8.506 et seq.
Exhibit B-1, SOW Page 1 of 52
1.1.2.6.2. FSSP 10 CCR 2505-10, Sections 8.613 et seq.
1.1.2.6.3. Long -Term Care 10 CCR 2505-10, Sections 8.400 through 8.409 et seq.
1.1.2.6.4. Long Term Care Single Entry Point System - 10 CCR 2505-10, Section 8.393 et seq.
1.1.2.6.5. HCBS-BI - 10 CCR 2505-10, Section 8.515 et seq.
1.1.2.6.6. HCBS-CES, 10 C.C.R. 2505-10 Section 8.503 et seq.
1.1.2.6.7. HCBS-CHRP, 10 C.C.R. 2505-10 Section 8.508 et seq.
1.1.2.6.8. HCBS-CIH 10 CCR 2505-10, Section 8.517 et seq.
1.1.2.6.9. HCBS-CLLI 10 CCR 2505-10, Section 8.504 et seq.
1.1.2.6.10. HCBS-CMHS 10 CCR 2505-10, Section 8.509 et seq.
1.1.2.6.11. HCBS-DD, 10 C.C.R. 2505-10 Sections 8.500 to 8.500.80 et seq.
1.1.2.6.12. HCBS-EBD 10 CCR 2505-10, Sections 8.485 through 8.486 et seq.
1.1.2.6.13. HCBS-SLS, 10 C.C.R. 2505-10 Sections 8.500.90 to 8.500.102 et seq.
1.1.2.6.14. PACE Section 25.5-5-412, Section 6a -b., C.R.S et seq.
1.1.2.6.15. Services for Individuals with Intellectual and Developmental Disabilities, 10 CCR
2505-10 Section 8.600 et seq.
1.1.2.6.16. State SLS Program, 10 CCR 2505-10, Section 8.501 et seq.
1.1.2.6.17. Recipient Appeals, 10 CCR 2505-10, Section 8.057 et seq.
1.1.2.6.18. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards (Uniform Guidance), 2 CFR Chapter I, Chapter II, Part 200 et al.
1.1.3. Contractor shall perform its obligations in conformity with the provisions of Title XIX of the
Social Security Act and other applicable federal and state laws and regulations.
1.1.4. Contractor shall ensure applicant and Member and individual rights are protected in
accordance with Title XIX of the Social Security Act, other applicable federal and state laws,
and Department regulations.
1.1.5. Contractor shall comply with written Operational Memos, policies, procedures, and guidance
issued by the Department.
1.1.6. Contractor shall submit LTHH PARs in accordance with 10 CCR 2505-10 8.519.14.A.3.
1.1.7. The general Business Functions of Contractor shall include, but is not limited to, all the
following:
1.1.7.1. Contractor shall maintain a physical, publicly accessible, and Americans with Disability
Act (ADA) compliant office within the Defined Service Area and appropriate staffing
pattern to serve the Defined Service Area.
1.1.7.1.1. Contractor shall ensure adequate staffing through virtual or in -person services
throughout the Defined Service Area in addition to a physical office space, providing
access to its office for staff, Members, families, services providers, and others to best
meet the needs of individuals based on individual preferences.
1.1.7.1.2. Contractor shall have the ability for case managers to travel, regional coverage, and
provide all required Work for the counties in which the agency operates.
Exhibit B-1, SOW Page 2 of 52
1.1.7.1.3.
Regular business office hours of operation shall follow a Monday through Friday
schedule except for federal, state, or local holidays and unplanned closures due to
inclement weather or other emergencies. Regular business office hours must be
posted and made available to the public.
Contractor shall have internal procedures for accommodating individuals, Members, and
families who need assistance or consultation outside regular business office hours.
Contractor shall have an emergency on -call procedure to respond to crisis situations
outside of regular business hours. Procedures must clearly document how Contractor will
ensure timely response to emergency situations such as hospital discharges, risk of
homelessness, unexpected termination of residential services, etc. Contractor shall make
the procedure available to the Department upon request. Contractor shall notify
individuals, Members, families, providers, and community partners of the procedures and
make it readily available through a variety of methods.
Contractor shall have an internal policy and procedure to respond to all telephone calls,
voicemails, and emails from Members and families on average within two Business Days
of receipt by Contractor.
Contractor shall overcome any geographic barriers within the Defined Service Area,
including distance from the agency office to provide timely assessment and case
management services to individuals, Members and families, as required by Contract,
Federal or State statutes and regulations. This may include staff who reside throughout
the Defined Service Area to best meet the needs of individuals and members.
Contractor shall protect Members' rights as they relate to the responsibilities of Case
Management Agencies as described in this Contract.
Contractor shall provide access to a telephone system and trained staff to ensure timely
response to messages and telephone calls received after hours.
Contractor shall provide access to telecommunication devices and/or interpreters for the
hearing and vocally impaired and foreign language interpreters as needed to fulfil all
Work. Contractor shall conduct an assessment of the communication needs of the
Members they serve and ensure their interpretation and telecommunication services
sufficiently meet the Member's need in a timely fashion.
Contractor shall follow communication standards set by the Department which includes,
but is not limited to, Memo Series, technical assistance documents, Provider Bulletins,
training documents, and email correspondence.
Contractor shall support the Department's National Core Indicators (NCI) efforts.
Contractor shall support the Department's Equity, Diversity, Inclusion, and Accessibility
(EDIA) efforts to include participation in a Department led EDIA assessment and survey.
Contractor shall have a written policy and procedure on the agency's commitment to
equity, diversity, inclusion, and accessibility that includes approaches to confronting
racism and building opportunity for inclusion that promotes equitable treatment of
historically underserved and marginalized communities. Contractor shall make the policy
and procedure available to the Department upon request.
Exhibit B -I, SOW Page 3 of 52
1.1.7.12. Contractor shall enroll and act as a Medicaid Targeted Case Management (TCM) provider
for all HCBS waivers to include, but not limited to, providing ongoing case management
and monitoring activities for the Defined Service Area.
1.1.7.13. Contractor may be granted a Conflict Free Case Management Waiver (CFCMW) by the
Department to provide specific HCBS services within the Defined Service Area when
one is necessary to maintain services in rural and frontier service areas.
1.1.7.13.1. Contractor shall obtain and maintain approval for the CFCMW throughout the
Contract Period to meet program requirements for a Case Management Agency.
1.1.7.13.2. The Department reserves the right to revoke Contractor's CFCMW at any time.
1.1.7.13.3. Contractor shall submit an annual report to the Department that includes, but is not
limited to, the following information:
1.1.7.13.3.1. Written processes in place to ensure remediation of conflict and separation of
entities.
1.1.7.13.3.2. Documentation of Member choice and informed consent of the conflict of the
agency being selected.
1.1.7.13.3.3. A summary of the individuals participating in direct services and case
management at the agency with the CFCMW.
1.1.7.13.3.4. Policies and procedures outlining how Contractor will validate that there are no
other willing and qualified providers in their Defined Service Area with capacity
to provide services for all eligible members in the service area.
1.1.7.13.3.5. How Contractor is supporting the recruitment of providers in their area to
remediate conflict.
1.1.7.13.4. If Contractor is denied a CFCMW for any reason, or one is revoked, Contractor must
have documented written plans for transitioning individuals and Members. Contractor
shall continue to provide services until a transition may be successfully implemented.
1.1.7.13.5. DELIVERABLE: Annual report and written processes and procedures on.
implementing rural exception and only willing and qualified provider requirements
for CMAs that have been granted a CFCMW.
1.1.7.13.6. DUE: June 15th of each year or prior to contract renewal for CMAs with an approved
rural exception
1.2. Collaboration with other Care Coordination Entities and Case Management Agencies
1.2.1. Contractor shall comply with written communication from the Department, provided by the
Department, between Contractor and community partners and service providers that outline
how Contractor will work together with these partners to coordinate care and better serve
individuals and Members. Contractor shall establish written memorandum of understanding
with local care coordination entities that outline roles and responsibilities, avoidance of
duplication of effort, and communication expectations. Contractor is responsible for
streamlining the Member experience to ensure full range of Medicaid services are being
offered and accessed based on the Member's needs. As applicable, a memorandum of
understanding shall address partnerships with:
1.2.1.1. Regional Accountable Entities (RAE)
Exhibit B-1, SOW Page 4 of 52
1.2.1.1.1. The RAE is responsible for coordinating for physical health services and providing
and arranging for behavioral health services, including, but not limited to mental
health services or other non -waiver behavioral services and supports available
through Medicaid. The RAE promotes the population's health and functioning,
coordinates care across disparate providers, interfaces with LTSS providers, and
collaborates social, educational, justice, recreational, and housing agencies to foster
healthy communities and address complex needs that span multiple agencies and
jurisdictions. The RAE manages a network of primary care physical health providers
and behavioral health providers to ensure access to appropriate care for Medicaid
Members.
1.2.1.1.1.1. Contractor shall ensure collaboration with RAEs occurs for all shared Members
that need care coordination services for physical, mental and behavioral health
services. Contractor shall identify which community agencies are responsible for
facilitation, follow-up, and solution focused on next steps for each Member
collaboration.
1.2.1.1.1.2. Contractor shall collaborate with the appropriate RAE when a Member needs
assistance in accessing or coordinating the Member's physical, behavioral, or
mental health needs. This shall include but is not limited to Members who have
complex medical or behavioral support needs, change of conditions or
involvement with Child Welfare or Adult Protection.
1.2.1.1.1.3. Coordinating with the RAE for shared Members who admit to a hospital, to
include, but not limited to, communicating reasons for admission, Member's
hospital status, and plans for discharge.
1.2.1.1.1.4. Collaborating with the RAE for shared Members discharging from the hospital to
ensure all support needs are reflected in the Support Plan and the Member is
connected to the necessary services to support a successful discharge.
1.2.1.1.1.5. Enter into a data sharing arrangement for the sharing of all necessary information
for the RAE to assist Members in accessing and coordinating physical and
behavioral health needs.
1.2.1.1.1.6. Contractor shall create a complex and creative solutions process with the RAE(s)
and designated staff to address needs spanning multiple Medicaid systems for all
shared Members. This shall include, but not be limited to, a regularly scheduled
joint coordination meeting at a cadence that best meets the Member's needs to
ensure holistic case management and care coordination.
1.2.1.1.1.7. Contractor shall honor Member's preferences for case management and care
coordination, when applicable, while ensuring collaboration with the RAE occurs.
1.2.1.1.1.8. Contractor shall work with the Department to identify a Key Performance
Indicator (KPI) to measure the effectiveness of coordination between Contractor
and RAE.
1.2.1.1.1.9.
1.2.1.1.1.9.1.
Contractor shall complete the following RAE coordination best practice kickoff
activities:
Establish regular collaboration meetings between Contractor and local
RAE(s).
Exhibit B-1, SOW Page 5 of 52
1.2.1.1.1.9.2.
1.2.1.1.1.9.3.
1.2.1.1.1.9.4.
1.2.1.1.1.9.5.
1.2.1.1.1.9.6.
Create a draft of the collaboration meeting charter including points of contact
for involved agencies, such as local Human Services, Health Care Policy and
Financing staff or other identified individuals necessary for effective
collaboration work.
Create a draft policy and procedure for collaboration between Contractor and
the RAE for shared member care coordination and complex solutions.
Create and sign data sharing agreements between Contractor and the RAE.
DELIVERABLE: RAE Collaboration Start -Up Report per Defined Service
Area
DUE: September 15, 2024. This is a one-time activity for the startup of best
practices for coordination and collaboration between Contractor and their
local RAE.
1.2.2. Medicaid Eligibility Sites
1.2.2.1. County department of human/social services (counties) and Medical Assistance (MA)
Sites are designated sites allowed by statute or certified by the Department of Health Care
Policy and Financing (Department) to process the State -authorized Medical Assistance
application for the programs that are administered by the Department and determine
eligibility for said programs. The role of county departments, specified in CRS 25.5-1-
118, is specific to the responsibility for the local administration of Medical Assistance.
Additionally, the Department is authorized to establish MA sites by statute (CRS 25.5-4-
205 et seq). Counties and MA Sites use the Colorado Benefits Management System
(CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Health First
Colorado (Colorado's Medicaid Program) programs.
1.2.2.2. Contractor shall ensure collaboration with all county and Medical Assistance sites
pertaining to application, renewal, case changes, or re -application status for members in
Contractor's designated service area.
1.2.2.3. Contractor shall collaborate with the appropriate counties and/or Medical Assistance sites
to ensure proper follow-up and communication to support members in obtaining and
maintaining their benefits.
1.2.3. Community Centered Boards
1.2.3.1. Community Centered Boards (CCB) are the agencies responsible for leveraging local and
regional resources to meet unmet needs for individuals with Intellectual and
Developmental Disabilities (IDD) and their families.
1.2.3.2. Contractor shall collaborate with CCBs, this may include, but is not limited to:
1.2.3.2.1. Receiving referrals or sharing information necessary for the CCB and/or CMA to
assist individuals and Members in accessing LTSS programs targeted for individuals
with intellectual and developmental disabilities or children with disabilities.
1.2.3.2.2. Coordinating care for non -waiver services for members with intellectual and
developmental disabilities where applicable or appropriate.
1.3. Qualification and Training Requirements
Exhibit B-1, SOW Page 6 of 52
1.3.1.
1.3.2.
1.3.3.
1.3.4.
1.3.5.
1.3.6.
1.3.6.1.
1.3.6.2.
1.3.6.3.
1.3.6.4.
1.3.6.5.
1.3.6.6.
1.3.6.7.
1.3.6.8.
1.3.6.9.
1.3.6.10.
1.3.6.11.
1.3.6.12.
1.3.6.13.
1.3.6.14.
1.3.6.15.
1.3.6.16.
1.3.6.17.
1.3.6.18.
1.3.6.19.
Contractor's personnel, including, but not limited to, Case Manager(s) and Case Management
Supervisor(s) shall meet all qualification requirements listed in 10 C.C.R. 2505-10, Sections
8.519 et seq.
Contractor shall ensure all case managers meet the qualification requirements established in
10 C.C.R. 2505-10, Section 8.519 et seq.
Contractor shall ensure all staff assigned to perform the Work in this Contract pass
competency -based training requirements as defined by the Department including, but not
limited to disability/cultural competency, person centeredness, soft skills, as well as program
specific knowledge and skills.
Contractor shall ensure that all case management staff receive training within 120 Calendar
Days after the staff member's hire date and prior to being assigned independent case
management duties. All other case management staff must receive retraining as required by
the Department, a Department -approved vendor, or Contractor.
Training modalities may include the Departments Learning Management System (LMS),
web -based training, virtual instructor -led training, in -person training sessions and training
materials available on the Department website. Contractor shall utilize training materials
provided by the Department.
Required Case Management Training includes, but is not limited to:
Applicable Federal and State laws and regulations for LTSS programs
Critical Incident Reporting
Determination of Developmental Disability or Delay
Disability and Cultural Competency
Equity, Diversity, Inclusion and Accessibility (EDIA)
Intake and Referral
Level of Care Screen and Needs Assessment (Colorado Single Assessment) or
Department Prescribed Tools
Long -Term Home Health (LTHH)
Long -Term Services and Supports Eligibility
Mandatory Reporting
Notices and Appeals
Nursing Facility Admissions
Participant Directed Training
Person -Centered Support Planning and Person -Centered Support Plan
Pre -Admission Screening and Resident Review (PASRR)
State General Fund Program Ongoing Case Management
State General Fund Program Requirements and Services
System Documentation
Waiver Requirements and Services
Exhibit B-1, SOW Page 7 of 52
1.3.7. DELIVERABLE: Case Management Training
1.3.8. DUE: Semi -Annually, trainings held between July 1St and December 31St are due January
15th, and trainings held between January 10 through June 1st are due June 15th.
1.3.9. Contractor shall maintain supporting documentation demonstrating case managers attended
the required trainings and make the information available to the Department upon request.
Supporting documentation must include the name and description of the training, the date the
training was held, case managers in attendance, and trainer sign -off showing the case
manager completed the training.
1.3.10. There will be no exemptions to the above list of required trainings as all case managers shall
have a basic knowledge of all case management activities regardless of ongoing duties.
1.3.11. Case Managers shall meet competency requirements determined by the Department to
perform case management tasks including the correct application of the Colorado Single
Assessment and Person -Centered Support Plan. Case Managers must pass assigned training
competency requirements to independently perform Case Management activities.
1.3.12. Contractor shall participate in Department trainings, which will be tracked by the
Department. Participation can be at the time of the presented training or, if applicable,
following the training using the materials available from the Department's website or LMS.
1.3.13. For Case Managers who have a documented minimum of one-year immediate prior work
experience at a different Colorado CMA, Contractor may assign independent case
management activities once Contractor has verified that the Case Manager's training
requirements were previously met.
1.3.14. Contractor may elect to perform additional training not outlined in the Contract, but
applicable to the Scope of Work, which may include mental health first aid, crisis
intervention, and trauma informed care. Contractor may utilize the Department's Case
Management Training Template to identify trainings attended that are not required by the
Department.
1.3.15. Case Management staff are required to retake training to address and remediate performance
concerns as directed by the Department.
1.3.16. Contractor shall provide the date all case management staff, including new and existing staff,
were hired and the dates of received training in the areas identified in Section 1.2.3, using the
reporting template provided by the Department for review, approval, and payment.
1.3.17. Case Managers shall receive oversight reviews of their performance including their
competency with completing the Level of Care Screen. Contractor shall shadow case
management staff completing the Level of Care Screen on an annual basis and prior to the
end of each Contract Fiscal year to establish case manager's competency administering the
Level of Care Screen. Documentation on case manager performance will be maintained by
Contractor and provided to the Department upon request. Supervisors, lead workers, or a case
manager with at least three years of case management experience may perform the
shadowing.
1.4. Care and Case Management (CCM) System Training
1.4.1. Contractor shall participate in all trainings required by the Department for the Care and Case
Management (CCM) Information Technology system and the new Colorado Single
Assessment and Person -Centered Support Plan.
Exhibit B-1, SOW Page 8 of 52
1.4.1.1. Staff employed by Contractor shall participate in training on the Colorado Single
Assessment and Person -Centered Support Plan instruments prior to performing the LOC
Screen, Needs Assessment, or Person -Centered Support Plan.
1.4.1.2. DELIVERABLE: Completed Case Management Training on the Colorado Single
Assessment, or Person -Centered Support Plan.
1.4.1.3. DUE: As Assigned by the Department
1.5. Complaints
1.5.1. Contractor shall develop and maintain a formal complaints procedure, notify Members
annually of the procedures, and make the procedure publicly available. Procedures must
include requirements for member notification in accordance with 10 CCR 2505-10 9.519.20
and 10 CCR 2505-10 8.605.
1.5.2. Contractor shall receive, document, and track any complaint received by Contractor as it
relates to the services provided through this Contract to include, but not limited to, general
business functions, administration, State General Funded Programs, and case management
functions outlined in this Contract. Complaints received outside of the scope of this Contract
shall not be included. Documentation shall consist of a complaint log that includes the date
of complaint, name of the complainant, the nature of the complaint and the date and
description of the resolution.
1.5.3. Contractor shall submit all complaints to the Community Advisory Committee for review,
feedback, and input on resolving complaints.
1.5.4. Contractor shall analyze complaints for trends quarterly and shall submit all complaint -
oriented trends observed since the Effective Date of this Contract and the remedial actions
taken to address them to the Department.
1.5.5. Trend analysis shall include an examination of information including, but not limited to:
1.5.5.1. A comparison of complaint types and number of complaints over a period of time.
1.5.5.2. Number of type of complaint against Contractor, time, location, individual involved, staff
involved, and/or any additional relevant information.
1.5.5.3. An examination of potential reasons for the increase or decrease in complaints by total
number, subcontractor, individual, or staff.
1.5.5.4. An examination of preventative measures that can be implemented to reduce the number
or frequency of future complaints.
1.5.5.5. Implementation of a plan of action or any future actions to take place.
1.5.5.6. An analysis of whether the plan of action and changes made were effective or if additional
changes need to occur.
1.5.5.7. As part of the complaint process Contractor shall include, but is not limited to, all of the
following:
1.5.5.7.1. Document complaints received.
1.5.5.7.2. Address substantiated complaints.
1.5.5.7.3. Respond to complaints received and document actions taken to resolve and/or
mitigate complaints.
Exhibit B -1, SOW Page 9 of 52
1.5.5.7.4. Conduct a quarterly trend analysis of all complaints received for the full period of the
Contract.
1.5.5.8. Contractor shall maintain all supporting documentation related to the collection and
follow-up to complaints and make it available to the Department upon request.
1.5.5.9. If Contractor received no complaints during the quarter, Contractor may submit the
Complaint Trends Analysis to the Department identifying no complaints were reported
during the quarter.
1.5.5.10. If Contractor received less than five complaints during the quarter and cannot establish a
complaint trend, Contractor may submit the Complaint Trends Analysis to the
Department with the complaint log that includes the date of complaint, name of the
complainant, the nature of the complaint and the date and description of the resolution.
1.5.5.11. Contractor shall submit the Complaint Trends Analysis to the Department for review and
approval.
1.5.5.11.1. DELIVERABLE: Complaint Trend Analysis
1.5.5.11.2. DUE: Quarterly, by October 15th, January 15th, April 15th and June 15th of each year.
1.6. Continuous Quality Improvement Plan
1.6.1. Contractor shall create and implement a Continuous Quality Improvement Plan for the
contract period. The Continuous Quality Improvement Plan shall include, but not be limited
to a description of the following:
1.6.1.1. How Contractor oversees the work performed by Case Managers as outlined in the
contract to ensure all tasks are being performed according to the requirements.
1.6.1.2. How Contractor reviews work to determine whether the work is being completed in a
correct and high -quality manner.
1.6.1.3. How Contractor identifies and addresses Case Management performance issues.
1.6.1.4. How Contractor notifies the Department of identified performance issues.
1.6.1.5. How Contractor will address at a minimum the following areas: operations, quality
controls, staffing, training, and community engagement. Required tasks will be outlined
in Department template that will be provided to Contractor yearly.
1.6.1.6. Contractor shall participate in the Department hosted Quality Community of Practice.
1.6.2. Contractor shall submit the Continuous Quality Improvement Plan to the Department for
review, approval, and payment. The Department will establish a regularly scheduled cadence
with Contractor to review and discuss the CQI Plan, data, and agency specific quality
dashboard. Contractor shall review the plan and metrics with the Department annually.
1.6.2.1. DELIVERABLE: Continuous Quality Improvement Plan
1.6.2.2. DUE: Within 90 Business Days after the Effective Date
1.6.3. Contractor shall review its Continuous Quality Improvement Plan on an annual basis and
update the plan as appropriate to account for any changes. Contractor shall submit the
Continuous Quality Improvement Plan Update or document that the plan was reviewed, and
changes were not required.
1.6.3.1. DELIVERABLE: Continuous Quality Improvement Plan Update
Exhibit B-1, SOW Page 10 of 52
1.6.3.2. DUE: Annually, by October 1st
1.7. Appeals
1.7.1. Contractor shall represent the Department and defend any adverse action in accordance with
10 CCR 2505-10 8.500.16 et seq., 10 CCR 2505-10 8.51922, and 10 CCR 2505-10 Sections
8.057 et. seq. in all HCBS, LTHH, PACE, Hospital Back -Up Facilities, and Nursing Facility
appeals initiated during this Contract. This section does not apply to State General Fund
Programs. Contractor shall coordinate with the Department for any adverse actions
necessitating Department attendance at a hearing.
1.7.1.1. Contractor shall identify and disclose to the Department immediately, and no later than
45 Calendar Days prior to a scheduled appeal hearing, any conflict of interest that would
interfere with Contractor's ability to represent the Department in any appeal.
1.7.2. Contractor shall represent its actions at Administrative Law Judge hearings when the
individual or Member appeals a denial or adverse action affecting individual's or Member's
program eligibility or receipt of services.
1.7.3. Contractor shall process appeals in accordance with schedules published by the State of
Colorado Office of Administrative Courts and rules promulgated by the Department.
1.7.4. Contractor shall develop an Appeals Packet which contains all relevant documentation to
support Contractor's denial or adverse action.
1.7.5. Contractor shall develop an Appeals Packet no later than 20 Business Days prior to the date
of a scheduled hearing.
1.7.6. Contractor shall submit exceptions when applicable and include all relevant information.
1.7.7. Contractor shall cooperate with the Office of the State Attorney General for any case in which
it is involved.
1.7.8. Contractor shall document all appeals where Contractor attends any hearing in an
Administrative Law Court.
1.7.9. Contractor shall make the Appeal Packets available to the Department upon request.
1.7.10. Contractor shall document all Appeals Creation of the Packet and Attendance at the Hearing
information, no later than the 10th day of the month following the month when the packet or
hearing was completed, and follow-up in the Department prescribed system and maintain
detailed documentation. The Department will review internal data reports to verify the
number of Appeal Packets completed and number of Hearings attended for payment
purposes.
1.7.10.1. PERFORMANCE STANDARD: 100% of Appeal Packets and Hearings Attended are
added to the Department prescribed system monthly by the 10th day of the month
following the month when the packet or hearing was completed.
1.8. Critical Incidents
1.8.1. Critical Incident Reporting
1.8.1.1. Contractor shall be responsible for entering critical incident reports (CIR) in the
Department prescribed system as soon as possible, but no later than 24 hours (one
business day) following notification.
Exhibit B-1, SOW Page 11 of 52
1.8.1.2. Contractor shall ensure all suspected incidents of abuse, neglect, and exploitation are
immediately reported consistent with current statute; Section 19-3-301 through 19-3-318
C.R.S. Colorado Children's Code, Section 18-8-115 C.R.S. (Colorado Criminal Code -
Duty to Report a Crime), 18-6.5-108 C.R.S. (Colorado Criminal Code -Wrongs to At -Risk
Adults), and Section 26-3.1-102, C.R.S. (Social Services Code -Protective Services).
1.8.1.3. Contractor shall document all CIR follow-up information in accordance with Department
direction in the Department prescribed system and maintain detailed documentation.
1.8.2. Critical Incident Follow -Up Completion and Entry
1.8.2.1. Contractor shall ensure all CIRs follow-up is completed and entered into the
Department's prescribed system within the timelines established by the Department
and/or the Department's Quality Improvement Organization.
1.8.2.2. Timelines for follow-up are determined by the Department and depend on the type and
severity of the CIR. The following are general timelines assigned to remediation and CIR
follow up:
1.8.2.2.1. High Priority Follow Up- CIRs which require immediate attention and must be
addressed to ensure the immediate health and safety of a waiver participant must be
remediated within and responded to in the Department prescribed system within 24-
48 hours.
1.8.2.2.2. Medium Priority Follow Up — CIRs which require additional information or follow
up to ensure appropriate actions are taken and there is no immediate risk to the health
and safety of the waiver participant must be completed in the Department prescribed
system within three to four Business Days.
1.8.2.2.3. Low Priority Follow Up — CIRs that have been remediated by CMAs, have addressed
immediate and long-term needs, have implemented services or supports to ensure
health and safety, and those that have protocols in place to prevent a recurrence of a
similar CIR but may require an edit to the CIR or additional information entered into
the Department prescribed system. The follow-up for CIRs in this category must be
completed and entered within five Business Days.
1.8.2.3. PERFORMANCE STANDARD: 90% of all CIRs assigned follow-up are completed
and entered into the Department's prescribed system within the timelines established by
the Department and/or the Department's Quality Improvement Organization each quarter.
1.9. Critical Incident Report Administrative Review
1.9.1. Contractor shall conduct a Critical Incident Report Administrative Review upon direction
from the Department.
1.10. Critical Incident Report administrative reviews shall be initiated by the Department and will
require the Contractor to upload documentation to the Department's prescribed system as
assigned. Contractor may be required to document that the reported incident of alleged
Mistreatment, Abuse, Neglect, or Exploitation (MANE) was reported to law enforcement, per
mandated reporting laws, and to adult/child protection services to be screened for additional
investigation by the Colorado Department of Human Services as appropriate. The Department
may also request that the Contractor file a report with the Colorado Department of Public Health
and Environment as necessary. Critical Incident Report administrative review may also require
documentation of whether additional services might be needed as a result of the incident, or
Exhibit B-1, SOW Page 12 of 52
gathering of additional documentation at the request of the Department. Human Rights
Committee (HRC).
1.10.1. Contractor shall establish and facilitate a Human Rights Committee (HRC) pursuant to §25.5-
10-209(h), C.R.S. and 10 C.C.R. 2505-10 Section 8.608.5 et seq. Contractor shall maintain
qualifications for each member of the HRC and make it available to the Department upon
request.
1.10.2. Contractor shall submit a list of HRC members annually.
1.10.2.1. DELIVERABLE: HRC Member List
1.10.2.2. DUE: Annually, by August 15th
1.10.3. Contractor shall notify the Department of any changes to the HRC members within 10
Business Days of the date of change.
1.10.3.1. DELIVERABLE: HRC Member Updates
1.10.3.2. DUE: Within 10 Business Days of the date of change to the HRC members
1.10.4. Contractor shall establish at least one HRC as a third -party mechanism to safeguard the rights
of persons enrolled in HCBS-CES, HCBS-CHRP, HCBS-SLS, HCBS-DD, State SLS,
OBRA-SS, and FSSP. The HRC is an advisory and review body to the administration of
Contractor.
1.10.5. Contractor shall develop policies and procedures to assure that all potential conflicts of
interest are addressed. Contractor shall utilize the Department's required universal documents
for all HRC reviews.
1.10.6. Contractor shall orient members regarding the duties and responsibilities of the Human
Rights Committee and make this information available to the Department upon request.
1.10.7. Contractor shall provide the HRC with the necessary staff support to facilitate its functions.
1.10.8. Contractor shall keep proper documentation and record of all HRC recommendations and
ensure that all documentation is a part of the individual's master record.
1.10.9. Contractor shall maintain HRC meeting minutes, attendance logs, and supporting
documentation related to an HRC meeting and make it available to the Department within 10
Business Days upon request.
1.10.10. Contractor shall notify the Department in writing of any changes to the HRC membership
within 10 Business Days.
1.10.11. Contractor shall document all reviews within the Department's prescribed system within 10
Business Days of the date of the HRC review.
2. PRE -ENROLLMENT ACTIVITIES
2.1. LTSS LOC Referral, Intake, and Screening
2.1.1. Contractor shall perform all long-term services and supports Level of Care referral, intake,
and screening functions/activities for enrollment into the following waivers and programs:
2.1.1.1. CHCBS
2.1.1.2. Consumer -Directed Attendant Support Services (CDASS)
2.1.1.3. Family Support Services Program (FSSP)
Exhibit B-1, SOW Page 13 of 52
2.1.1.4. HCBS-BI
2.1.1.5. HCBS-CES
2.1.1.6. HCBS-CHRP
2.1.1.7. HCBS-CIH
2.1.1.8. HCBS-CLLI
2.1.1.9. HCBS-CMHS
2.1.1.10. HCBS-DD
2.1.1.11. HCBS-EBD
2.1.1.12. HCBS-SLS
2.1.1.13. Hospital Back -Up
2.1.1.14. In Home Supports and Services (IHSS)
2.1.1.15. Intermediate Care Facilities for Individuals with Intellectual and Developmental
Disabilities (ICF/IID)
2.1.1.16. Nursing Facilities
2.1.1.17. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS)
2.1.1.18. PACE
2.1.1.19. State Supported Living Services Program (State SLS)
2.2. Contractor shall perform all Long Term Supports and Services Level of Care (LTSS LOC)
referral, intake, and screening functions/activities in accordance with §25.5-6-104, C.R.S. and 10
CCR 2505-10, Sections 8.7202.B., 8.500.1 and 8.393.2.B. et seq., shall include, but not limited
to, the following:
2.2.1.1. Timelines shall be applied based on the location of the applicant at the time the Contractor
receives the LTSS Level of Care (LOC) referral or another intake referral:
2.2.1.1.1. Hospital
2.2.1.1.2. Skilled Nursing Facility, or
2.2.1.1.3. Community
2.2.1.1.3.1. Programs such as Hospital Back-up and PACE are subject to timelines based on
the location of the applicant at the time the Contractor receives the LTSS LOC
referral or another referral for LOC Assessment.
2.2.1.2. CMAs shall not require a LTSS LOC Referral form to intake a referral requesting a LOC
assessment.
2.2.1.3. Conduct and document the Colorado Intake Screen Tool (CIST) and LOC Assessment
within required timelines set forth by the Department.
2.2.1.3.1. Conduct and document the CIST in the Department's prescribed system within 2
business days of receiving the LTSS LOC referral or any other intake referral
requesting a LOC Assessment.
Exhibit B-1, SOW Page 14 of 52
2.2.1.3.2.
2.2.1.3.3.
Timeline to conduct and document the CIST does not extend the LOC Assessment
timelines set forth by the Department.
Ensure documentation includes the individual's need for LTSS and/or the individual's
request for a LOC Screen even if the CIST indicates the individual may not be eligible
for LTSS.
2.2.1.3.4. LTSS LOC referral form is uploaded to the Department's prescribed system.
2.2.1.3.4.1. Any other referral requesting a LOC assessment is uploaded in the Department's
prescribed system.
2.2.1.3.5. Document all efforts to contact an applicant to conduct the CIST, LOC Assessment,
and any referrals made to non-LTSS services in the Department's prescribed system.
2.2.1.4. Have a written policy and procedure for expediting the LTSS LOC referral or another
referral for LOC Assessment in the event that an applicant is in an emergency situation.
2.2.1.5. Conduct and document a LOC Assessment without delay if an applicant has requested a
Delay Determination or Developmental Disability Determination required for HCBS-
DD, HCBS-SLS, HCBS-CES, and HCBS-CHRP waivers.
2.2.1.6. For an individual who is not being discharged from a hospital or a nursing facility, the
CIST, and LOC Assessment shall be conducted and documented in the Department's
prescribed system within 10 business after receiving confirmation that the Medicaid
application has been received by the county department of social services.
2.2.1.6.1. CMAs shall attempt to verify that a LTC Medicaid Application has been submitted
after receiving a LTSS LOC referral but should not delay a LOC assessment if the
interview conducted to complete the CIST indicates that an applicant has not
submitted a LTC Medicaid Application.
2.2.1.6.2. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
2.2.1.7. Individuals shall be notified at the time of the decision of their application for publicly
funded LTSS that they have the right to appeal the actions of Contractor according to 10
CCR 2505-10 section 8.5007 and 8.519.22 et seq. The notification shall include the right
to request a fair hearing before an Administrative Law Judge.
2.2.1.7.1. PERFORMANCE STANDARD: 100% of LTSS LOC Referrals and all intake
referrals submitted to the Contractor are entered or uploaded into the Department
prescribed system within two Business Days of the LTSS LOC Referral or intake
referral receipt date.
2.3. Developmental Disability and Delay Determinations
2.3.1. Contractor shall determine whether an applicant meets the definition of an Individual with a
Developmental Disability or Delay as defined under 10 CCR 2505-10, section 8.600.4 et seq.
and 8.508.20T et seq., in accordance with 10 C.C.R. 2505-10 section 8.607.2 et seq.
2.3.2. Contractor may expedite psychological or adaptive behavior testing for Developmental
Disability Determinations when there are delays due to issues identifying a provider or
scheduling testing with a provider in order complete the PASRR Level II assessments for
individuals residing in skilled nursing facilities. Requests for testing funding must be
submitted on the template prescribed by the Department.
Exhibit B-1, SOW Page 15 of 52
2.3.3. Contractor may request funding for testing necessary to complete Delay or Developmental
Determination to move forward with intake and referral activities. This includes cases where
an applicant cannot access testing due to financial burden and other funding is not available
if they have submitted a long-term care Medicaid application and the financial eligibility has
not been determined. Requests for funding must be submitted to the Department for approval
prior to funding being approved.
2.3.3.1. DELIVERABLE: Prior Approval for Testing Funding and Invoice
2.3.3.2. DUE: Monthly, by the 15th
2.3.3.3. Contractor shall maintain all supporting documentation related to the testing for DD
Determination and make it available to the Department upon request.
2.3.4. Contractor shall complete the individual's determination record and assessment record in the
Department prescribed system with all applicable dates and information within 10 Business
Days after a determination is complete.
2.3.5. Contractor shall maintain the individual's determination, documents, and upload them to the
Department's prescribed system.
2.3.6. Contractor shall ensure that all determinations are complete, in accordance with Department
regulations, and the individual has been determined to have a disability or delay prior to
enrollment into HCBS-DD, HCBS-SLS, HCBS-CHRP, HCBS-CES, State SLS, FSSP, and
OBRA-SS.
2.3.7. Individuals shall be notified at the time of the decision of the determination that they have
the right to appeal actions of Contractor to 10 CCR 2505-10 sections 8.500.16 et seq.,
8.519.22 et seq., and 8.393.3.A.b et seq. The notification shall include the right to request a
fair hearing before an Administrative Law Judge.
2.4. Waiting List Management
2.4.1. Contractor shall maintain a program specific waiting list within the Department's prescribed
system for all eligible individuals for whom funding is not available. Waiting lists may be
applicable for HCBS-DD, State SLS, and FSSP dependent on available funding. Contractor
shall not maintain a waiting list for any of the other programs included within this Contract.
2.4.2. Contractor shall determine HCBS-DD waiting list eligibility by conducting an assessment
that clearly defines detailed and member specific information that specifies how the
individual meets the HCBS-DD waiver requirement for needing access to services and
supports twenty-four (24) hours a day pursuant to 10 CCR 2505-10 8.500.7.B.
2.4.2.1. Contractor's description of daily living needs of an individual who requires access to
twenty-four (24) hour a day services and support in the LOC waiting list assessment
should indicate services and support needs that are only available in the HCBS-DD
waiver to determine why access to services and supports twenty-four hours a day are
necessary for the individual.
2.4.3. The name of a person eligible for the program shall be placed on the waiting list by Contractor
making the eligibility determination.
2.4.4. When an eligible person is placed on the waiting list for Waiver services, a written notice of
action including information regarding individual rights and appeals shall be sent to the
person or the person's legal guardian in accordance with the provisions of 10 C.C.R. 2505-
10 8.519.22 et seq.
Exhibit B-1, SOW Page 16 of 52
2.4.5. When funding has been made available for an individual Contractor will remove the person
from the "As Soon as Available" (ASAA) waiting list within 10 Business Days.
2.4.6. The placement date used to establish a person's order on an HCBS waiver waiting list shall
be:
2.4.6.1. The date on which the person was initially determined to have a developmental disability
by Contractor; or
2.4.6.2. The 14th birth date if a child is determined to have a developmental disability by
Contractor prior to the age of 14.
2.4.7. When an individual is eligible for a program and funding is not available, Contractor shall:
2.4.7.1. Verify demographic information.
2.4.7.2. Compile and correct data.
2.4.8. Contractor shall complete data entry of Waiting List record into the Department prescribed
system within 10 Business Days of any addition or change to the Waiting List.
2.4.9. Contractor shall conduct and document, in the Department's prescribed system, an annual
follow-up with individuals 18 and older for all HCBS waivers with a Waiting List timeline
of ASAA, Safety Net (SN), or "see date" to update changes in demographic information and
ensure the individual is appropriately identified on waiting lists for the program and services
the individual is eligible to receive.
2.4.9.1. PERFORMANCE STANDARD: One 100% of HCBS individuals 18 and older with an
ASAA, SN, or "see date" timeline on the Waiting List are contacted annually and
documented within the Department's prescribed system within 10 Business Days.
2.5. Program Enrollment from the Waiting List
2.5.1. HCBS-DD Enrollment from the Waiting List
2.5.1.1. When an enrollment becomes available from the HCBS-DD Waiting List, the Department
will notify Contractor of the individual who will be offered an enrollment by the order of
selection date.
2.5.1.2. Contractor shall notify the individual of the enrollment offer within 5 Business Days.
Contractor shall make three attempts to contact the individual within a 30 -calendar day
period. Contractor shall document in the Departments prescribed system all attempts to
contact the individual for the enrollment offer. If the individual does not respond to the
offer of enrollment, Contractor shall change the individuals waiting list timeline to
"Safety Net".
2.5.1.3. Individuals shall be notified at the time of the enrollment offer that they have the right to
appeal the actions of Contractor to 10 CCR 2505-10 sections 8.500.16 et seq. and 8.393A
et seq. The notification shall include the right to request a fair hearing before an
Administrative Law Judge.
2.5.2. HCBS-DD Waiting List Enrollment Capacity Building
2.5.2.1. As appropriated and earmarked by the General Assembly, Contractor may receive
capacity building funding to support the enrollment of members into the HCBS-DD
waiver from the waiting list.
Exhibit B-1, SOW Page 17 of 52
2.5.2.2. Contractor shall receive written notification of any capacity building funding for
individuals enrolling into the HCBS-DD waiver from the waiting list.
2.5.2.3. If funding is allocated, Contractor shall report how the capacity building funding was
used to support the enrollment of the authorized Member(s) into the HCBS-DD waiver
on a template developed by the Department. Funding must be used to support Member
enrollment in the following categories:
2.5.2.3.1. Staffing costs
2.5.2.3.2. Recruiting and hiring
2.5.2.3.3. Professional development
2.5.2.3.4. Equipment and supplies
2.5.2.3.5. Information technology
2.5.2.3.6. Program costs
2.5.2.3.7. Advertising
2.5.2.3.8. Equipment and supplies
2.5.2.4. DELIVERABLE: Capacity Building Funding Expenses
2.5.2.5. DUE: Quarterly, if funding is allocated, by October 31st, January 31st, April 30th, and
June 15th or the Fiscal Year end close date determined by the Department
2.5.3. FSSP Enrollment from the Waiting List
2.5.3.1. In cooperation with the local Family Support Council, Contractor shall develop
procedures for determining how and which individuals on the Waiting List will be
enrolled into FSSP. These procedures must comply with Department regulations on
waiting list and prioritization of funding.
2.5.3.2. Contractor shall select individuals from the waiting list to enroll into FSSP in accordance
with 10 CCR 2505-10 8.613(D).
2.5.4. State SLS Enrollment from the Waiting List
2.5.4.1. Contractor shall develop procedures for determining how and which individuals on the
waiting list will be enrolled into the State SLS program in accordance with 10 C.C.R.
2505-10 Section 8.501.7. These procedures shall be made available to the Department
upon request and used to select individuals from the waiting list to enroll into State SLS.
2.5.5. Waiting List Records Maintenance
2.5.5.1. Contractor shall remove individuals from the Waiting List after an enrollment is
authorized to the individual and the individual or guardian accepts or refuses the
authorization for enrollment within 10 Business Days after the individual or guardian's
response or the last communication attempt.
2.5.5.2. If an individual or guardian declines an enrollment, Contractor shall enter the reason for
declining an enrollment into the Department prescribed system Waiting List record within
10 Business Days of the enrollment being declined.
2.5.5.3. Contractor shall provide information and referrals to individuals, families and/or
guardians at the time of the annual follow-up.
Exhibit B-1, SOW Page 18 of 52
2.5.5.4. Contractor shall continue to refer individuals on the Waiting List to other community
resources that may be available and inform individuals of their choice of providers,
waivers, and services.
2.5.5.5. Contractor shall provide assistance completing Medicaid financial applications or other
public assistance program applications at the time assistance is requested by the
individual, family, or guardian.
2.5.5.6. Individuals shall be notified at the time of the enrollment authorization that they have the
right to appeal actions of Contractor as described in 10 CCR 2505-10 section 8.500.16 et
seq., 8.519.22 et seq., and 5.393.A.2 et seq. The notification shall include the right to
request a fair hearing before an Administrative Law Judge.
2.6. Compilation and Correction of Waiting List Data
2.6.1. Contractor shall correct 100% of Waiting List data errors discovered by the Department
within 10 Business Days of notification from the Department of an error.
2.6.1.1. PERFORMANCE STANDARD: 100% of Waiting List data corrected within 10
Business Days of notification.
2.7. Authorization and Reporting of HCBS-DD Enrollments
2.7.1. Contractor shall obtain prior authorization from the Department for all enrollments into the
HCBS-DD waiver.
2.7.2. In accordance with 10 CCR 2505 Section 8.500.7.E, Contractor shall inform the Department
of all vacancies in the HCBS-DD waiver. Vacancies shall be submitted to the Department
monthly on the date and template prescribed by the Department.
2.7.3. Individuals shall be notified at the time of the enrollment authorization that they have the
right to appeal the actions of Contractor to 10 CCR 2505-10 section 8.519 et seq. The
notification shall include the right to request a fair hearing before an Administrative Law
Judge.
2.7.3.1. DELIVERABLE: HCBS-DD Vacancy Reporting
2.7.3.2. DUE: Monthly, by the 15th on the template prescribed by the Department
2.7.4. Contractor shall report all enrollment dates or changes to enrollment status for the HCBS-
DD waiver to the Department monthly on the date and template prescribed by the
Department.
2.7.4.1. DELIVERABLE: HCBS-DD Enrollment Date and Enrollment Change Reporting
2.7.4.2. DUE: Monthly, by the 15th on the template prescribed by the Department
3. SCREENING AND ASSESSMENT
3.1. Contractor shall perform the Level of Care (LOC) (100.2) Assessment as indicated in Section
3.2 or the LOC Screen and Needs Assessment as indicated in Section 3.3 for each Member as
directed by the Department. Contractor shall not perform both a LOC Assessment (100.2) and a
LOC Screen and Needs Assessment for the same Member unless directed to do so by the
Department.
3.2. Level of Care Assessment (100.2)
Exhibit B-1, SOW Page 19 of 52
3.2.1. Contractor shall provide staff that meet the case manager qualifications set forth in state
statutes and regulations to perform all LOC Assessments.
3.2.2. Contractor shall utilize and conduct the Department prescribed tools for the Initial LOC
Assessment for all new applicants to the HCBS waivers, PACE, Nursing Facilities, Hospital
Back -Up, LTHH only, and ICF-IDD. Initial Level of Care Assessment include the following
Assessment Event types: Initial Review, HCBS-DD Waitlist, Deinstitutionalization (DI), and
Reverse Deinstitutionalization. Continued Stay Review LOC Assessments include the
following Assessment Event types: Continued Stay Review and Unscheduled Review.
3.2.3. An Unscheduled Review Assessment Event Type shall be utilized when a LOC Assessment
is completed due to a significant change in the Member functioning and support needs
including documented medical conditions, post hospitalization, or significant change in
activities of daily living.
3.2.3.1. Contractor shall schedule an in -person Initial LOC Assessment in accordance with 10
CCR 2505-10 8.702.E. and shall adhere to the following processes and timelines based
on type:
3.2.3.1.1. Hospital to HCBS
3.2.3.1.1.1. Contractor conducts and documents the LOC Assessment within 2 Business Days
of receiving a LTSS LOC referral for LOC Assessment.
3.2.3.1.1.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the Contractor.
3.2.3.1.1.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
3.2.3.1.1.4. Referral to LOC Eligibility Determination not to exceed 2 Business Days.
3.2.3.1.2. Hospital to Skilled Nursing Facility
3.2.3.1.2.1. Contractor conducts and documents the LOC Assessment and PASRR Level I
Screen within 2 Business Days of receiving a LTSS LOC referral or another
referral for LOC Assessment.
3.2.3.1.2.2. Contractor completes and documents the Nursing Facility Length of Stay form to
indicate the length of stay necessary to meet the applicant's needs.
3.2.3.1.2.3. LOC Eligibility Determination date may be the date of LTSS LOC referral form
is received by the Contractor.
3.2.3.1.2.4. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 Business Days of the LTSS LOC Referral or another
referral requesting a LOC Assessment.
3.2.3.1.2.5. Referral to LOC Eligibility Determination not to exceed 2 Business Days.
3.2.3.1.2.6. Hospital timelines apply to any applicant in a hospital wanting to enroll in PACE,
HBU, and for applicants interested in LTHH Only.
3.2.3.1.3. Skilled Nursing Facility to HCBS
Exhibit B -1, SOW Page 20 of 52
3.2.3.1.3.1. Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date or another referral requesting a LOC Assessment.
3.2.3.1.3.2. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 5 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
3.2.3.1.3.3. Referral to LOC Eligibility Determination not to exceed 5 Business Days.
3.2.3.1.4. Skilled Nursing Facility Payer Source Change
3.2.3.1.4.1. Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date or another referral requesting a LOC Assessment.
3.2.3.1.4.2. Contractor generates a LOC Eligibility Determinations in the Department's
prescribed system within 5 Business Days of the LTSS LOC Referral or another
referral requesting a LOC Assessment.
3.2.3.1.4.3. Referral to LOC Eligibility Determination not to exceed 5 Business Days.
3.2.3.1.5. HCBS to Skilled Nursing Facility
3.2.3.1.5.1. Contractor completes the LOC Assessment and PASRR Level I Screen within 10
Business Days of the LTSS LOC referral date or another referral requesting a
LOC Assessment.
3.2.3.1.5.2. Contractor completes the nursing facility length of stay form to indicate the length
of stay necessary to meet the applicant's needs.
3.2.3.1.5.3. LOC Eligibility Determination start date will be the date of referral on the LTSS
LOC referral form or another referral requesting a LOC Assessment.
3.2.3.1.5.4. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
3.2.3.1.5.5. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.2.3.1.6. HCBS Referral
3.2.3.1.6.1. Contractor completes the LOC Assessment within 10 Business Days of the LTSS
LOC referral date or another referral requesting a LOC assessment.
3.2.3.1.6.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the Contractor.
3.2.3.1.6.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 Business Days of the LTSS LOC referral or another
referral requesting a LOC assessment.
3.2.3.1.6.4. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.2.3.1.6.5. CMAs shall attempt to verify that a LTC Medicaid Application has been
submitted after receiving a LTSS LOC referral but should not delay a LOC
assessment if the interview conducted to complete the CIST indicates that an
applicant has not submitted a LTC Medicaid Application.
3.2.3.1.6.6. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
Exhibit B-1, SOW Page 21 of 52
3.2.3.2. Contractor shall consider a LOC Assessment to be complete when the following has been
done: an in -person assessment is completed, the PMIP has been obtained and verified to
be accurate by the Case Manager to determine target criteria, and the assessment has been
entered in the Department's prescribed system.
3.2.3.3. A LOC Certification notice shall be provided to referring agencies such as PACE
organizations, Nursing Facilities, or Hospitals upon obtaining written consent provided
by the applicant that meets HIPAA standards.
3.2.3.3.1. PERFORMANCE STANDARD: Contractor shall ensure a Professional Medical
Information Page (PMIP) is signed by a medical professional and dated no earlier
than six months from the certification start date and of an Initial LOC Assessment.
3.2.3.4. Contractor shall conduct all Level of Care Evaluations in accordance with regulations.
3.2.3.5. Contractor shall conduct an in -person Continued Stay Review Assessment every 12
months for Clients who are continually enrolled for the HCBS waivers, PACE, Nursing
Facilities, Hospital Back -Up, LTHH only, and ICF-IDD. Contractor shall enter the review
into the Department's prescribed system within 10 Business Days of conducting the
assessment.
3.2.3.5.1. PERFORMANCE STANDARD: Contractor shall ensure a Professional Medical
Information Page (PMIP) is signed within 90 Calendar Days of the certification start
date and before the certification end date for a Continued Stay Review (CSR) for all
applicants and individuals currently receiving services through the Hospital Back -Up
Unit (HBU), Nursing Facility (NF), Intermediate Care Facility for Individuals with
Intellectual and Developmental Disabilities (ICF-IDD), and Program for All -
Inclusive Care for the Elderly (PACE).
3.2.3.6. Contractor shall enter and complete the Continued Stay Reviews within 10 Business Days
after conducting the assessment.
3.2.4. Failure by Contractor to complete the annual Level of Care Assessment shall cause a break
in payment authorization for waiver services for the individual or Member.
3.2.4.1. Contractor shall ensure that this break in payment authorization shall not affect the
continued delivery of waiver services to the individual or Member. Service costs incurred
during a break in payment authorization are non -allowable costs.
3.2.4.2. Contractor shall bear the sole financial responsibility for all costs incurred during this
break in payment authorization and shall be responsible for reimbursing providers for any
loss in funding as a result of the break in payment authorization.
3.2.4.3. Contractor shall notify all providers of the discontinuation of services no later than 11
Calendar Days prior to the certification end date that services shall not be authorized past
the certification end date.
3.3. Level of Care Screen and Needs Assessment
3.3.1. Contractor shall perform all Initial and Annual Reassessment Level of Care Screens and
Needs Assessments for the operation of a CMA in accordance with §25.5-6-104, C.R.S., 10
CCR 2505-10, Section 8.401, and 10 CCR 2505-10, Sections 8.393.2 et seq.
3.3.1.1. The Initial and Reassessment Level of Care Screen shall include and ensure, but not
limited to, the following:
Exhibit B-1, SOW Page 22 of 52
3.3.1.1.1. A verification of Long -Term Care (LTC) Medicaid Financial eligibility or LTC
Medicaid application submission.
3.3.1.1.2. All Level of Care Screens are conducted in person with the individual or Member, at
minimum, and in the place where the individual or Member resides.
3.3.1.1.3. Needs Assessment shall be conducted in person or virtually based on the Member's
preference.
3.3.1.1.4. Contractor shall verify that a Member needs an institutional level of care by receiving
a PMIP signed by a medical professional and dated no earlier than six months from
the certification start date and no later than 90 Calendar Days from the evaluation date
of an Initial Level of Care Screen; and within 90 Calendar Days of the certification
start date and before the certification end date for a Reassessment for all individuals
and Members currently receiving services through Hospital Back -Up Unit (HBU),
Nursing Facility (NF), Intermediate Care Facility for Individuals with Intellectual and
Developmental Disabilities (ICF-IDD), and Program for All -Inclusive Care for the
Elderly (PACE).
3.3.1.1.5. A review of all supportive information related to the Level of Care for the Member to
include, but not limited to, documentation and interviews.
3.3.1.1.6. Communicating Level of Care Eligibility status to the appropriate eligibility site.
3.3.1.1.7. Representing the Department in all appeals relevant to a LTSS program eligibility.
3.3.1.1.8. A review of HCBS waiver Target Criteria for applicant or Member participation.
3.3.1.1.9. Determine individual or Member Level of Care Eligibility for enrollment in an HCBS
Waiver, PACE, LTHH, HBU, Nursing Facility admission, or ICF-IDD admission.
Analyzing the information obtained to determine the most appropriate responses to
the Level of Care Screen questions.
3.3.1.1.10. Providing notice of action to Members of all appealable actions related to their
eligibility in a LTSS program.
3.3.1.1.11. Documenting and maintaining Level of Care Screens and Needs Assessments,
including all relevant information, utilizing the Department's prescribed system
within the timeframes established in 10 CCR 2505-10, Sections 8.393.2.C et seq.
3.3.2. Level of Care Screen
3.3.2.1. The LOC Screen shall include the following event types:
3.3.2.1.1. Initial
3.3.2.1.2. Reassessment
3.3.2.1.3. Off -Cycle Review
3.3.2.1.4. Waiting List
3.3.2.2. Contractor shall conduct an Initial LOC Screen prior to enrolling in the following
programs:
3.3.2.2.1. HCBS Waivers
3.3.2.2.2. PACE
Exhibit B-1, SOW Page 23 of 52
3.3.2.2.3. Nursing Facilities
3.3.2.2.4. Hospital Back -Up
3.3.2.2.5. LTHH (only)
3.3.2.2.6. ICF-IDD
3.3.2.3. Contractor shall conduct an Initial LOC Screen in accordance with 10 CCR 2505-10
8.702.E.:
3.3.2.3.1. Hospital to HCBS
3.3.2.3.1.1. Contractor conducts and documents the LOC Assessment within 2 business days
of receiving a LTSS LOC referral or another referral requesting a LOC
assessment.
3.3.2.3.1.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the CMA.
3.3.2.3.1.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 business days of the LTSS LOC referral or another
referral requesting a LOC assessment.
3.3.2.3.1.4. Referral to LOC Eligibility Determination not to exceed 2 Business Days.
3.3.2.3.2. Hospital to Skilled Nursing Facility
3.3.2.3.2.1. Contractor conducts and documents the LOC Assessment and PASRR Level 1
Screen within 2 business days of receiving a LTSS LOC referral another referral
requesting a LOC assessment.
3.3.2.3.2.2. Contractor completes and documents the Nursing Facility Length of Stay form to
indicate the length of stay necessary to meet the applicant's needs.
3.3.2.3.2.3. LOC Eligibility Determination date may be the date of LTSS LOC referral form
is received by the Contractor.
3.3.2.3.2.4. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 Business Days of the LTSS LOC Referral or another
referral requesting a LOC assessment.
3.3.2.3.2.5. Referral to LOC Eligibility Determination not to exceed 2 Business Days.
3.3.2.3.2.6. Hospital timelines apply to any applicant in a hospital wanting to enroll in PACE,
HBU, and for applicants interested in LTHH Only.
3.3.2.3.3. Skilled Nursing Facility to HCBS
3.3.2.3.3.1. Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date or another referral requesting a LOC assessment.
3.3.2.3.3.2. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 5 Business Days of the LTSS LOC or another referral
requesting a LOC assessment.
3.3.2.3.3.3. Referral to LOC Eligibility Determination not to exceed 5 Business Days.
3.3.2.3.4. Skilled Nursing Facility payer source change
Exhibit B -I, SOW Page 24 of 52
3.3.2.3.4.1. Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date another referral requesting a LOC assessment.
3.3.2.3.4.2. Contractor generates a LOC Eligibility Determinations in the Department's
prescribed system within 5 Business Days of the LTSS LOC Referral or another
referral requesting a LOC assessment.
3.3.2.3.4.3. Referral to LOC Eligibility Determination not to exceed 5 Business Days.
3.3.2.3.5. HCBS to Skilled Nursing Facility
3.3.2.3.5.1. Contractor completes the LOC Assessment and PASRR Level 1 Screen within 10
Business Days of the LTSS LOC referral date or another referral requesting a
LOC assessment.
3.3.2.3.5.2. Contractor completes the nursing facility length of stay form to indicate the length
of stay necessary to meet the applicant's needs.
3.3.2.3.5.3. LOC Eligibility Determination start date will be the date of referral on the LTSS
LOC referral form another referral requesting a LOC assessment.
3.3.2.3.5.4. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 business days of the LTSS LOC referral or another
referral requesting a LOC assessment.
3.3.2.3.5.5. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.3.2.3.6. HCBS Referral
3.3.2.3.6.1. Contractor completes the LOC Assessment within 10 Business Days of the LTSS
LOC referral date another referral requesting a LOC assessment.
3.3.2.3.6.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the Contractor.
3.3.2.3.6.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 Business Days of the LTSS LOC referral or another
referral requesting a LOC assessment.
3.3.2.3.6.4. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.3.2.3.7. CMAs shall attempt to verify that a LTC Medicaid Application has been submitted
after receiving a LTSS LOC referral but should not delay a LOC assessment if the
interview conducted to complete the CIST indicates that an applicant has not
submitted a LTC Medicaid Application.
3.3.2.3.8. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
3.3.2.4. The Initial Level of Care Screen shall include, but is not limited to the following:
3.3.2.4.1. A review of financial eligibility information
3.3.2.4.2. A review of the Level of Care Screen information
3.3.2.4.3. A review of relevant medical, educational, social, or other assessment records or
information when applicable.
Exhibit B-1, SOW Page 25 of 52
3.3.2.4.4.
3.3.3.
3.3.3.1.
3.3.3.2.
3.3.3.2.1.
3.3.3.2.2.
3.3.3.2.3.
3.3.3.2.4.
3.3.4.
3.3.4.1.
3.3.5.
3.3.5.1.
3.3.5.1.1.
3.3.5.2.
3.3.5.2.1.
A review of all community living information and options as an alternative to nursing
facility/institutionalized care.
Annual Level of Care Screen Reassessment
Contractor shall conduct an Annual Reassessment Level of Care Screen no earlier than
90 Calendar Days prior to and no later than 30 Calendar Days prior to the current Level
of Care Screen certification end date.
An Off -Cycle Review event type shall be utilized when a Level of Care Screen is needed
outside of the Annual Reassessment cycle, due to a material change in the Member's
condition that can reasonably be expected to result in a change in the Level of Care or
Target Criteria eligibility.
In the event Contractor fails to conduct the Annual Reassessment Level of Care
Screen for a Member enrolled in a HCBS waiver, Contractor shall be responsible for
reimbursing any providers for services rendered during the gap in eligibility.
Contractor shall follow 10 C.C.R. 2505-10, Section 8.393.6 et seq. when transferring
a Member from one county to another county or from one Defined Service Area to
another Defined Service Area.
Contractor shall take action regarding Member Medicaid eligibility within one
Business Day of receipt from the eligibility site.
In the event Contractor fails to discontinue waiver services for a Member found
ineligible for a HCBS waiver, Contractor shall be responsible for reimbursing any
providers for services rendered.
PERFORMANCE STANDARD: 100% of Initial Level of Care Screen and Annual Level
of Care Screen assessments are conducted within required timelines at 10 CCR 2505-10,
Sections 8.393.2.C et seq. and are entered into the Department prescribed system. The Level
of Care Screen must be entered into the Department's prescribed system following the
timelines at 10 CCR 2505-10 Section 8.393.2.C et seq.
Members shall be notified at the time of the eligibility decision that they have the right to
appeal the actions of Contractor to 10 CCR 2505-10 Section 8.519.22 et seq. The
notification shall include the right to request a fair hearing before an Administrative Law
Judge.
Needs Assessment
Contractor shall conduct an Initial and Annual Needs Assessment for the following
programs:
HCBS Waivers
Contractor shall conduct a Needs Assessment (Initial) prior to enrollment into a HCBS
waiver, annually (Reassessment), and as needed (off -cycle) by the Member due to a
material change of situation or condition that may reasonably result in a change in the
support needs of the Member. Members who are financially eligible, who choose to enroll
in HCBS waiver services, and who meet the required Level of Care for LTSS and waiver
Target Criteria for one of more HCBS waivers must have a Needs Assessment conducted.
Contractor shall conduct a Needs Assessment with Members to determine the level
of support needed and identify personal preferences and goals.
Exhibit B-1, SOW Page 26 of 52
3.3.5.2.2. Contractor shall explain to the Member the option to respond to required questions
only or the choice to answer additional voluntary questions in the Needs Assessment.
3.3.5.3. Contractor shall conduct and document a Needs Assessment for Members in accordance
with the following timelines:
3.3.5.3.1. Within 15 Business Days after determination of Level of Care and Financial
eligibility for HCBS Waivers.
3.3.5.3.2. The Needs Assessment shall be administered prior to the Person -Centered Support
Plan being developed with the Member; however, both the Needs Assessment and
Person -Centered Support Planning may occur during a single session with the
Member. However, they may also be completed over two or more sessions, if the
Member needs or prefers to do so.
3.3.5.3.3. The Needs Assessment shall be conducted at time, modality, and location convenient
to the Member and should include people of the Member's identified preference.
3.4. At -Risk Diversion
3.4.1. Contractor shall:
3.4.1.1. Outreach the identified At -Risk Diversion individuals in conjunction with timelines
determined by the Department to ensure basic health and safety needs in the community
are being met to avoid nursing facility placement.
3.4.1.2. Initial Outreach shall include any Member's first occurrence on the at -risk determination
list as indicated by the Department.
3.4.1.2.1. At -Risk Diversion activities shall include, but are not limited to:
3.4.1.2.2. Assessing the effectiveness of current support and services to determine if there is a
need for additional resources, supports, and/or services.
3.4.1.2.3. Support in assessing if the individual has become eligible for any other resources
including community resources and other Medicaid resources.
3.4.1.2.4. Documenting all At -Risk Diversion activities in detail in the Department's prescribed
system within 10 Business Days of the activity.
3.4.1.2.5. Maintaining all supporting documentation and make it available to the Department
upon request.
3.4.1.2.5.1. DELIVERABLE: At -Risk Diversion Invoice
3.4.1.2.5.2. DUE: Monthly, by the 15th
3.5. Supports Intensity Scale -A Assessment
3.5.1. Contractor shall conduct a Supports Intensity Scale -A (SIS) assessment for all HCBS-DD
and HCBS-SLS enrollments and reassessments when criteria set forth at 10 C.C.R. 2505-10
Section 8.612.1 et seq. are met. Contractor shall not be reimbursed for an SIS assessment
prior to the individual being determined eligible for a waiver through the Level of Care
Screen and confirmation of financial eligibility. Contractor shall not be reimbursed for SIS
reassessments without prior authorization from the Department to conduct the SIS
reassessment.
Exhibit B-1, SOW Page 27 of 52
3.5.2. Contractor shall conduct all initial SIS Assessments within 60 Calendar Days from the date
of the Initial Level of Care Screen. Contractor shall conduct all SIS reassessments within 60
calendar days from the date of approval from the Department.
3.5.3. Contractor shall enter the SIS Assessment into SIS-A Online within 65 Calendar Days of
completing the Level of Care Screen.
3.5.4. Contractor shall complete the SIS-A assessment and enter it into SIS-A Online prior to the
Prior Authorization Review (PAR) Date.
3.6. HCBS-CES Applications
3.6.1. Contractor shall complete initial and CSR applications for persons applying for the HCBS-
CES waiver as set forth by the Department's prescribed guidelines.
3.6.2. Initial HCBS-CES applications shall be submitted to the designated entity for review no more
than 30 Calendar Days after the initial LOC is completed or no more than 30 Calendar Days
after the Applicant/family has chosen enrollment onto the HCBS-CES waiver.
3.6.3. CSR HCBS-CES applications shall be submitted to the designated entity in accordance with
timelines as set forth by the Department in order to prevent any break in services.
3.6.4. Contractor shall maintain all HCBS-CES applications and supporting documentation and
make it available to the Department upon request.
3.7. Support Need Level Assessment
3.7.1. Contractor shall conduct a Support Need Level Assessment for all HCBS-CHRP enrollments
and re -assessments as set forth by the Department's prescribed guidelines.
3.7.2. Contractor shall conduct an initial Support Need Level Assessment within 45 Calendar Days
from the date of the Initial Level of Care Screen. Contractor shall conduct all reassessments
as necessary when individual's needs change.
3.7.3. Contractor shall submit a list of all completed HCBS-CHRP Support Need Level
Assessments on a template prescribed by the Department.
3.7.3.1. DELIVERABLE: Completed HCBS-CHRP Support Need Level Assessment List
3.7.3.2. DUE: Monthly, by the 15th
3.7.4. Contractor shall maintain all Support Need Level Assessments and supporting documentation
and make it available to the Department upon request.
3.7.4.1. PERFORMANCE STANDAND: Support Need Level Assessment
3.7.4.2. DUE: Within 10 Business Days of the Department's request
4. STATE GENERAL FUND PROGRAM OBLIGATIONS
4.1. Service and Support Requirements
4.1.1. Contractor shall administer the three State General Fund Programs: State SLS, OBRA-SS,
and FSSP and purchase services and supports for persons determined to be eligible under this
Contract. If Contractor has been determined to be the only willing and qualified provider by
the Department for the Defined Service Area, Contractor must administer the State Programs
and purchase and/or provide services and supports for persons determined to be eligible under
this Contract. Contractor shall not be responsible for guaranteeing services to eligible persons
under this Contract if there are no Providers available to provide services and supports.
Exhibit B-1, SOW Page 28 of 52
Contractor must ensure separation of case management responsibilities and the provision of
services for both State SLS and OBRA-SS.
4.1.2. Contractor shall ensure that written notifications are provided to individuals and Members
informing them of their rights and the potential influence Contractor has on the Service
Planning process, such as exercising free choice of providers.
4.1.3. Contractor shall provide the individual, Members, and/or guardian with written information
about how to file a provider agency complaint as well as how to make a complaint against
Contractor.
4.1.4. Contractor shall have procedures for a dispute resolution process, as described in 10 C.C.R.
2505-10, Section 8.605.2 et seq. and 8.552.9 et seq., when an action to terminate, change,
reduce or deny services is initiated by the provider service agency.
4.2. State General Fund Service Expenditure Reporting
4.2.1. Contractor shall report all State SLS, FSSP, and OBRA-SS direct service expenditures on the
template provided by the Department. All services must be reported and reimbursed within
the fiscal year the service is provided.
4.2.1.1. DELIVERABLE: State General Fund Program Service Expenditure Reports
4.2.1.2. DUE: Monthly, by the 15th of each month or Fiscal Year end close date determined by
the Department for the month of June.
4.2.2. Adjustments to direct service expenditures must be added to the next direct service
expenditure report submitted by Contractor at the time of discovery. If the adjustment is
identified after the close of the fiscal year the service is rendered, Contractor must report the
adjustment to the Department within 10 Business Days of discovery and a check must be sent
to the Department with the amount of the overpayment in addition to details about the
overpayment to include member name, program, services, and dollar amount.
4.2.3. Contractor shall verify all services are supported with required documentation as required in
10 C.C.R. 2505-10 Section 8.613.J.2 et seq. and 10 C.C.R. 2505-10 Section 8.501.3 et seq.
4.3. State Supported Living Services (State SLS)
4.3.1. General Requirements
4.3.1.1. Contractor shall operate the State SLS program pursuant to 10 C.C.R. 2505-10 Section
8.501et seq.
4.3.1.2. Contractor shall not add surcharges to the purchase of covered services for State SLS.
4.3.1.3. Contractor shall provide a list of qualified providers for all services to Members and
families, during the State SLS Individual Support Plan process, and to other interested
parties upon request.
4.3.1.4. Contractor shall provide or subcontract with local service providers to provide
community services to individuals enrolled in State SLS who meet the intellectual and
developmental disabilities criteria and the eligibility requirements for the specific
program required in 10 C.C.R. 2505-10 Section 8.501 et seq.
4.3.1.5. The Department will notify Contractor of the target number of individuals that shall be
served through State SLS prior to the start of each State Fiscal Year (SFY). Contractor
may choose to enroll more individuals in State SLS than authorized, ensuring all
Exhibit B-1, SOW Page 29 of 52
individuals can be served within the funding allocated. Target caseload is calculated using
the unique number of members that receive direct services during the contract period.
4.3.2. State SLS Eligibility
4.3.2.1. Contractor shall determine eligibility for the State SLS program pursuant to 10 C.R.S.
2505-10 Section 8.501.2(2)(a) et seq.
4.3.2.2. Eligibility for the State SLS program does not guarantee the availability of services and
supports.
4.3.3. State SLS Individual Support Plans
4.3.3.1. Pursuant to 10 C.R.S. 2505-10 Section 8.501.4.E.6 et seq. all State SLS Members must
have a State SLS ISP.
4.3.3.2. Contractor shall develop a State SLS Individual Support Plan (State SLS ISP) within 10
Business Days after an initial Individual Support Plan (ISP) meeting for those individuals
not established with Contractor and with a Developmental Disability determination at
time of referral. Contractor shall have up to 10 Business Days to complete additional
meetings and/or assessments that allow for the creation of the State SLS ISP during this
time. Contractor shall ensure the State SLS ISP is signed by all required parties prior to
implementation.
4.3.3.3. The State SLS ISP shall be developed through an in -person meeting that includes, at a
minimum, the individual seeking services and Contractor.
4.3.3.4. Contractor shall utilize the ISP within the Department's prescribed system.
4.3.3.5. Contractor shall document and finalize all ISP information in the Department's prescribed
system within 10 Business Days of the date of the initial ISP meeting.
4.3.3.5.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the State
SLS ISPs are developed within 10 Business Days of the individual's referral to a State
General Fund program or after the initial ISP meeting.
4.3.3.6. The State SLS ISP shall be effective for no more than one year and reviewed by
Contractor at least every six months in an in -person monitoring contact.
4.3.3.7.
4.3.4.
4.3.4.1.
4.3.4.1.1.
4.3.4.1.2.
4.3.4.1.3.
4.3.4.1.4.
4.3.4.1.5.
4.3.4.1.6.
4.3.4.1.7.
If an individual seeks additional supports or alleges a change in need, Contractor shall
review and update the ISP prior to changing the authorized services and supports.
State SLS Ongoing Case Management
Contractor shall utilize appropriated funds to perform Case Management duties in
accordance with 10 C.C.R. 2505-10 Section 8.501.5(B) et seq.:
Intake and referral.
Determining program eligibility.
Supporting individuals with learning and accessing other community resources.
Developing a State SLS Individual Support Plan.
Maintaining the determination of eligibility for services and supports.
Providing service and support authorization and coordination.
Program transition coordination.
Exhibit B-1, SOW Page 30 of 52
4.3.4.1.8.
4.3.4.1.9.
4.3.4.1.10.
4.3.4.2.
4.3.4.3.
4.3.4.4.
4.3.4.4.1.
4.3.4.4.1.1.
4.3.4.4.2.
4.3.4.4.2.1.
4.3.4.4.2.2.
4.3.4.4.2.3.
4.3.4.4.2.4.
4.3.4.4.2.5.
4.3.4.4.2.6.
4.3.4.4.3.
4.3.4.4.3.1.
4.3.4.5.
4.3.4.5.1.
4.3.4.6.
4.3.4.6.1.
4.3.4.7.
4.3.4.7.1.
Exhibit B-1, SOW
Case Management, policy, and regulation training.
Service records maintenance.
Utilization review.
Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
State SLS Monitoring
State SLS Monitoring shall be person centered and include at least one in person
contact with the Member and three additional monitoring contacts per year using the
individual's selected modality; in person or virtual and should be discussed and
determined based on Member preference and need.
The Member's selected modality must be documented within the case notes for
each monitoring contact within the Department's prescribed system.
State SLS Monitoring activities shall include, but not be limited to:
Monitoring all services and supports delivered pursuant to the State SLS
Individual Support Plan.
Assessing the effectiveness of the State SLS supports and services.
Assessing if additional State SLS supports and services are needed.
Support in assessing if the individual has become eligible for any other resources
including community resources and other Medicaid resources.
Reviewing health and safety concerns.
Reviewing any Critical Incidents.
Contractor shall document all monitoring activities in detail in the Department's
prescribed system within 10 Business Days of the activity.
PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the
required quarterly interval.
State SLS Transfers
Contractor shall manage State SLS transfers in accordance with 10 C.R.S 2505-10
Section 8.501.6 et seq.
State SLS Direct Services
Contractor shall utilize appropriated funds to provide or subcontract with providers
to provide services to support individuals with an intellectual and developmental
disability living in the community in accordance with 10 C.C.R. 2505-10 Section
8.501.4(A -D).
State SLS Records Maintenance
Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make it available to the Department upon request as required
in 10 C.C.R. 2505-10 Section 8.130.2 et seq.
Page 31 of 52
4.3.4.7.2. Receipts, invoices, and service logs must contain, at a minimum: Member name,
service description, provider name, first and/or last date of service, service rate, and
amount due or paid.
4.3.4.7.3. If Contractor does not maintain supporting documentation in the required format for
all services rendered, the Department may recover these funds pursuant to 10 C.C.R.
2505-10 Section 8.076 et seq.
4.3.4.7.4. Through ongoing monitoring, Contractor shall ensure all services reimbursed by
Contractor are rendered by service providers in accordance with the State SLS
Individual Support Plan.
4.3.4.7.5. Contractor shall attempt to resolve any discrepancies with the subcontractor/ service
provider directly.
4.3.4.7.6. Contractor shall notify the Department of any instances of suspected fraud or waste,
and any supporting documentation at the time of discovery.
4.3.4.7.7. Contractor shall notify all service providers acting as subcontractors that all records
and supporting documentation related to services rendered through State SLS are
subject to inspection and recovery by the Department pursuant to 10 C.C.R. 2505-10
Section 8.076 et seq.
4.4. Omnibus Budget Reconciliation Act of 1987 Specialized Services (OBRA-SS)
4.4.1. Contractor shall provide or arrange for the provision of OBRA-SS to any individual where
the Pre -Admission Screening and Resident Review (PASRR) Level II Evaluation identified
the need for placement into a nursing facility and need for additional specialized services.
Contractor shall ensure the OBRA-SS being provided are listed on the individual's Notice of
Determination (NOD). Contractor shall ensure that OBRA-SS are related to the individual's
intellectual or developmental disability or related condition and individualized to the
resident's needs.
4.4.2. PASRR Level II Evaluation
4.4.2.1. Contractor will review the PASRR Level II Evaluations received from the Skilled
Nursing Facility or State appointed vendor prior to developing an OBRA-SS Individual
Support Plan or providing services.
4.4.3. Maintaining Eligibility and Enrollment
4.4.3.1. Contractor shall enroll individuals into OBRA-SS, if the individual resides in a nursing
facility, demonstrates a need, and agrees to receive services.
4.4.3.2. Upon approval of the nursing facility admission by the State Intellectual Disability
Authority and receipt of the Final Notice of Determination, Contractor shall send referrals
to subcontractors for OBRA-SS within 10 Business Days from the date the PASRR
Notice of Determination is issued and/or received from the Skilled Nursing Facility or
State appointed vendor.
4.4.3.3. Contractor shall maintain Member records within the Department prescribed system. All
changes to OBRA-SS enrollments, shall be entered into the Department prescribed
system within 10 Business Days of the change. The Department may adjust the number
of authorized enrollments based on fluctuating enrollments. If the individual does not
receive OBRA-SS within one calendar month Contractor shall inactivate the individual's
record in the Department prescribed system.
Exhibit B-1, SOW Page 32 of 52
4.4.4. OBRA-SS Individual Support Plans
4.4.4.1 Contractor shall develop an OBRA-SS Individual Support Plan (ISP) within 10 Business
Days after an initial ISP meeting for those individuals not established with Contractor
and with a Developmental Disability determination at time of referral. Contractor shall
have up to 10 Business Days to complete additional meetings and/or assessments that
allow for the creation of the OBRA-SS ISP during this time. Contractor shall ensure the
OBRA-SS ISP is signed by all required parties prior to implementation.
4.4.4.2. The OBRA-SS ISP shall be developed through an in -person meeting that includes, at a
minimum, the individual seeking services and Contractor.
4.4.4.3. Contractor shall utilize the ISP template within the Department's prescribed System.
4.4.4.4. Contractor shall document and finalize all ISP information in the Department's prescribed
system within 10 Business Days of the date of the initial ISP meeting.
4.4.4.4.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the OBRA-
SS Individual Support Plans are developed within 10 Business Days of the
individual's referral to a State General Fund program or after the initial ISP meeting.
4.4.4.5. The OBRA ISP shall be effective for no more than one year and reviewed by Contractor
at least every six months in an in -person monitoring contact.
4.4.4.6. If a member seeks additional supports or alleges a change in need, Contractor shall review
and update the ISP prior to changing the authorized services and supports.
4.4.4.7. Contractor shall maintain all OBRA-SS ISPs and supporting documentation and make
them available to the Department upon request.
4.4.5. OBRA-SS Ongoing Case Management
4.4.5.1. Contractor shall utilize appropriated funds to perform Case Management duties to
include:
4.4.5.1.1. Intake and referral.
4.4.5.1.2. Verifying a PASRR Level II Evaluation and Skilled Nursing Facility residency.
4.4.5.1.3. Developing an OBRA-SS Individual Support Plan.
4.4.5.1.4. Maintaining the determination of eligibility for services and supports.
4.4.5.1.5. Providing service and support authorization and coordination.
4.4.5.1.6. Ensuring there is not a duplication of authorized services with the services provided
in the nursing facility.
4.4.5.1.7. Program transition coordination.
4.4.5.1.8. Service records maintenance.
4.4.5.1.9. Case Management, policy, and regulation training.
4.4.5.1.10. Utilization review.
4.4.5.2. Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
4.4.5.3. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
Exhibit B-1, SOW
Page 33 of 52
4.4.6. OBRA-SS Monitoring
4.4.6.1.1. Monitoring shall be person centered and include at least one in person contact with
the Member and three additional monitoring contacts per year using the individual's
selected modality; in person or virtual and should be discussed and determined based
on Member preference and need. The Member's selected modality must be
documented within the narrative for each monitoring contact within the Department's
prescribed system.
4.4.6.2. Monitoring activities shall include but not be limited to:
4.4.6.2.1. Monitoring all services and supports delivered pursuant to the OBRA-SS ISP.
4.4.6.2.2. Assessing the effectiveness of the supports and services.
4.4.6.2.3. Assessing if additional supports and services are needed.
4.4.6.2.4. Support in assessing if the individual has become eligible for any other resources
including community resources or other Medicaid resources.
4.4.6.2.5. Reviewing health and safety concerns.
4.4.6.2.6. Reviewing any Critical Incidents.
4.4.6.3. Contractor shall document all monitoring activities in detail in the Department's
prescribed system within 10 Business Days of the activity.
4.4.6.3.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the
required quarterly interval.
4.4.7. OBRA-SS Direct Services
4.4.7.1. Contractor shall not utilize OBRA-SS funds to purchase mental health related services.
Contractor shall seek provision of, or payment for, mental health services for those
individuals through the Medicaid -funded mental health system or other local sources of
funding.
4.4.7.2. Contractor shall not utilize or authorize OBRA-SS funds to provide or purchase services
and supports that are covered and provided by the nursing facility.
4.4.7.3. Contractor shall utilize appropriated funds to provide services or subcontract with a
provider to support individuals with intellectual and developmental disabilities living in
a nursing facility. Contractor shall not utilize funding for services that are provided by
the Nursing Facility through Medicaid reimbursement. Services eligible through OBRA
include:
4.4.7.3.1. Assistive Technology
4.4.7.3.2. Behavioral Consultation
4.4.7.3.3. Behavioral Line Services
4.4.7.3.4. Behavioral Counseling
4.4.7.3.5. Behavioral Counseling Group
4.4.7.3.6. Behavioral Plan Assessment
4.4.7.3.7. Day Habilitation - Specialized Habilitation
4.4.7.3.8. Day Habilitation - Supported Community Connections
Exhibit B-1, SOW Page 34 of 52
4.4.7.3.9. Dental — Basic
4.4.7.3.10. Dental — Major
4.4.7.3.11. Mileage
4.4.7.3.12. Other Public Conveyance
4.4.7.3.13. Prevocational Services
4.4.7.3.14. Recreational Facility Fees/Passes
4.4.7.3.15. Job Coaching — Individual
4.4.7.3.16. Job Coaching — Group
4.4.7.3.17. Job Development — Individual
4.4.7.3.18. Job Development — Group
4.4.7.3.19. Job Placement
4.4.7.3.20. Vision
4.4.7.4. Services must be provided in accordance with the service definitions found in 10 C.C.R.
2505-10 Section 8.500.94.B et seq.
4.4.8. OBRA-SS Records Maintenance
4.4.8.1. Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make it available to the Department upon request as required in 10
C.C.R. 2505-10 Section 8.130.2 et seq.
4.4.8.1.1. Receipts or invoices must contain, at a minimum: Member name, service description,
provider name, first and/or last date of service, service rate, and amount due or paid.
4.4.8.2. If Contractor does not maintain supporting documentation in the required format for all
services rendered, the Department may recover these funds pursuant to 10 C.C.R. 2505-
10 Section 8.076 et seq.
4.4.8.3. Through ongoing monitoring, Contractor shall ensure all services reimbursed by
Contractor are rendered by service providers in accordance with the OBRA-SS Individual
Support Plan.
4.4.8.4. Contractor shall attempt to resolve any discrepancies with the service provider directly.
4.4.8.5. Contractor shall notify the Department of any instances of suspected fraud and any
supporting documentation at the time of discovery.
4.4.8.6. Contractor shall notify all service providers that all records and supporting documentation
related to services rendered through OBRA-SS are subject to inspection and recovery by
the Department pursuant to 10 C.C.R. 2505-10 Section 8.076 et seq.
4.4.8.7. Mental Health Services Prohibited
4.4.8.7.1. Contractor shall not utilize state funds to purchase mental health related services for
individuals with intellectual disabilities who are Medicaid eligible and who also have
a Medicaid covered mental health diagnosis.
Exhibit B-1, SOW Page 35 of 52
4.4.8.7.2. Contractor shall seek provision of, or payment for, mental health services for those
individuals through the Medicaid funded mental health system or other local sources
of funding.
4.5. Family Support Services Program (FSSP)
4.5.1. Contractor shall administer and provide or purchase Family Support Services pursuant to
§25.5-10-305, C.R.S. and 10 C.C.R. 2505-10 Section 8.613 et seq.
4.5.2. Eligibility, Needs Assessment, and Prioritization of Families
4.5.2.1. Contractor shall determine individual eligibility for the FSSP pursuant to 10 C.R.S 2505-
10 Section 8.613.C.(1-4).
4.5.2.2. After FSSP eligibility has been determined, Contractor shall conduct an FSSP Needs
Assessment prior to authorizing services. Contractor shall develop a Needs Assessment
Tool that is, at a minimum, inclusive of all requirements outlined in 10 C.C.R 2505-10
Section 8.613.E.7(a-e) and have documented scoring criteria for the tool. The tool shall
be included in Contractor's policies and procedures.
4.5.2.2.1. DELIVERABLE: Needs Assessment Tool Template and Scoring Criteria
4.5.2.2.2. DUE: Annually, by August 15th
4.5.2.3. Any revisions to the needs assessment tool template and scoring criteria must be
submitted to the Department within 10 Business Days of the updated tool being
implemented.
4.5.2.4. Contractor shall assess all families, both on the waiting list as "As Soon as Available"
and currently receiving FSSP services, for level of need on an annual basis in accordance
with 10 CCR 2505 Section 8.613.E et seq.
4.5.2.5. Contractor shall document all completed FSSP Needs Assessments within the
Department's prescribed system within 10 Business Days of completion of the
assessment.
4.5.2.6. Contractor shall maintain all Needs Assessment documentation and make it available to
the Department upon request.
4.5.2.7. The Department will notify Contractor of the target number of individuals that shall be
served through FSSP prior to the start of each State Fiscal Year (SFY). Contractor may
choose to enroll more individuals in FSSP than targeted, ensuring all individuals can be
served within the funding allocated. Target caseload is calculated using the unique
number of members that receive direct services during the contract period.
4.5.3. Family Support Plans (FSP)
4.5.3.1. Contractor shall ensure that individuals and families enrolled in the FSSP have an
individualized Family Support Plan (FSP) which meets the requirements of an
Individualized Plan, as defined in Section 25.5-10-202 et seq. and 25.5-10-211 C.R.S
prior to receiving services.
4.5.3.2. Contractor shall develop the FSP within 10 Business Days after an initial Individualized
Support Plan (ISP) meeting for those individuals not established with Contractor and with
a Developmental Disability or Delay Determination at the time of referral. Contractor
shall ensure the FSP is signed by all required parties prior to implementation.
Exhibit B-1, SOW Page 36 of 52
4.5.3.3. The FSP shall be developed through by, at a minimum, a family representative, and
Contractor.
4.5.3.3.1. Contractor shall ensure that 100% of the FSPs are developed within 10 Business Days
of the individual's referral to FSSP or after the initial ISP meeting.
4.5.3.3.2. PERFORMANCE STANDARD: 100% of the FSPs are developed within 10
Business Days of the individual's referral to FSSP or after the initial ISP meeting.
4.5.3.4. The FSP shall be effective for no more than one year.
4.5.3.5. If the Member seeks additional supports or alleges a change in need, Contractor shall
review and update the FSP prior to changing the authorized services and supports.
4.5.3.6. Contractor shall document and finalize all FSP information in the Department's
prescribed system within 10 Business Days of the initial FSP meeting.
4.5.4. FSSP Ongoing Case Management
4.5.4.1. Pursuant to 10 C.R.S 2505-10 Section 8.613.G Contractor shall provide case management
for the FSSP, to include coordination of services provided for individuals with an IDD or
Developmental Delay that consists of facilitating enrollment, assessing needs, locating,
coordinating, and monitoring needed FSSP funded services, and monitoring the effective
and efficient provision of services across multiple funding sources.
4.5.4.2. Contractor shall not charge families to provide direct services and case management for
Family Support Services.
4.5.4.3. Contractor shall provide a list of qualified providers for appropriate services to applicants,
Member(s), and families, during the individualized planning process, and to other
interested parties upon request.
4.5.4.4. Contractor shall utilize appropriated funds to perform case management duties in
accordance with 10 CCR 2505 8.613.G et seq. to include:
4.5.4.4.1. Development, application assistance, and annual re-evaluation of the Family Support
Plan (FSP) which shall be conducted at least once per year and include making
changes to the FSP as indicated.
4.5.4.4.2. Providing service authorization and support coordination to include but not limited to
assessing the effectiveness of FSSP supports and services.
4.5.4.4.3. Ensuring all services and supports are delivered in accordance with the FSP.
4.5.4.4.4. Coordinating with families to obtain required documentation for services.
4.5.4.4.5. Supporting the individual in assessing eligibility for other community and/or
Medicaid resources.
4.5.4.4.6. Program transition coordination.
4.5.4.4.7. Service records maintenance.
4.5.4.4.8. Case Management, policy, and regulation training.
4.5.4.4.9. Utilization review.
4.5.4.5. Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
Exhibit B-1, SOW Page 37 of 52
4.5.4.6. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
4.5.5. FSSP Direct Services
4.5.5.1. Contractor shall utilize appropriated FSSP funds to purchase services and/or reimburse
or advance funds to families for expenses that are incurred as a result of supporting the
family and/or individual with an intellectual or developmental disability or delay living
in the family home.
4.5.5.2. Contractor shall only authorize and advance or reimburse services that are needed as a
result of the individual's Intellectual and Developmental Disability or Developmental
Delay and shall not be approved if the need is a typical age -related need. The correlation
between the need and the disability must be documented in the FSP.
4.5.5.3. Contractor shall ensure that all services are provided in the most cost-effective manner,
meaning the least expensive manner to meet the need.
4.5.5.4. Contractor shall ensure that all services are authorized pursuant to the FSP.
4.5.5.5. Contractor shall utilize FSSP funds to provide funding to families for expenses referenced
in §25.5 -10 -305(a -j), C.R.S and 10 C.R.S. 2505-10 Section 8.613(F)(8)(a-i). Contractor
shall not authorize or provide any service that is not outlined in these regulations.
4.5.5.6. Contractor shall ensure the authorized services through FSSP are not duplicative of other
resources the family has access to, including HCBS waivers, third party insurance, etc.
4.5.5.7. Contractor shall prioritize funding for the FSSP pursuant to 10 C.R.S 2505-10 Section
8.613.E(1-2).
4.5.6. Family Support Council
4.5.6.1. Contractor shall establish and maintain a Family Support Council (FSC) pursuant to
§25.5-10-304 et seq., C.R.S. and 10 C.C.R. 2505-10 Section 8.613.B et seq.
4.5.6.2. Contractor shall submit a list of FSC members annually.
4.5.6.2.1. DELIVERABLE: FSC Member List
4.5.6.2.2. DUE: Annually, by August 15th
4.5.6.3. Contractor shall notify the Department in writing of any changes to the FSC within 10
Business Days.
4.5.6.3.1. DELIVERABLE: FSC Member Updates
4.5.6.3.2. DUE: Within 10 Business Days of the date of change to the FSC members
4.5.6.4. Contractor shall provide orientation and training to all FSC members on the duties and
responsibilities of the FSC. The training and orientation shall be documented with a
record of the date of the training, who provided the training, training topic, and names of
attendees. Contractor shall make the training and orientation materials available to the
Department upon request.
4.5.6.5. Contractor shall ensure the FSC fulfills all duties outlined in 10 C.C.R. 2505-10 Section
8.613.B et seq. Contractor shall document the meeting minutes and submit them to the
Department. Contractor shall maintain all supporting documentation related to an FSC
meeting and make it available to the Department upon request.
Exhibit B-1, SOW Page 38 of 52
4.5.6.5.1.
4.5.6.5.2.
4.5.7.
4.5.7.1.
4.5.7.2.
4.5.7.2.1.
4.5.7.2.2.
4.5.8.
4.5.8.1.
4.5.8.2.
4.5.8.2.1.
4.5.8.2.2.
4.5.9.
4.5.9.1.
DELIVERABLE: FSC Meeting Minutes
DUE: Monthly, by the 15th of each month and by June 30th
FSSP Evaluation
In coordination with the FSC, Contractor shall be responsible for evaluating the
effectiveness of the FSSP on an annual basis. Contractor shall ensure the annual program
evaluation addresses all areas required in 10 CCR 2505-10 Section 8.613.K et seq.
Contractor shall provide the Annual Evaluation Report to the Department for review and
approval.
DELIVERABLE: Annual Evaluation Report
DUE: Annually, by June 1St
FSSP Annual Program Report
Contractor shall create and submit an FSSP Annual Program Report to the Department.
The FSSP Program Report shall contain all requirements outlined in 10 CCR 2505-10
Section 8.613.M et seq. Council member signatures approving the report must be
submitted as a separate attachment to the Annual Program Report. Contractor must ensure
the Annual Program Report does not contain Member PHI.
Contractor shall provide the FFS Program Report to the Department for review and
approval.
DELIVERABLE: FSSP Annual Program Report and Council Signature Page
DUE: Annually, by October 1St
FSSP Records Maintenance
Contractor shall maintain supporting documentation capable of substantiating all
expenditures and reimbursements made to providers, Members and/or families.
4.5.9.2. When Contractor purchases services or items directly for Members and/or families,
Contractor shall:
4.5.9.2.1. Maintain receipts or invoices from the service provider and documentation
demonstrating that the provider was paid by Contractor.
4.5.9.2.1.1. Receipts or invoices must contain, at a minimum: Member and/or family name,
provider name, first and/or last date of service, item(s) or service(s) purchased,
item(s) or service(s) cost and amount due or paid.
4.5.9.3. When Contractor reimburses Members and/or families for services or items, Contractor
shall:
4.5.9.3.1. Ensure the Member and/or family provides Contractor with receipts or invoices prior
to reimbursement.
4.5.9.3.1.1. Maintain receipts or invoices from the Member and/or family, and documentation
demonstrating that the individual and/or family was reimbursed by Contractor.
4.5.9.3.2. Ensure all receipts or invoices provided by the Members and/or family contain, at a
minimum: Member and/or family name, provider name, first and/or last date of
service, item(s) or service(s) purchased, items(s) or service(s) cost, and amount paid.
Exhibit B-1, SOW Page 39 of 52
4.5.9.4. When Contractor provides funding to Members and/or families for the purchase of
services or items in advance, Contractor shall include, but is not limited to:
4.5.9.4.1. Establish policies and procedures outlining Contractor's processes for advancing
funds, ensuring supporting documentation is received by the Member and/or family,
and remedial action steps Contractor will take if supporting documentation is not
received. The policies and procedures shall identify timelines and shall be made
available to the Department upon request.
4.5.9.4.2. Notify the Member and/or family that they are required to submit invoices or receipts
to Contractor of all purchases made prior to the close of the State Fiscal Year.
4.5.9.4.3. Ensure the Member and/or family provides Contractor with receipts or invoices.
4.5.9.4.4. Maintain receipts or invoices from the Members and/or family, and documentation
demonstrating that the Members and/or family was provided with advanced funds by
Contractor.
4.5.9.4.4.1. Ensure all receipts or invoices provided by the Members and/or family contain, at
a minimum: Members and/or family name, provider name, first and/or last date
of service, item(s) or service(s) purchased, items(s) or service(s) cost, and amount
paid.
4.5.9.4.5. Contractor shall ensure the documentation received by the Member and/or family
indicates that the amount was paid.
4.5.9.4.6. If a Member and/or family does not submit invoices or receipts, Contractor shall
document all attempts to obtain receipts or paid invoices and any remedial action
taken. Contractor shall make all supporting documentation available to the
Department upon request.
4.5.9.4.7. If Contractor cannot provide supporting documentation as described in this section,
the Department may recover any unsubstantiated expenditure from Contractor.
4.5.9.5. Contractor shall ensure supporting documentation is recorded for all FSSP dollars for
multiple family services to include a detailed description of the service provided and the
date(s) of service.
4.5.9.5.1. Contractor shall ensure all program expenses related to multiple family expenses can
be substantiated through time tracking, wage costs, benefit costs, or any other
supporting documentation to verify expenses related to proving the services.
5. DATA ENTRY, DATA MONITORING, AND OVERSIGHT
5.1. Individual/Member Records
5.1.1. Contractor shall:
5.1.1.1. Comply with all reporting and billing policies and procedures established by the,
Department, document individual and Member records within the Department's
prescribed systems and adhere to the system requirements provided by the Department
for these systems. Systems include, but are not limited to, the Colorado interChange
Medicaid Management Information System (MMIS) and its subsystems: Bridge HCBS
PAR subsystem and the Care and Case Management (CCM) System. Contractor shall
have access to member eligibility, PAR, and claims data through reporting provided
through a COGNOS data query application.
Exhibit B -t, SOW Page 40 of 52
5.1.1.2. Maintain individual and Member records within the Department's prescribed systems for
the purposes of individual and Member information management.
5.1.1.3. Maintain accurate and detailed documentation of all case management and State General
Fund Program activities required through the Contract.
5.1.1.4. Maintain accurate and detailed supporting documentation of all activities required
through this Contract to substantiate reimbursement and make all documentation
available to the Department upon request if not documented within the Department's
prescribed systems.
5.1.1.5. Correct 100% of data errors discovered by the Department and confirm the accuracy of
the data entered into the Department prescribed system within 10 Business Days of
notification from the Department of an error.
5.1.1.5.1. PERFORMANCE STANDARD: 100% of data errors corrected within 10 Business
Days of notification.
5.1.1.6. Develop and implement a plan to conduct, at minimum, an annual data integrity review.
That includes, but is not limited to, the following:
5.1.1.6.1. Member program records completeness and accuracy as directed by the Department.
5.1.1.6.2. Member demographic information completeness and accuracy.
5.1.1.6.3. Member care team provider and team staff accuracy and completeness, as directed by
the Department.
5.1.1.7. DELIVERABLE: Data Integrity and Data Quality Policies and Procedures
5.1.1.8. DUE: Annually, October 1St after the Contract Start Date or within 10 Business Days as
revisions are made.
5.2. Systems Access and Training
5.2.1. Contractor shall develop and implement policies and procedures to internally oversee data
integrity and data quality to include but not limited to how Contractor will:
5.2.1.1. Ensure all staff receive the required systems training as specified in this Contract.
5.2.1.2. Be responsible for management of user access and timely revocation for required systems
to include the CCM, MMIS, Bridge, COGNOS, and PeakPro.
5.2.1.3. Ensure all provision forms are reviewed and submitted accurately and completely within
at least 14 Calendar Days prior to needing access. Any forms submitted without all
necessary information are subject to resubmission and delay.
5.2.1.4. Ensure all revocation forms are submitted immediately upon knowledge of license user's
separation of employment.
5.2.1.5. Conduct an internal audit of all provisioned user licenses monthly or quarterly to ensure
that the list of users is up to date, permissions are accurate, and revocation forms are
submitted in a timely manner.
6. ACCOUNTING
6.1. Contractor's accounting methods shall conform to the standards of Generally Accepted
Accounting Principles (GAAP), and any updates thereto, throughout the Term of the Contract.
Exhibit B-1, SOW Page 41 of 52
6.2. Contractor shall establish and maintain internal control systems and standards that apply to the
operation of the organization.
6.3. Contractor shall assure, all financial documents are filed in a systematic manner to facilitate
audits, all prior years' expenditure documents are maintained for use in the budgeting process
and for audits, and records and source documents are made available to the Department, its
contracted representative, or an independent auditor for inspection, audit, or reproduction.
6.4. Contractor shall establish any necessary cost accounting systems to identify the application of
funds and record the amounts spent.
6.5. Contractor shall document all transactions and funding sources and this documentation shall be
available for examination by the Department within 10 Business Days of the Department's
request.
6.5.1. DELIVERABLE: Transaction and Funds Documentation
6.5.2. DUE: Within 10 Business Days of the Department's Request
7. SUBRECIPIENT STATUS AND REQUIREMENTS
7.1. Contractor has been determined to be a Subrecipient under 2 CFR Chapter I, Chapter II, Part 200
et al. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards (Uniform Guidance); Final Rule (the "Final Rule"), released December 26, 2013,
and subsequently updated, and thus shall be required to follow all requirements and guidance
contained in the Final Rule.
7.2. Single Audits
7.2.1. Under the Final Rule, all Non -Federal Entities, as defined in the Final Rule, expending
$750,000.00 or more from all federal sources (direct or from pass -through entities) must have
a single or program -specific audit conducted for that year in accordance with Subpart F of
the Final Rule.
7.2.2. Contractor shall notify the State when expected or actual expenditures of federal assistance
from all sources equal or exceed $750,000.00.
7.2.3. If the expected or actual expenditures of federal assistance from all sources do not equal or
exceed $750,000.00 Contractor shall provide an attestation to the State that they do not
qualify for a Single Audit.
7.2.4. Pursuant to the Final Rule §200.512 (a)(1) the Single Audit must be completed and submitted
to the Department within the earlier of 30 Calendar Days after receipt of the auditor's
report(s), or nine months after the end of the audit period. If the due date falls on a Saturday,
Sunday, or federal holiday, the reporting package is due the next Business Day.
7.2.4.1. DELIVERABLE: Single Audit
7.2.4.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or
nine months after the end of the audit period
7.2.5. If Contractor did not receive enough federal funds to require a Single Audit, Contractor shall
submit an attestation form stating a Single Audit was not required utilizing the Department's
template.
7.2.5.1. DELIVERABLE: Attestation Form
Exhibit B-1, SOW Page 42 of 52
7.2.5.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or
nine months after the end of the audit period
7.2.6. The audit period shall be Contractor's fiscal year.
7.3. Treatment of Funds
7.3.1. All funding identified as a subaward with matching federal dollars received through this
Contract is subject to the requirements within Uniform Guidance.
7.3.1.1. All subawards must be used on allowable expenses associated with performing the
activities outlined in this Contract and on allowable expenses per Uniform Guidance.
7.3.1.2. Any subawards not used on the activities outlined in this Contract is subject to recovery
at the end of the Period of Performance as identified by the Department.
8. FINANCIAL TRANSPARENCY
8.1. Contractor shall comply with all transparency requirements pursuant to C.R.S. Title 25.5-6-1708.
8.2. Board of Director or Governing Body Changes
8.2.1. Contractor shall notify the Department in writing of any changes to the Board of Directors or
Governing Body within 10 Business Days.
8.2.1.1. DELIVERABLE: Written notification of changes to Board of Director or Governing
Body membership
8.2.1.2. DUE: Within 10 Business Days of the effective date
8.3. Annual Financial Statements and Independent Auditor's Report
8.3.1. Contractor shall submit a copy of Contractor's annual Financial Statements and Independent
Auditor's Report to the Department.
8.3.1.1. DELIVERABLE: Financial Statements and Independent Auditor's Report
8.3.1.2. DUE: No later than 30 Calendar Days following the acceptance of the audit by
Contractor's Board of Directors or Governing Body
8.4. IRS Form 990 or Applicable Documents
8.4.1. Contractor shall submit a copy of Form 990 or applicable documents Contractor filed with
the Federal Internal Revenue Service to the Department.
8.4.1.1. DELIVERABLE: IRS Form 990 or Applicable Documents
8.4.1.2. DUE: No later than 30 Calendar Days following Contractor's filing of the form with the
Internal Revenue Service
9. COMPENSATION AND INVOICING
9.1. State General Fund Program Allocations
9.1.1. The Department will notify Contractor in writing of Contractor's individual allocation for
State SLS, OBRA-SS, and FSSP for each State Fiscal Year.
9.1.2. Reimbursement for activities and services performed by Contractor shall not exceed the
maximum amount identified in Contractor's individual allocation. Activities and services
must be rendered during the State Fiscal Year.
Exhibit B-1, SOW Page 43 of 52
9.1.3. The Department, in its sole discretion, may increase or decrease Contractor's individual
allocations under this Contract by notifying Contractor's Representative. Increases or
decreases in the amount of State funding during the term of this Contract may be made by
written notice by the Department to Contractor or by amendment of the Contract. The
circumstances may include but shall not be limited to:
9.1.3.1. If necessary to fully utilize program appropriations.
9.1.3.2. Adjustments to reflect prior year final contract utilization and current year expenditures.
9.1.3.3. Supplemental appropriation changes resulting in an increase or decrease in the amounts
originally appropriated and available for the purposes of this program.
9.1.3.4. Closure of programs and/or termination of related contracts.
9.1.3.5. Delay or difficulty in implementing new programs or services.
9.1.3.6. Other special circumstances as deemed necessary by the Department.
9.1.3.7. Changes in Member utilization due to changing needs, new enrollments, terminations,
and/or delays in services.
9.1.3.8. Target caseloads not being met.
9.2. State General Fund Program Target Caseloads
9.2.1. The Department will notify Contractor in writing of the target number of individuals that
shall be served in State SLS and FSSP prior to the start of each State Fiscal Year.
9.2.2. Contractor may choose to enroll more individuals in State SLS and FSSP than authorized,
ensuring all individuals can be served within the funding allocated.
9.2.3. Target caseload is calculated by the Department using the unique number of members that
receive direct services during the contract period.
9.2.4. Contractor shall enroll members into OBRA-SS if the need for services is identified through
the PASRR Level II and shall notify the Department if sufficient funding is not available in
Contractor's individual allocation to support the individual's needs.
9.2.5. Contractor shall redirect unallocated funding from one State Funded Program to another to
fully utilize funding allocated and best serve member needs within the Defined Service Area.
Contractor shall not redirect unallocated funding from one State Funded Program to another
unless the minimum caseload requirement is being met or Contractor has obtained written
approval from the Department to do so.
9.2.6. The Department may reduce the amount of funding allocated during the State Fiscal Year if
Contractor does not meet minimum caseload requirements for State SLS or FSSP.
9.3. State General Fund Program Compensation
9.3.1. The compensation under this Contract shall consist of rates -based reimbursement intended to
cover the costs of all State General Fund activities provided through this Contract. The
Department shall pay Contractor for the State SLS and OBRA-SS activities at the rates
specified in Exhibit C, Rates. Direct services for State SLS and OBRA-SS shall be
reimbursed at the rates posted and distributed on the Department's website on the Provider
Rates and Fee Schedule. The Department shall pay Contractor for FSSP activities at the rates
specified in Exhibit C, Rates. Direct services for FSSP shall be reimbursed at one dollar per
unit.
Exhibit B-1, SOW Page 44 of 52
9.3.2. The liability of the State, at any time, for such payment shall be limited to the unexpended
amount remaining of such funds available to the Department.
9.3.3. Payments shall be made in accordance with rates as specified in Exhibit C, Rates of this
Contract as determined by the Department and may be amended during the term of the
contract using an Option Letter. When Contractor's maximum allocation of State funding has
been paid to Contractor, no additional funds shall be provided under this Contract.
9.3.4. Payment pursuant to this Contract is contingent upon Contractor, or subcontractor(s),
securing and properly maintaining all necessary licenses, certifications, approvals, etc.,
required to properly provide the services or goods covered by the contract.
9.3.5. The rates specified in Exhibit C; Rates are determined by the approved appropriation from
the Colorado General Assembly. The Department, at its discretion, shall have the option to
increase or decrease these rates as the Department determines is necessary based on its
approved appropriation or to correct an administrative error in rate calculations. To exercise
this option, the Department shall provide written notice to Contractor in a form substantially
similar to the Sample Option Letter in the original Contract, and any new rates table or exhibit
shall be effective as of the effective date of that notice unless the notice provides for a
different date. The Department may modify the rates shown in this section based on the
Medicaid Provider rate increases or decreases authorized by the Colorado legislature or due
to an administrative error. If the Department does modify these rates, the Department may
modify them using an Option Letter.
9.3.6. The rates for State SLS and OBRA-SS direct services will be posted on the Department's
website on the Provider Rates and Fee Schedule. Contractor shall bill all FSSP direct services
at one dollar per unit.
9.4. Adjustments to Fund Disbursement Amounts
9.4.1. The Department reserves the right to adjust during the Contract period and post -period
adjustment to disbursements following the end of the Contract period, or an adjustment to the
Fiscal Year contract if:
9.4.2. Contractor does not achieve the Performance Standards identified for each program.
9.5. Case Management Agency Compensation
9.5.1. The compensation under this Contract shall consist of rates -based reimbursement intended to
cover the costs of all activities provided through this Contract.
9.5.2. Contractor will receive payment as specified in Exhibit C, Rates.
9.5.2.1. The rates specified in Exhibit C are determined by the approved appropriation from the
Colorado General Assembly. The Department, at its discretion, shall have the option to
increase or decrease these rates as the Department determines necessary based on its
approved appropriation or to correct an administrative error in rate calculations. To
exercise this option, the Department shall provide written notice to Contractor in a form
substantially similar to the Sample Option Letter in the original Contract, and any new
rates table or exhibit shall be effective as of the effective date of that notice unless the
notice provides for a different date. The Department may modify the rates shown in this
section based on the Medicaid Provider rate increases or decreases authorized by the
Colorado legislature or due to an administrative error. If the Department does modify
these rates, the Department may modify them through the use of an Option Letter.
Exhibit B-1, SOW Page 45 of 52
9.6. Rural or Urban Designation
9.6.1. The Department shall determine whether Contractor is a Rural and Frontier or an Urban
agency.
9.7. Detailed Invoicing and Payment Procedures
9.7.1. Applications — HCBS-CES
9.7.1.1. Contractor shall submit all HCBS-CES applications to the Department's vendor for
review and approval, as directed by the Department. The Department will pay for initial
application per person applying for HCBS-CES per year, as well as CSR HCBS-CES
application each year thereafter. The Department will not pay for initial or CSR
applications that were denied due to being incomplete. Incomplete applications include
any application that did not contain: a signature page, a completed Level of Care, DD or
Delay Determination date, dates of service, or partial application (missing pages) which
are required from Contractor necessary to process the application. An incomplete
application denial is different than a denial for the client not meeting nighttime and/or
daytime criteria. The Department will pay for HCBS-CES applications from reports
received by the Department's vendor on the 11th of the month for assessments from the
previous month.
9.7.2. Appeal Packets and Hearing Attendance
9.7.2.1. Contractor shall ensure that all Appeal Packets and Hearing Attendance information is
entered into the Department prescribed system within the required timeframe. The
Department will pay for all Appeal Packets and Hearing Attendances from data pulled
from the Department prescribed system on the 15th day of the month for Appeal Packets
and Hearing Attendance from the previous month. Contractor shall maintain all
supporting documentation and packets related to all Appeals.
9.7.3. At -Risk Diversion
9.7.3.1. Contractor shall complete all At -Risk Diversion activities as required by the Department
and shall invoice the Department for all completed contacts by the 15th day of the month
for all contacts completed in the previous month. The Department will pay for contacts
once the invoice and supporting documentation is reviewed and accepted.
9.7.4. Case Management Training
9.7.4.1. Contractor shall submit the Case Management Training deliverable. Contractor will
receive payment once the Department has reviewed and accepted the Deliverable. If the
original submission is rejected by the Department, Contractor shall not receive payment
until a revised deliverable has been received and accepted by the Department. If a case
manager did not receive one or more of the required trainings prior to being assigned
independent duties, Contractor shall not receive payment for the Deliverable until all
trainings have been provided. Contractor shall have 30 Calendar Days to provide any
outstanding trainings and resubmit the Deliverable.
9.7.5. Community Advisory Committee Updates
9.7.5.1. Contractor shall submit the Committee Updates Deliverable. Contractor shall receive
payment once the Department has reviewed and accepted the Deliverable. If the
Deliverable shows that no committee meeting updates have been included, Contractor
shall not receive payment for the Deliverable.
Exhibit B-1, SOW Page 46 of 52
9.7.6. Complaint Log and Trend Analysis
9.7.6.1. Contractor shall submit a quarterly Complaint Log and Trend Analysis deliverable.
Contractor will receive payment once the Department has reviewed and accepted the
Deliverable. If the original submission is rejected by the Department, Contractor shall not
receive payment until a revised deliverable has been received and accepted by the
Department.
9.7.7. Continuous Quality Improvement Plan
9.7.7.1. Contractor shall submit the Continuous Quality Improvement Plan deliverable and
updates. Contractor shall receive payment once the Department has reviewed and
accepted the Deliverable. If the original submission is rejected by the Department,
Contractor shall not receive payment until a revised deliverable has been received and
accepted by the Department.
9.7.8. Critical Incident Quarterly Follow -Up Completion and Entry Performance Standard
9.7.8.1. Contractor is eligible to receive a quarterly performance -based payment for timely
completion of the requested HCBS CIR follow-up action. To receive this quarterly
performance -based payment, Contractor must have 90% of all CIRs assigned follow-up
completed and entered into the Department's prescribed system within the timelines
assigned by the Department and/or Department Quality Improvement Organization. The
Department will calculate Contractor's performance at the close of each quarter to
determine if Contractor will be awarded the performance -based payment. HCBS and SGF
CIRs will be calculated and paid separately.
9.7.9. Critical Incident Reports and Critical Incident Report Administrative Review: HCBS IDD
Waivers
9.7.9.1. Contractor shall ensure all CIRs have been entered in the Department prescribed system
within the required timeframe. The Department will pay per Member enrolled each month
based on actively enrolled Members pulled from the Department prescribed system on
the 15th day of the month for HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS
enrollments from the previous month.
9.7.10. Critical Incident Reports: HCBS LTSS Waivers
9.7.10.1. Contractor shall ensure all CIRs have been entered in the Department prescribed system
within the required timeframe. The Department will pay per Member enrolled each month
based on actively enrolled Members pulled from the Department prescribed system on
the 15th day of the month for CHCBS, HCBS-BI, HCBS-CIH, HCBS-CLLI, HCBS-
CMHS, and HCBS-EBD.
9.7.11. Critical Incident Reporting and Critical Incident Report Administrative Review State SLS,
OBRA-SS, FSSP
9.7.11.1. Contractor shall ensure all CIRs have been entered in the Department prescribed system
within the required timeframe. The Department will pay for all State SLS, OBRA-SS,
and FSSP CIRs MANE and CIRs non -MANE based on data pulled from the
Department's prescribed system on the 15th day of the month for CIRS from the previous
month.
9.7.12. Developmental Disability and Delay Determinations
Exhibit B-1, SOW Page 47 of 52
9.7.12.1.
9.7.13.
9.7.13.1.
9.7.14.
9.7.14.1.
9.7.15.
9.7.15.1.
9.7.16.
9.7.16.1.
9.7.17.
9.7.17.1.
9.7.18.
9.7.18.1.
Contractor shall input all disability determinations into the Department prescribed system
within the required timeframes. The Department will pay disability determinations, based
on data pulled from the Department prescribed system on the 15th day of the month for
determinations from the previous month.
Direct Services: State SLS, OBRA-SS, FSSP
Contractor shall submit the State General Fund program direct service expenditure report
invoice for all direct service expenditures for State SLS, OBRA-SS, and FSSP by the 15th
of each month. The Contract shall receive reimbursement for allowable direct services
not to exceed maximum for State General Fund programs for all reimbursable activities
for the fiscal year.
Testing for IDD Determinations
Contractor shall obtain prior approval from the Department for IDD Determination
Testing funding by invoicing the Department each month for the costs of IDD
Determination testing by the 15th day of the month. If approved, the Department will pay
for the actual cost of testing once the request has been approved and the invoice has been
reviewed and accepted. All invoices shall be submitted in the format prescribed by the
Department.
Family Support Council Meetings
Contractor shall submit meeting minutes to the Department for FSC meetings attended
by the 15th day of the month for meetings attended in the previous month, and by June
30th or the Fiscal Year end close date determined by the Department for all meetings
attended in June. The Department will pay for up to six FSC meetings attended within
the Fiscal Year once the invoice and supporting documentation has been reviewed and
accepted. Contractor shall maintain all supporting documentation related to an FSC
meeting and make it available to the Department upon request.
FSSP Annual Report
Contractor shall submit an FSSP Report on an annual basis to the Department. Contractor
shall receive payment for the Annual FSSP Report after it has been reviewed and accepted
by the Department.
FSSP Evaluation Report
Contractor shall submit an FSSP Evaluation Report on an annual basis to the Department.
Contractor shall receive payment for the FSSP Evaluation Report after it has been
reviewed and accepted by the Department.
HCBS-DD Waiting List Enrollment Capacity Building
The Department will pay Contractor for each new member enrolled into the HCBS-DD
waiver from the waiting list as authorized by the Department and as funding is
appropriated and earmarked by the General Assembly. The Department will determine
which HCBS-DD enrollments from the waiting list qualify for capacity building funding
as defined in this Contract.
9.7.19. Human Rights Committee: HCBS IDD Waivers
9.7.19.1.
Contractor shall create all HRC packets in accordance with Department requirements and
timeframes. Contractor shall maintain all supporting documentation related to a Human
Exhibit B-1, SOW Page 48 of 52
Rights Committee meeting and make it available to the Department upon request. The
Department will pay per member enrolled each month based on actively enrolled
members pulled from the Department prescribed system on the 15th day of the month for
HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous
month.
9.7.20.
9.7.20.1.
9.7.21.
9.7.21.1.
9.7.22.
9.7.22.1.
9.7.23.
9.7.23.1.
Human Rights Committee Packet Creation: State SLS, OBRA-SS, FSSP
Contractor shall invoice the Department for all State SLS, OBRA-SS, and FSSP member
packets created during a Human Rights Committee meeting by the 15th day of the month
for all meetings held in the previous month. The Department will pay for each packet
created once the invoice has been reviewed and accepted. All invoices shall be submitted
in the format prescribed by the Department.
Level of Care Screen: Initial and Reassessments
Contractor shall conduct and enter all initial and reassessment Level of Care Screens into
the Department's prescribed system within the required timeframes. The Department will
pay for initial and reassessment Level of Care Screens based on data pulled from the
Department's prescribed system on the 15th day of the month for Screens conducted in
the previous month.
Long -Range Plan
Contractor shall submit a Long -Range Plan on an annual basis and present it to the
Department. Contractor shall receive payment for the Long -Range Plan after it has been
reviewed and accepted by the Department.
Monitoring Contacts: State SLS and OBRA-SS
Contractor shall conduct and enter all monitoring contacts for State SLS and OBRA-SS
into the Department's prescribed system within the required timeframe. Contractor shall
receive payment for the four required monitoring contacts per service plan year. The
Department will pay for monitoring contacts based on data pulled from the Department's
prescribed system on the 15th day of the month for contacts conducted in the previous
month.
9.7.24. Most in Need Assessment: FSSP
9.7.24.1. Contractor shall conduct and enter all completed Needs Assessments into the
Department's prescribed system within the required timeframe. Contractor shall receive
payment for one Needs Assessment for members enrolled or on the FSSP ASAA waiting
list per fiscal year. The Department will pay for Needs Assessments each month based
on data pulled from the Department's prescribed system on the 15th day of the month for
assessments conducted in the previous month.
9.7.25.
9.7.25.1.
Needs Assessment: Initial and Reassessment
Contractor shall conduct and enter all initial and reassessment Needs Assessments into
the Department's prescribed system within the required timeframes. The Department will
pay for initial and reassessment Needs Assessments based on data pulled from the
Department's prescribed system on the 15th day of the month for assessments conducted
in the previous month.
9.7.26. Ongoing Case Management: State SLS, OBRA-SS, FSSP
Exhibit B-1, SOW Page 49 of 52
9.7.26.1. Contractor shall conduct and enter all ongoing case management activities for State SLS,
OBRA-SS, and FSSP into the Department's prescribed system within the required
timeframe. Contractor shall receive one ongoing case management payment each month
per member for allowable activities completed. The Department will pay for ongoing case
management activities based on data pulled from the Department's prescribed system on
the 15th day of the month for activities conducted in the previous month.
9.7.27. Operations Guide
9.7.27.1. Contractor shall develop an Operations Guide that meets all requirements outlined in this
Contract for year one. Contractor shall receive payment for the Operations Guide once
the deliverable has been reviewed and accepted by the Department.
9.7.28. Operations Guide Updates
9.7.28.1. Contractor shall review the Operations Guide for years two, three, four, and five of this
Contract, and determine if any modifications are required. Updates shall include but not
be limited to any changes in the Work, in the Department's processes and procedures, or
in Contractor's processes and procedures. Contractor shall submit the Annual Operations
Guide Update as well as a summary of all changes to the Department or an explanation
demonstrating that the Operations Guide was reviewed, and Contractor determined that
no edits were necessary. The Department shall review the Operations Guide Update and
the summary to determine whether significant modifications were completed. Contractor
shall receive payment for the updated Operations Guide only after the Department has
determined that significant changes were made, and the Department has accepted the
Deliverable. If minor changes or no changes were completed Contractor shall not receive
payment for this deliverable. The Department does not consider changes such as updating
dates, contact information or locations to be significant changes.
9.7.29. RAE Collaboration Start -Up Report
9.7.29.1. Contractor shall submit the RAE Collaboration Start -Up Report by the required
timeframe. Contractor shall receive payment once the Department has reviewed and
accepted the report. This report shall only be reimbursed once as a start-up activity.
9.7.30. Rural Travel Add -On for Rural and Frontier Counties
9.7.30.1. Contractor shall receive an additional payment for Rural Travel Add -On for Rural and
Frontier Counties for the following activities only: initial and Reassessment Level of Care
Screen, initial and Reassessment Needs Assessment, State SLS and OBRA-SS In -Person
Monitoring, and State SLS and OBRA-SS In -Person Individualized Support Plans based
on data pulled from the Department prescribed system on the 15th day of the month for
activities from the previous month.
9.7.31. SIS-A Assessments
9.7.31.1. Contractor shall enter all SIS assessments into SIS Online by the last day of the month.
The Department will pay for all SIS-A Assessments from data pulled from the
Department prescribed system on the 15th day of the month for assessments from the
previous month. Reassessment requests must be reviewed and accepted by the
Department prior to completion, entry, and payment.
9.7.32. Support Need Level Assessment - HCBS-CHRP
Exhibit B-1, SOW Page 50 of 52
9.7.32.1. Contractor shall maintain all supporting documentation related to the Support Need Level
Assessment and make it available to the Department upon request. Contractor shall
invoice the Department for all completed assessments by the 15th day of the month for
all assessments completed in the previous month. The Department will pay for
assessments once the invoice and supporting documentation is reviewed and accepted.
9.7.33. Training on the Colorado Single Assessment, and Person -Centered Support Plan Instruments
and Streamlined Eligibility
9.7.33.1. Contractor shall receive payment once participating case managers complete the training
on the Colorado Single Assessment, and Person -Centered Support Plan instruments and
streamlined eligibility. The payment will be based on an allocation calculated by the
Department based on funding availability, the time required for training completion, and
the average number of case managers participating.
9.7.34. Waiting List Management
9.7.34.1. Contractor shall enter all waiting list management contacts with individuals and families
into the Department prescribed system within the required timeframe. The Department
will pay for required Waiting List contacts from data pulled from the Department
prescribed system on the 15th of the month for contacts from the previous month or using
an invoice developed by the Department. The Department shall not pay for more than one
contact per individual (18 and older) on the HCBS-DD ASAA, See Date and Safety Net
waiting list and State SLS or FSSP ASAA waiting list per year.
9.7.35. Year End Close Deadlines
9.7.35.1. The due dates identified in this section shall be adhered to, and information entered into
the Department's prescribed systems and/or submitted to the Department by a date
identified in this Contract. For the month of June, the Department will notify Contractor
of the modified due date to account for year-end closing. Any submission past the
assigned year end close date will not be reimbursed.
9.8. Payment and Billing Errors
9.8.1. Contractor shall review all payments made by the Department to ensure all activities are
appropriately reimbursed.
9.8.2. Contractor shall notify the Department of any errors in billing or payment by the 15th of the
month for the prior month's payment on the Department's prescribed template to ensure over
and under payments are adjusted.
9.8.2.1. DELIVERABLE: Payment Correction Form
9.8.2.2. DUE: On the 15th of each month for corrections on the prior month's payment, with
exception of June payments which must meet year-end close deadlines established by the
Department.
9.9. Unexpended Funds
9.9.1. Contractor shall remit any Subawards disbursed under this Contract that are not expended by
the close of the Period of Performance.
9.10. Closeout Payments
Exhibit B-1, SOW Page 51 of 52
9.11. Notwithstanding anything to the contrary in this Contract, all payments for the final month of
this Contract shall be paid to Contractor no sooner than 10 Business Days after the Department
has determined that Contractor has completed all the requirements of the Closeout Period.
Exhibit B-1, SOW Page 52 of 52
EXHIBIT C-1, RATES
Case Management Agency (CMA) Subaward Rates Table
Description
Rate
Frequency
Payment
Type
Funding
Source
Operations Guide
$7,905.56
Annually —
Year 1 of the
Contract
Deliverable
Federal/State
Funded
Operations Guide Update
$1,424.14
Annually —
Years 2+ of
the Contract
Deliverable
Federal/State
Funded
Long -Range Plan
$3,543.31
Annually
Deliverable
Federal/State
Funded
Committee Updates
$1,071.73
Semi-
Annually
Deliverable
Federal/State
Funded
Continuous Quality
Improvement Plan
$506.72
Annually
Deliverable
Federal/State
Funded
Complaint Trend Analysis
$3,857.04
Quarterly
Deliverable
Federal/State
Funded
Case Management Training
$648.75
Semi-
Annually
Deliverable
Federal/State
Funded
Creation of Packet - Appeals
$531.60
Per Packet
Report
Federal/State
Funded
Attendance at Hearing -
Appeals
$490.97
Per Hearing
Report
Federal/State
Funded
IDD Critical Incident
Reporting (HCBS — CES,
HCBS — CHRP, HCBS —
DD, HCBS — SLS)
$6.30
Monthly, Per
Member
Enrolled
Report
Federal/State
Funded
LTSS Critical Incident
Reporting (HCBS — BI,
HCBS — CHCBS, CMHS,
HCBS — EBD, HCBS — SCI,
HCBS - CLLI)
$1.61
Monthly, Per
Member
Enrolled
Report
Federal/State
Funded
Critical Incident Follow -Up
Performance Standard
$3,457.07
Quarterly
Deliverable
Federal/State
Funded
Human Rights Committee
(HCBS — CES, HCBS —
CHRP, HCBS - DD, HCBS
— SLS)
$5.95
Monthly, Per
Member
Enrolled
Report
Federal/State
Funded
Initial Level of Care
Assessment (100.2)
$283.62
Per
Assessment
Report
Federal/State
Funded
CSR Level of Care
Assessment (100.2)
$214.03
Per
Assessment
Report
Federal/State
Funded
Initial Level of Care Screen
$210.27
Per Screen
Report
Federal/State
Funded
Exhibit C-1, Rates
Page 1 of 3
Annual Reassessment —
Level of Care Screen
$195.63
Per Screen
Report
Federal/State
Funded
Initial Needs Assessment —
Required Questions Only
$265.49
Per
Assessment
Report
Federal/State
Funded
Annual Reassessment Needs
Assessment — Required
Questions Only
$249.20
Per
Assessment
Report
Federal/State
Funded
Initial Needs Assessment —
Voluntary Questions
Included
$331.87
Per
Assessment
Report
Federal/State
Funded
Annual Reassessment Needs
Assessment — Voluntary
Questions Included
$317.15
Per
Assessment
Report
Federal/State
Funded
SIS Assessment
$357.09
Per
Assessment
Report
Federal/State
Funded
Initial At -Risk Diversion —
In Person
$104.70
Monthly
Invoice
Federal/State
Funded
Initial At -Risk Diversion -
Virtual
$87.45
Monthly
Invoice
Federal/State
Funded
HCBS-CHRP ICAP
Assessment
$165.26
Per
Assessment
Invoice
Federal/State
Funded
Initial HCBS-CES
Application
$189.21
Per
Application
Report
Federal/State
Funded
CSR HCBS-CES
Application
$142.76
Per
Application
Report
Federal/State
Funded
Medicaid Eligible IDD
Determination
$458.81
Per
Determination
Report
Federal/State
Funded
Medicaid Eligible Delay
Determination
$272.96
Per
Determination
Report
Federal/State
Funded
IDD Determination Testing
$481.10
Actual Costs
up to Rate for
Testing
Invoice
Federal/State
Funded
Rural Travel Add -On
$37.46
Per Required
in Person
Contact for
Rural and
Frontier
Agencies
Report
Federal/State
Funded
Completed Training on the
Colorado Single Assessment
and Person -Centered
Support Plan Instruments
Calculated
Allocation Based
on Funding
Availability
Upon Training
Completion
Deliverable
Federal/State
Funded
RAE Collaboration Start -Up
Report
$ 70,650
One -Time
Completion
and
Acceptance of
Report
Deliverable
Federal/State
Funded
Exhibit Cl,-Rates
Page 2 of 3
Case Management Agency (CMA) State Only Rates Table
Waiting List Management
$95.42
Per Contact
Report
State Funded
Non -Medicaid Eligible IDD
Determination
$458.81
Per
Determination
Report
State Funded
Non -Medicaid Eligible
Delay Determination
$272.96
Per
Determination
Report
State Funded
State SLS, OBRA-SS, and
FSSP Critical Incident
Reporting & Investigation:
MANE
$349.18
Per Incident
Report
State Funded
State SLS, OBRA-SS, and
FSSP Critical Incident
Reporting & Investigation:
Non -MANE
$46.71
Per Incident
Report
State Funded
State SLS, OBRA-SS, and
FSSP Human Rights
Committee
$125.73
Per Member
Reviewed
Invoice
State Funded
State SLS and OBRA-SS
Complaints Trend Analysis
$220.69
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS, and
FSSP CIR Follow -Up
Performance Standard
$51.81
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS, and
FSSP Ongoing Case
Management
$91.67
Monthly, Per
Activity
Report
State Funded
State SLS and OBRA-SS
Monitoring — In Person
$104.70
Per Contact
Report
State Funded
State SLS and OBRA-SS
Monitoring - Virtual
$87.45
Per Contact
Report
State Funded
State SLS Expenditure
Report
$625.76
Monthly
Invoice
State Funded
OBRA-SS Expenditure
Report
$369.56
Monthly
Invoice
State Funded
FSSP Needs Assessment
$33.25
Per
Assessment
Report
State Funded
FSSP Expenditure Report
$556.57
Monthly
Invoice
State Funded
Family Support Council
Meetings
$418.29
Per Meeting
Invoice
State Funded
FSSP Annual Report
$621.79
Annually
Deliverable
State Funded
FSSP Program Evaluation
$529.19
Annually
Deliverable
State Funded
Exhibit C-1, Rates
Page 3 of 3
EXHIBIT E-1, CONTRACTOR'S ADMINISTRATIVE REQUIREMENTS
1. CONTRACTOR'S GENERAL REQUIREMENTS
1.1. The Department will contract with only one organization, Contractor, and will work solely
with that organization with respect to all tasks and deliverables to be completed, services
to be rendered and performance standards to be met under this Contract.
1.2. Contractor shall serve as the Case Management Agency for the following counties:
1.2.1. Weld County
1.3. Contractor may be privy to internal policy discussions, contractual issues, price
negotiations, confidential medical information, Department financial information, advance
knowledge of legislation and other Confidential Information. In addition to all other
confidentiality requirements of the Contract, Contractor shall also consider and treat any
such information as Confidential Information and shall only disclose it in accordance with
the terms of the Contract.
1.4. Contractor shall work cooperatively with Department staff and, if applicable, the staff of
other State contractors to ensure the completion of the Work. The Department may, in its
sole discretion, use other contractors to perform activities related to the Work that are not
contained in the Contract or to perform any of the Department's responsibilities. In the
event of a conflict between Contractor and any other State contractor, the State will resolve
the conflict and Contractor shall abide by the resolution provided by the State.
1.5. Contractor shall inform the Department on current trends and issues in the healthcare
marketplace and provide information on new technologies in use that may impact
Contractor's responsibilities under this Contract
1.6. Contractor shall maintain complete and detailed records of all meetings, system
development life cycle documents, presentations, project artifacts, and any other
interactions or Deliverables related to the Work described in the Contract Contractor shall
make such records available to the Department upon request throughout the term of the
Contract.
1.7. Deliverables
1.7.1. All Deliverables shall meet Department -approved format and content requirements.
The Department will specify the number of copies and media for each Deliverable.
1.7.1.1. Contractor shall submit each Deliverable to the Department for review and approval
and shall adhere to the following Deliverable process such for any documentation
creation, review, and acceptable cycle, Contractor shall:
1.7.1.1.1. Gather and document requirements for the Deliverable.
1.7.1.1.2. Create a draft in the Department -approved format for the individual
Deliverable.
1.7.1.1.3. Perform internal quality control review(s) of the Deliverable, including, but not
limited to:
1.7.1.1.3.1. Readability.
Exhibit E-1, Contractor's Administrative Requirements Page 1 of 23
1.7.1.1.3.2. Spelling.
1.7.1.1.3.3. Grammar.
1.7.1.1.3.4. Completion.
1.7.1.1.4. Adhere to all required templates or development of templates.
1.7.1.1.5. Perform modifications that include version control and tracked changes.
1.7.1.2. The Department will review the Deliverable and may direct Contractor to make
changes to the Deliverable. Contractor shall make all changes within five Business
Days following the Department's direction to make the change unless the
Department provides a longer period in writing.
1.7.1.2.1. Changes the Department direct include, but are not limited to, modifying
portions of the Deliverable, requiring new pages or portions of the Deliverable,
requiring resubmission of the Deliverable or requiring inclusion of information
or components that were left out of the Deliverable.
1.7.1.2.2. The Department may also direct Contractor to provide clarification or provide
a walkthrough of any Deliverable to assist the Department in its review.
Contractor shall provide the clarification or walkthrough as directed by the
Department.
1.7.1.3. Once the Department has received an acceptable version of the Deliverable,
including all changes directed by the Department, the Department will notify
Contractor of its acceptance of the Deliverable in writing. A Deliverable shall not
be deemed accepted prior to the Department's notice to Contractor of its acceptance
of that Deliverable.
1.7.2. Contractor shall employ an internal quality control process to ensure that all
Deliverables are complete, accurate, easy to understand and of high quality, as
described herein. Contractor shall provide Deliverables that, at a minimum, are
responsive to the specific requirements for that Deliverable, organized into a logical
order, contain accurate spelling and grammar, are formatted uniformly, and contain
accurate information and correct calculations. Contractor shall retain all draft and
marked -up documents and checklists utilized in reviewing Deliverables for reference
as directed by the Department.
1.7.3. In the event any due date for a Deliverable falls on a day that is not a Business Day, the
due date shall be automatically extended to the next Business Day, unless otherwise
directed by the Department.
1.7.4. All due dates or timelines that reference a period of days, months or quarters shall be
measured in Calendar Days, months and quarters unless specifically stated as being
measured in Business Days or otherwise. All times stated in the Contract shall be
considered to be in Mountain Time, adjusted for Daylight Saving Time as appropriate,
unless specifically stated otherwise.
1.7.5. No Deliverable, report, data, procedure or system created by Contractor for the
Department that is necessary to fulfilling Contractor's responsibilities under the
Contract, as determined by the Department, shall be considered proprietary.
Exhibit E-1, Contractor's Administrative Requirements Page 2 of 23
1.7.6. If any Deliverable contains ongoing responsibilities or requirements for Contractor,
such as Deliverables that are plans, policies or procedures, then Contractor shall
comply with all requirements of the most recently approved version of that Deliverable.
Contractor shall not implement any version of any such Deliverable prior to receipt of
the Department's written approval of that version of that Deliverable. Once a version
of any Deliverable described in this subsection is approved by the Department, all
requirements, milestones, and other Deliverables contained within that Deliverable
shall be considered to be requirements, milestones and Deliverables of this Contract.
1.7.6.1. Any Deliverable described as an update of another Deliverable shall be considered
a version of the original Deliverable for the purposes of this subsection.
1.8. Stated Deliverables and Performance Standards
1.8.1. Any section within this Statement of Work headed with or including the term
"DELIVERABLE" or "PERFORMANCE STANDARD" is intended to highlight a
Deliverable or performance standard contained in this Statement of Work and provide
a clear due date for the Deliverables. The sections with these headings are for ease of
reference not intended to expand or limit the requirements or responsibilities related to
any Deliverable or performance standard, except to provide the due date for the
Deliverables.
1.9. Communication with the Department
1.9.1. Contractor shall enable all Contractor staff to exchange documents and electronic files
with the Department staff in formats compatible with the Department's systems. The
Department currently uses Microsoft Office 2016 and/or Microsoft Office 365 for PC.
If Contractor uses a compatible program, then Contractor shall ensure that all
documents or files delivered to the Department are completely transferrable and
reviewable, without error, on the Department's systems.
1.9.2. The Department will use a transmittal process to provide Contractor with official
direction within the scope of the Contract. Contractor shall comply with all direction
contained within a completed transmittal. For a transmittal to be considered complete,
it must include, at a minimum, all of the following:
1.9.2.1. The date the transmittal will be effective.
1.9.2.2. Direction to Contractor regarding performance under the Contract.
1.9.2.3. A due date or timeline by which Contractor shall comply with the direction
contained in the transmittal.
1.9.2.4. The signature of the Department employee who has been designated to sign
transmittals.
1.9.2.4.1.
The Department will provide Contractor with the name of the person it has
designated to sign transmittals on behalf of the Department, who will be the
Department's primary designee. The Department will also provide Contractor
with a list of backups who may sign a transmittal on behalf of the Department
if the primary designee is unavailable. The Department may change any of its
designees from time to time by providing notice to Contractor through a
transmittal.
Exhibit E -1, Contractor's Administrative Requirements Page 3 of 23
1.9.3. The Department may deliver a completed transmittal to Contractor in hard copy, as a
scanned attachment to an email or through a dedicated communication system, if such
a system is available.
1.9.3.1. If a transmittal is delivered through a dedicated communication system or other
electronic system, then the Department may use an electronic signature to sign that
transmittal.
1.9.4. If Contractor receives conflicting transmittals, Contractor shall contact the
Department's primary designee, or backup designees if the primary designee is
unavailable, to obtain direction. If the Department does not provide direction otherwise,
then the transmittal with the latest effective date shall control.
1.9.5. In the event that Contractor receives direction from the Department outside of the
transmittal process, it shall contact the Department's primary designee, or backup
designees if the primary designee is unavailable, and have the Department confirm that
direction through a transmittal prior to complying with that direction.
1.9.6. Transmittals may not be used in place of an amendment, and may not, under any
circumstances be used to modify the term of the Contract or any compensation under
the Contract. Transmittals are not intended to be the sole means of communication
between the Department and Contractor, and the Department may provide day-to-day
communication to Contractor without using a transmittal.
1.9.7. Contractor shall retain all transmittals for reference and shall provide copies of any
received transmittals upon request by the Department.
1.9.8. Contractor shall provide written notification to the Department in instances where
Contractor has not been successful in meeting any requirement or timeframe identified
in this Contract. This notification must be provided to the Department within three
Business Days of discovery on a template provided by the Department.
1.9.8.1. DELIVERABLE: Contract Requirements Not Met
1.9.8.2. DUE: Within 3 Business Days of Discovery
1.10. Individual and Member Engagement
1.10.1. Person- and Family -Centered Approach
1.10.2. Contractor shall actively engage Members in their health and well-being by
demonstrating the following:
1.10.2.1. Responsiveness to Member and family/caregiver needs by incorporating best
practices in communication and cultural responsiveness in service delivery.
1.10.2.2. Utilization of various tools to communicate clearly and concisely.
1.10.2.3. Contractor shall align Member engagement activities with the Department's
person- and family -centered approach that respects and values individual
preferences, strengths, and contributions.
1.11. Cultural Responsiveness
1.11.1. Contractor shall provide and facilitate the delivery of services in a culturally competent
manner to all individuals and Members, including those with limited English
Exhibit E-1, Contractor's Administrative Requirements Page 4 of 23
proficiency and diverse cultural and ethnic backgrounds, disabilities, and regardless of
gender, sexual orientation, or gender identity.
1.11.2. Contractor shall provide all information for individuals and Members in a manner and
format that may be easily understood and is readily accessible by individuals and
Members.
1.11.3. Readily accessible is defined as electronic information and services that comply with
modern accessibility standards, such as Section 508 of the Americans with Disabilities
Act, Section 504 of the Rehabilitation Act.
1.12. Language Assistance Services
1.12.1. Contractor shall provide language assistance services including bilingual staff and/or
interpreter services, at no cost to any individual or Member. Language assistance shall
be provided at all points of contact, in a timely manner and during all hours of
operation.
1.12.2. Contractor shall make oral interpretation available in all languages.
1.12.3. Contractor shall ensure the competence of language assistance provided by interpreters
and bilingual staff.
1.12.4. Contractor shall not use family and friends to provide interpretation services except by
request of the individual or Member.
1.12.5. Contractor shall provide interpreter services for all interactions with individuals and
Members when there is no Contractor staff person available who speaks a language
understood by an individual or Member.
1.12.6. Contractor shall notify individuals and Members verbally regarding the individual's or
Member's right to receive the following language assistance services, as well as how
to access the following language assistance services.
1.12.7. Oral interpretation for any language. Oral interpretation requirements apply to all non-
English languages, not just those that the state identifies as prevalent.
1.12.8. Contractor shall ensure that language assistance services shall include, but are not
limited to, the use of auxiliary aids such as TTY/TDY and American Sign Language.
1.12.9. Contractor shall ensure that customer service telephone functions easily access
interpreter or bilingual services.
1.13. Written Materials for Individuals and Members
1.13.1. Contractor shall ensure that all written materials it creates for distribution to individuals
and Members meet all noticing requirements of 45 C.F.R. Part 92.
1.13.2. Contractor shall ensure that all written materials it creates for distribution to individuals
and Members are culturally and linguistically appropriate to the recipient.
1.13.3. Contractor shall write all materials in easy -to -understand language.
1.14. Individual and Member Communications
1.14.1. Contractor shall maintain consistent communication, both proactive and responsive,
with individuals and Members.
Exhibit E-1, Contractor's Administrative Requirements Page 5 of 23
1.14.2. Contractor shall assist any individual or Member who contacts Contractor, including
individuals and Members not in Contractor's Defined Service Area who need
assistance with contacting his/her/their CMA, CCB, RAE, or other agencies.
1.15. Individual and Member Rights
1.15.1. Contractor shall have written policies guaranteeing each individual's and Member's
right to be treated with respect and due consideration for his or her dignity and privacy.
1.15.2. Contractor shall provide information to individuals and Members regarding their rights
that include, but are not limited to:
1.15.2.1. The right to be treated with respect and due consideration for their dignity and
privacy.
1.15.2.2. The right to participate in decisions regarding their services.
1.15.2.3. The right to be free from any form of restraint or seclusion used as a means of
coercion, discipline, convenience or retaliation.
1.15.2.4. The right to request and receive a copy of their records.
1.15.2.5. The right to obtain available and accessible services under the Contract.
1.15.3. Contractor shall post and distribute rights to individuals, including but not limited to:
1.15.3.1. Individuals/Members.
1.15.3.2. Individual's/Member's families.
1.15.3.3. Providers.
1.15.3.4. Case Workers.
1.15.3.5. Stakeholders.
1.16. Start -Up Plan
1.16.1. Contractor shall create a Start -Up Plan that contains, at a minimum, the following:
1.16.1.1. A description of all steps, timelines, and milestones necessary to fully
transition the services described in the Contract from a prior contractor to
Contractor.
1.16.1.2. A description of all steps, timelines, milestones, and Deliverables necessary
for Contractor to be fully able to perform all Work by the Operational Start Date.
1.16.1.3. A listing of all personnel involved in the start-up and what aspect of the
start-up they are responsible for.
1.16.1.4. An operational readiness review for the Department to determine if
Contractor is ready to begin performance of all Work.
1.16.1.5. The risks associated with the start-up and a plan to mitigate those risks.
1.16.2. DELIVERABLE: Start -Up Plan
1.16.3. DUE: 20 Calendar Days Prior to the Contract Start Date
1.17. Start -Up Period
Exhibit E-1, Contractor's Administrative Requirements Page 6 of 23
1.17.1. With input from the Department, Contractor shall complete all of the following during
the Start -Up Period:
1.17.1.1. Schedule and facilitate a Kickoff Meeting that includes the following:
1.17.1.1.1. Key Personnel.
1.17.1.1.2. Department Leadership.
1.17.1.1.3. Department Project Team Members.
1.17.1.1.4. Any other relevant and needed persons or organizations.
1.17.1.2. Develop Kickoff Meeting materials and an agenda that contains, at a minimum, the
following:
1.17.1.2.1. Initial timelines for starting the Work and creating initial Deliverables.
1.17.1.2.2. Establishment of Communication channels to describe how the Work is to be
completed.
1.17.1.2.3. Transmission methods and specific Deliverable templates or requirements.
1.17.1.2.4. Any other item required to initiate and ensure Work is started and completed
on time.
1.17.1.3.
1.17.1.3.1.
1.17.1.3.2.
1.17.1.4.
1.17.1.5.
1.17.1.5.1.
1.17.1.5.2.
Prepare Kickoff Meeting Minutes and deliver them to the Department for review
and approval.
DELIVERABLE: Kickoff Meeting Agenda & Materials
DUE: Within three Business Days after the Kickoff Meeting
Create a Policy and Procedures Manual that contains the policies and procedures
for all systems and functions necessary for Contractor to complete its obligations
under the Contract.
Prepare all documents, forms, training materials, and any other documents,
information and protocols that require approval by the Department prior to the end
of the Start -Up Period and are necessary for Contractor to begin work on the
Operational Start Date. Contractor shall deliver all documents, forms, training
materials, and any other documents, information and protocols that require
approval by the Department to the Department for review and approval in a timely
manner that allows the Department to review and approve those documents prior
to end of the Start -Up Period.
DELIVERABLE: Policies & Procedures Manual
DUE: No later than the Operational Start Date
1.18. Operations Guide
1.18.1. Contractor shall not engage in any Work under the Contract, other than the Work
described in this Sections 1.106 and 12.17 prior to the Operational Start Date. The
Department shall not be liable to Contractor for, and Contractor shall not receive, any
payment for any period prior to the Operational Start Date under this Contract.
Exhibit E-1, Contractor's Administrative Requirements Page 7 of 23
1.18.2. Contractor shall create and implement an Operations Guide. The Operations Guide
shall include the creation and management of the following:
1.18.2.1. Communication Plan.
1.18.2.2. Business Continuity Plan.
1.18.2.3. Closeout Plan.
1.18.3. Contractor shall submit the Operations Guide to the Department for review and
approval.
1.18.3.1. DELIVERABLE: Operations Guide
1.18.3.2. DUE: Within 30 Business Days after the Effective Date
1.18.4. Contractor shall review its Operations Guide on annual basis and determine if any
modifications are required to account for any changes in the Work, in the Department's
processes and procedures or in Contractor's processes and procedures and update the
Guide as appropriate to account for any changes. Contractor shall submit an Annual
Operations Guide Update that contains all changes from the most recently approved
prior Operations Guide or Annual Operations Guide Update or shall note that there
were no changes.
1.18.4.1. DELIVERABLE: Annual Operations Guide Update
1.18.4.2. DUE: Annually, by July 31St
1.18.5. The Operational Start Date shall not occur until Contractor has completed all
requirements of the Operations Guide unless the Department provides written approval
otherwise.
1.18.6. Communication with Members, Providers, and Other Entities
1.18.6.1. Contractor shall create a Communication Plan that includes, but is not limited to,
all of the following:
1.18.6.1.1. A description of how Contractor will communicate to Members any changes to
the services those Members will receive or how those Members will receive the
services.
1.18.6.1.2. A description of the communication methods, including things such as email
lists, newsletters and other methods, that Contractor will use to communicate
with Providers and Subcontractors.
1.18.6.1.3. The specific means of immediate communication with Members and a method
for accelerating the internal approval and communication process to address
urgent communications or crisis situations.
1.18.6.1.4. A general plan for how Contractor will address communication deficiencies or
crisis situations, including how Contractor will increase staff, contact hours or
other steps Contractor will take if existing communication methods for
Members or Providers are insufficient.
1.18.6.1.5. A listing of the following individuals within Contractor's organization,
including cell phone numbers and email addresses:
Exhibit E-1, Contractor's Administrative Requirements Page 8 of 23
1.18.6.1.5.1.
1.18.6.1.5.2.
1.18.6.1.5.3.
An individual who is authorized to speak on the record regarding the Work,
the Contract or any issues that arise that are related to the Work.
An individual who is responsible for any website or marketing related to the
Work.
Back-up communication staff that can respond in the event that the other
individuals listed are unavailable.
1.18.7. Business Continuity Plan
1.18.7.1. Contractor shall create a Business Continuity Plan that Contractor will follow in
order to continue operations after a Disaster or a Business Interruption to include
but not limited to a Disaster, Pandemic, power outage, strike, loss of necessary
personnel, or computer virus. The Business Continuity Plan shall include, but is not
limited to, all of the following:
1.18.7.1.1. The essential services and functions provided by Contractor.
1.18.7.1.2. The lead person and response team responsible for implementing the business
continuity plan, individual/team roles, and contact information.
1.18.7.1.3. How emergency responses procedures will be implemented and who will
activate the business continuity plan.
1.18.7.1.4. How Contractor will implement a flexible work plan that includes social
distancing, hygiene etiquette, cancellation of non -essential activities, closure of
buildings, and/or relocation to alternative facilities.
1.18.7.1.5. How Contractor will address training personnel, preparing equipment, and
backup systems.
1.18.7.1.6. How Contractor will address budget and finance mechanisms to ensure
financing of essential services.
1.18.7.1.7. How Contractor will ensure necessary supplies and equipment are available to
maintain essential services.
1.18.7.1.8. How Contractor will replace staff that are lost or unavailable during or after a
Business Interruption so that the Work is performed in accordance with the
Contract.
1.18.7.1.9. How Contractor will manage employees who are exposed to a Pandemic related
illness or are suspected to be ill or become ill at a worksite, such as infection
control response and immediate mandatory sick leave.
1.18.7.1.10. How Contractor will ensure or enhance communication and information
technology infrastructure to support tele-commuting.
1.18.7.1.11. How Contractor will back-up all information necessary to continue performing
the Work remotely, so that no information is lost because of a Business
Interruption.
1.18.7.1.12. In the event of a Disaster, the plan shall also include how Contractor will make
all information available at its back-up facilities.
Exhibit E-1, Contractor's Administrative Requirements Page 9 of 23
1.18.7.1.13. How Contractor will maintain complete back-up copies of all data, databases,
operating programs, files, systems, and software pertaining to enrollment
information at a Department -approved, off -site location.
1.18.7.1.14. How Contractor will minimize the effects on Members of any Business
Interruption to include how Contractor will notify members of closures and
cancellations.
1.18.7.1.15. How Contractor will communicate with the Department during the Business
Interruption and points of contact within Contractor's organization the
Department can contact in the event of a Business Interruption.
1.18.7.1.16. How Contractor will transition from in person meetings to conference calls or
other virtual platforms or cancel or delay meetings as necessary.
1.18.7.1.17. Planned long-term back-up facilities out of which Contractor can continue
operations after a Disaster.
1.18.7.1.18. The time period it will take to transition all activities from Contractor's regular
facilities to the back-up facilities after a Disaster.
1.18.7.1.19. How Contractor will prepare necessary internal staff for implementing the
business continuity plan, which may include tests, drills, or training annually
and revising the plan based on lessons learned.
1.18.7.1.20. How Contractor will identify and engage with external organizations to help the
community, such as sharing best practices and sharing timely and accurate
information about a Business Interruption.
1.18.7.1.21. How Contractor will implement steps to return to normal after a Business
Interruption.
1.18.8. Closeout Plan
1.18.8.1. Contractor shall create a Closeout Plan that describes all requirements, steps,
timelines, milestones, and Deliverables necessary to fully transition the services
described in the Contract from Contractor to the Department or to another
contractor selected by the Department to be Contractor after the termination of the
Contract. The Closeout Plan shall include, but is not limited to:
1.18.8.1.1. Transfer of individuals and Members
1.18.8.1.2.
1.18.8.1.3.
1.18.8.1.4.
1.18.8.1.5.
1.18.8.2.
Transfer of documentation to include all electronic and physical documentation.
Transfer of all individual and Member records through the Department Case
Management Systems.
Transfer of services
Transfer of Case Management Services
The Closeout Plan shall also designate an individual to act as a closeout coordinator
who will ensure that all requirements, steps, timelines, milestones, and deliverables
contained in the Closeout Plan are completed and work with the Department and
any other contractor to minimize the impact of the transition on Members and the
Department.
Exhibit E-1, Contractor's Administrative Requirements Page 10 of 23
1.18.8.2.1. Contractor shall ensure all policy, procedures, training, and appeals information
are transferred to the Department.
1.18.8.3. Contractor shall deliver the Closeout Plan to the Department for review and
approval.
1.18.8.4. Contractor shall provide weekly updates to the Department throughout the creation
of and the performances within the Operations Guide, that show Contractor's status
toward meeting the milestones described herein.
1.18.8.5. Contractor shall be ready to perform all Work by the Operational Start Date.
1.19. Closeout Period
1.19.1.
1.19.1.1.
1.19.1.2.
1.19.1.3.
1.19.1.4.
1.19.1.5.
1.19.1.7.
During the Closeout Period, Contractor shall complete all of the following:
Implement the most recent Closeout Plan or Closeout Plan Update as approved by
the Department in the Operations Guide, as described herein and complete all steps,
Deliverables and milestones contained in the most recent Closeout Plan or Closeout
Plan Update that has been approved by the Department.
Provide to the Department, or any other contractor at the Department's direction,
all reports, data, systems, Deliverables, and other information reasonably necessary
for a transition as determined by the Department or included in the most recent
Closeout Plan or Closeout Plan Update that has been approved by the Department.
Ensure that all responsibilities under the Contract have been transferred to the
Department, or to another contractor at the Department's direction, without
significant interruption.
Notify any Subcontractors of the termination of the Contract, as directed by the
Department.
Notify all Members that Contractor will no longer be the CMA as directed by the
Department. Contractor shall create these notifications and deliver them to the
Department for approval. Once the Department has approved the notifications,
Contractor shall deliver these notifications to all Members, but in no event shall
Contractor deliver any such notification prior to approval of that notification by the
Department.
DELIVERABLE: Member Notifications
DUE: 90 Calendar Days prior to termination of the Contract
Continue meeting each requirement of the Contract as described in the Department -
approved and updated Closeout Plan, or until the Department determines that
specific requirement is being performed by the Department or another contractor,
whichever is sooner. The Department will determine when any specific
requirement is being performed by the Department or another contractor and will
notify Contractor of this determination for that requirement.
The Closeout Period may extend past the termination of the Contract. The
Department will perform a closeout review to ensure that Contractor has completed
all requirements of the Closeout Period. If Contractor has not completed all of the
Exhibit E-1, Contractor's Administrative Requirements Page 11 of 23
requirements of the Closeout Period by the date of the termination of the Contract,
then any incomplete requirements shall survive termination of the Contract.
1.20. Long -Range Plan
1.20.1. The Contract shall create and present to the Department a Long -Range Plan for its
Defined Service Area that describes, at a minimum, the following:
1.20.1.1. Administrative and case management accomplishments of Contractor in the
previous year.
1.20.1.2. Identified unmet needs of eligible persons in the Defined Service Area and action
steps necessary to meet those needs.
1.20.1.3. How Contractor will solicit input from Members and families to ensure quality
services.
1.20.1.4. Local area issues that impact or are expected to impact the Defined Service Area
and action steps on how to resolve those issues.
1.20.1.5. Policies that are considered by Contractor to be a barrier to ensuring a
comprehensive case management system and suggested modifications to overcome
the barriers.
1.20.1.6. A summary of how Contractor is working to recruit and retain case management
staff currently and for the future to maintain and improve the case management
services in its Defined Service Area.
1.20.1.7. A summary of how Contractor is working to recruit new and existing providers to
expand their services in the Defined Service Area.
1.20.1.8. A summary of past efforts and future plans to accelerate equity, diversity, inclusion,
and access.
1.20.1.9. The Contractor's efforts to recruit members of the Community Advisory
Committee who represent the characteristics of the community as it relates to
diversity of race, ethnicity, religious affiliation, etc.
1.20.1.10. How Contractor will engage with and facilitate existing social networks including,
but not limited to: CCBs, RAEs, Behavioral Health Authorities, schools, nursing
facilities and other unpaid supports and advocacy partners will be used to support
members in the Defined Service Area.
1.20.1.11. How State General Fund programs and supports will be used to support individuals,
members, and families within the Defined Service Area.
1.20.1.12. How the voices of historically underserved and marginalized communities will be
incorporated into decision -making within the Defined Service Area.
1.20.1.13. How feedback will be obtained from community members, members receiving
services, and individuals seeking or waiting for services and how the feedback will
be incorporated into strategies for delivering case management services within the
Defined Service Area.
1.20.2. DELIVERABLE: Long -Range Plan and Presentation to the Department
Exhibit E-1, Contractor's Administrative Requirements Page 12 of 23
1.20.3. DUE: Annually, by August 15th
1.21. Community Advisory Committee
1.21.1. Within 30 Calendar Days of the Contract execution date, Contractor shall establish a
Community Advisory Committee of no less than five committee members that will
meet at least quarterly to obtain public input and guidance for CMA operations and
follow rules and regulations set forth in C.R.S. 8.7201.C.
1.21.2. The Community Advisory Committee shall include, but not be limited to, at least one
person as the regional representation from among the following categories:
1.21.2.1. The Defined Service Area's county commissioners, area agencies on aging,
medical professionals, physical and/or intellectual disability professionals,
ombudsmen, human services agencies, county government officials,
mental/behavioral health professionals, and
1.21.2.2. Regional representation from one or more LTSS members or family members of
individuals receiving LTSS and make every effort to recruit and maintain a majority
of individuals with this lived experience on the committee:
1.21.2.2.1. Members with I/DD and/or
1.21.2.2.2. Members with disabilities
1.21.2.2.3. Members shall be given priority of selection over family members.
1.21.3. Contractor shall submit the Community Advisory Committee member list annually on
the template prescribed by the Department.
1.21.4. If Contractor is unable to recruit and maintain a majority of members, advocates, and
people with lived experience on the committee, Contractor shall outline efforts to do
so with their deliverable submissions.
1.21.4.1. DELIVERABLE: Community Advisory Committee Member List
1.21.4.2. DUE: Annually, by August 15th
1.21.5. Contractor shall notify the Department of any changes to Community Advisory
Committee membership within 10 Business Days of the date of change.
1.21.5.1. DELIVERABLE: Community Advisory Committee Membership Updates
1.21.5.2. DUE: Within 10 Business Days of the date of change to the membership list.
1.21.6. The Community Advisory Committee shall include at least two regional
representatives of individuals or family members of individuals receiving long-term
disability and/or I/DD services.
1.21.7. The Contractor shall demonstrate efforts to recruit members of the committee who
represent the characteristics of the community as it relates to diversity of race, ethnicity,
religious affiliation, etc. These efforts shall be reflected in the Long -Range Plan.
1.21.8. The Community Advisory Committee is an advisory body to the Contractor that
provides recommendations and is not a decision -making body. As such the Community
Advisory Committee shall:
Exhibit E-1, Contractor's Administrative Requirements Page 13 of 23
1.21.8.1. Provide public input and guidance to the Contractor in the review of service
delivery policies and procedures, marketing strategies, resource development,
overall operations, service quality, individual member satisfaction and other related
programmatic opportunities. The Contractor shall receive and consider
recommendations from the Community Advisory Committee to modify policies
and procedures to address systemic barriers at a local or regional level, in the Long -
Range Plan.
1.21.8.2. Support the Contractor with developing strategies for resolving complaints at the
local or regional level.
1.21.8.3. Maintain and post public notices of meetings, meeting minutes, and documented
follow up on Contractor's website.
1.21.8.4. Report to the Contractor's governing body or board of directors quarterly on all
case management complaints trends and follow-up completed by the Contractor.
1.21.8.5. Provide reports to the Department and its committees upon request.
1.21.8.6. The Community Advisory Committee may be combined in purpose or name with
other CMA committees in the Contractor's defined service area so long as it meets
the above purpose, criteria, and reports.
1.21.8.7. The Community Advisory Committee must use the operational templates
prescribed by the Department as minimum standards.
1.21.8.7.1. DELIVERABLE: Semi-annual Community Advisory Committee Meetings
Summary
1.21.8.7.2. DUE: Semi -Annually, for meetings held between July l St and December 31St,
Committee Updates are due January 15th, and for meetings held between
January 1St through June 1St, Committee Updates are due June 15th
1.22. Performance Reviews
1.22.1. The Department may conduct performance reviews or evaluations of Contractor in
relation to the Work performed under the Contract.
1.22.2. The Department may work with Contractor in the completion of any performance
reviews or evaluations or the Department may complete any or all performance reviews
or evaluations independently, at the Department's sole discretion.
1.22.3. Contractor shall provide all information necessary for the Department to complete all
performance reviews or evaluations, as determined by the Department, upon the
Department's request. Contractor shall provide this information regardless of whether
the Department decides to work with Contractor on any aspect of the performance
review or evaluation.
1.22.4. The Department may conduct these performance reviews or evaluations at any point
during the term of the Contract, or after termination of the Contract for any reason.
1.22.5. The Department may make the results of any performance reviews or evaluations
available to the public or may publicly post the results of any performance reviews or
evaluations.
Exhibit E-1, Contractor's Administrative Requirements Page 14 of 23
1.22.6. The Department may recoup funding as a result of any performance review or
evaluation where payment was rendered for services not complete or not in alignment
with federal and/or state regulations or this Contract.
1.23. Corrective Action Plan
1.23.1. When the Department determines that Contractor is not in compliance with any term
of this Contract, Contractor, upon written notification by the Department, shall develop
a corrective action plan. Corrective action plans shall include, but not be limited to:
1.23.1.1. A detailed description of actions to be taken including any supporting
documentation. Contractor's employee(s) responsible for implementing the actions.
1.23.1.2. The implementation time frames and a date for completion.
1.23.2. Contractor shall submit the Corrective Action Plan to the Department within 10
Business Days of the receipt of a written request from the Department.
1.23.2.1. DELIVERABLE: Corrective Action Plan
1.23.2.2. DUE: Within 10 Business Days of receipt of a written request from the Department
1.23.3. Contractor shall notify the Department in writing, within three Business Days, if it will
not be able to present the Corrective Action Plan by the due date. Contractor shall
explain the rationale for the delay and the Department may grant an extension, in
writing, of the deadline for Contractor's compliance.
1.23.4. Upon receipt of Contractor's Corrective Action Plan, the Department will accept,
modify, or reject the proposed Corrective Action Plan. Modifications and rejections
shall be accompanied by a written explanation.
1.23.5. In the event of a rejection of Contractor's Corrective Action Plan Contractor shall re-
write a revised Corrective Action Plan and resubmit it along with requested
documentation to the Department for review.
1.23.5.1. DELIVERABLE: Revised Corrective Action Plan
1.23.5.2. DUE: Within five Business Days of the Department's rejection
1.23.6. Upon acceptance by the Department Contractor shall implement the Corrective Action
Plan.
1.23.7. If corrections are not made by the timeline and/or quality specified by the Department
then funds may be withheld from this Contract. Payments of funds from this Contract
will resume beginning the month that the correction is made and accepted by the
Department.
1.23.8. As part of the Corrective Action Plan, supporting documentation demonstrating that
deficiencies have been remediated may be required. Contractor shall ensure all
supporting documentation is submitted within the timeframes established in the
Corrective Action Plan.
1.23.9. Upon receipt of Contractor's supporting documentation, the Department will accept,
request modifications, or reject the documentation. Modifications and rejections shall
be accompanied by a written explanation.
Exhibit E-1, Contractor's Administrative Requirements Page 15 of 23
1.23.10. In the event of a rejection of Contractor's supporting documentation to the Corrective
Action Plan, Contractor shall correct and resubmit the supporting documentation to the
Department for review.
1.23.11. If a Corrective Action Plan or any supporting activities or documentation are required
to correct a deficiency, are not submitted within the requested timeline and/or quality
specified by the Department, funds may be suspended or withheld from this Contract.
1.23.11.1. DELIVERABLE: Revised Supporting Documentation
1.23.11.2. DUE: Within five Business Days of the Department's rejection
1.23.12. If corrections are not made by the timeline and quality specified by the Department
then funds may be withheld and recovered from this Contract. Payments of funds from
this Contract will resume beginning the month that the correction is made and accepted
by the Department.
1.24. Renewal Options and Extensions
1.24.1. The Department may, within its sole discretion, choose to not exercise any renewal
option in the Contract for any reason. If the Department chooses to not exercise an
option, it may reprocure the performance of the Work in its sole discretion.
1.24.2. The Parties may amend the Contract to extend beyond eight years, in accordance with
the Colorado Procurement Code and its implementing rules, in the event that the
Department determines the extension is necessary to align the Contract with other
Department contracts, to address state or federal programmatic or policy changes
related to the Contract, or to provide sufficient time to transition the Work.
1.25. Department System Access
1.25.1. In the event that Contractor requires access to any Department computer system to
complete the Work, Contractor shall have and maintain all hardware, software, and
interfaces necessary to access the system without requiring any modification to the
Department's system. Contractor shall follow all Department policies, processes, and
procedures necessary to gain access to the Department's systems.
1.25.2. Contractor shall be responsible for any costs associated with obtaining and maintaining
access to systems needed to perform the Work under this solicitation, as determined by
the Department. The Department will not reimburse Contractor for any costs associated
with obtaining and maintaining access to Department systems.
1.26. Provider Fraud
1.26.1. Contractor shall notify the Department and the Colorado Medicaid Fraud Control Unit
of the Colorado Department of Law (MFCU) if it identifies or suspects possible
Provider Fraud as a result of any activities in its performance of this Contract.
1.26.2. Upon identification or suspicion of possible Provider Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.26.2.1. For each incident of identified or suspected Provider Fraud, Contractor shall
provide all of the following, at a minimum:
1.26.2.1.1. Written documentation of the findings.
Exhibit E-1, Contractor's Administrative Requirements Page 16 of 23
1.26.2.1.2. Information on any verbal or written reports.
1.26.2.1.3. All details of the findings and concerns, including a chronology of Contractor
actions which resulted in the reports, in a format agreed to by the Department.
1.26.2.1.4. Information on the identification of any affected claims that have been
discovered.
1.26.2.1.5. Any claims data associated with its report (in a mutually agreed upon format, if
possible).
1.26.2.1.6. Any additional information as required by the Department.
1.26.3. For each incident of identified or suspected Provider Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department and the
MFCU.
1.26.3.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.26.3.2. DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.26.4. Contractor shall revise or provide additional information related to Contractor
Suspected Fraud Written Notice Form as requested by the Department or the MFCU.
1.26.4.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and
Additional Information
1.26.4.2. DUE: Within three Business Days following the Department's or the MFCU's
request, unless the Department or MFCU provides for a different period in its
request.
1.27. Member Fraud
1.27.1. Contractor shall notify the Department if it identifies or suspects possible Member
Fraud as a result of any activities in its performance of this Contract.
1.27.2. Upon identification or suspicion of possible Member Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.27.2.1. For each incident of identified or suspected Member Fraud, Contractor shall
provide all of the following, at a minimum:
1.27.2.1.1. All verbal and written reports related to the suspected fraud.
1.27.2.1.2. All details of the findings and concerns, including a chronology of Contractor
actions which resulted in the reports, and the Member's State ID number, and
Member's date of birth if applicable.
1.27.2.1.3. Information on the identification of any affected claims that have been
discovered.
1.27.2.1.4. Any claims data associated with its report in a format agreed to by the
Department.
1.27.2.1.5. Any additional information as required by the Department.
Exhibit E-1, Contractor's Administrative Requirements Page 17 of 23
1.27.3. For each incident of identified or suspected Member Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department at
report.clientfraud@state.co.us, or at such other email address as provided by the
Department from time to time.
1.27.3.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.27.3.2. DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.27.4. Contractor shall revise or provide additional information related to Contractor
Suspected Fraud Written Notice Form as requested by the Department.
1.27.4.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and
Additional Information
1.27.4.2. DUE: Within three Business Days following the Department's request, unless the
Department provides for a different period in its request.
2. CONTRACTOR PERSONNEL
2.1. Personnel General Requirements
2.1.1. Contractor shall provide qualified Key Personnel and Other Personnel as necessary to
perform the Work throughout the term of the Contract.
2.1.2. Contractor shall designate the following Key Personnel positions:
2.1.2.1. Executive Director or Administrator
2.1.2.2. Finance Director
2.1.2.3. Case Management Director
2.1.2.4. Continuous Quality Improvement Lead
2.1.2.5. Contract Lead
2.1.2.6. Information Technology Liaison
2.1.2.7. Regional Accountable Entity (RAE) Liaison
2.1.2.8. Medical Assistance (MA) Site/County Eligibility Liaison
2.1.2.9. Member and Family Liaison
2.1.3. The Contract Lead shall be responsible for all the following:
2.1.3.1. Serving as Contractor's primary point of contact for the Department.
2.1.3.2. Serving as Contractor's primary point of contact for contract deliverables and other
contract -related questions or issues for the Department.
2.1.3.3. Ensuring the completion of all Work in accordance with the Contract's
requirements. This includes, but is not limited to, ensuring the accuracy, timeliness,
and completeness of all work.
2.1.3.4. Ensuring the timely submission and accuracy of all Deliverables submitted to the
Department.
Exhibit E-1, Contractor's Administrative Requirements Page 18 of 23
2.1.4. Contractor shall provide the Department with a final list of individuals assigned to the
Contract and appropriate contact information for those individuals using the template
provided by the Department. Contractors with more than one Defined Service Area
must submit the final list of individuals assigned to the Contract using the template
provided by the Department for each Defined Service Area. The Department shall
determine which Key Personnel may be allocated across organizational functions,
which Key Personnel must be dedicated to the Contract, and which Key Personnel or
Other Personnel must be dedicated to each Defined Service Area.
2.1.4.1. DELIVERABLE: Key Personnel, final list of individuals assigned to the Contract
2.1.4.2. DUE: Within five Business Days after the Effective Date and annually by July 15th
2.1.5. Contractor shall update this list upon the Department's request to account for changes
in the individuals assigned to the Contract.
2.1.5.1. DELIVERABLE: Key Personnel, updated list of individuals assigned to the
Contract
2.1.5.2. DUE: Within five Business Days after any change to the Key Personnel list
2.1.6. Contractor shall not permit any individual proposed for assignment to Key Personnel
positions to perform any Work prior to the Department's approval of that individual to
be assigned as Key Personnel.
2.1.7. Other Personnel
2.1.7.1. Contractor shall have sufficient staffing levels to include case managers, case aids,
supervisors, and other staff as necessary to complete the Work and to maintain
caseload sizes to support the Work. Contractor shall meet or exceed best practice
standards as set forth by the Department through operational memos for HCBS
waiver caseloads. Contractor shall not exceed the best practice caseload size
standards without written approval from the Department.
2.1.7.2. Contractor's Case Manager(s) shall meet all the qualifications listed in 10 C.C.R.
2505-10, Section 8.519.5 et seq.
2.1.7.3. Contractor shall ensure appropriate staffing and infrastructure to address the needs
of all populations including children and adults for all HCBS waivers.
2.1.7.4. All Key Personnel and Other Personnel assigned to this Contract shall complete
annual Equity, Diversity, Inclusion, and Accessibility (EDIA) related training.
Training must ensure staff are culturally competent and provide culturally
responsive services and business practices at all levels of the agency. The
Department's EDIA Officer and/or their designee will offer free EDIA-related
professional development training to Contractor upon request within the
Department's LMS.
2.2. Background Checks
2.2.1. Contractor shall conduct background checks on all new applicants for positions in
which direct care, as defined in section §26.3.1.101(3.5), C.R.S. will be provided to an
at -risk adult, as defined in section §26-3.1-101 (1.5), C.R.S to include at a minimum a
Colorado Bureau of Investigation check. On and after January 1, 2019, prior to
Exhibit E-1, Contractor's Administrative Requirements Page 19 of 23
employment, Contractor shall submit the name of a person who will be providing direct
care, to an at -risk adult, as well as any other required identifying information, to the
Colorado Department of Human Services for a check of the Colorado Adult Protective
Services data system pursuant to section §26-3.1-111, C.R.S. to determine if the person
is substantiated in a case of mistreatment of an at -risk adult.
2.2.2. If any of Contractor's Key Personnel, or Other Personnel, are required to have and
maintain any professional licensure or certification issued by any federal, state, or local
government agency, then Contractor shall maintain copies of such current licenses and
certifications and provide them to the Department upon request.
2.3. Personnel Availability
2.3.1. Contractor shall ensure Key Personnel and Other Personnel assigned to the Contract
are available for meetings with the Department during the Department's normal
business hours, as determined by the Department. Contractor shall also make these
personnel available outside of the Department's normal business hours and on
weekends with prior notice from the Department.
2.3.2. Contractor shall ensure that appropriate Key Personnel and Other Personnel are
available for all regularly scheduled meetings between the Contractor and the
Department. The Department may, at times, require specific personnel to attend a
meeting and will notify the Contractor of such request.
2.3.3. Contractor shall ensure that the Key Personnel and Other Personnel attending all
meetings between the Department and Contractor have the authority to represent and
commit Contractor regarding work planning, problem resolution and program
development.
2.3.4. At the Department's direction, Contractor shall make its Key Personnel and Other
Personnel available to attend meetings as subject matter experts with stakeholders both
within the State government and external private stakeholders.
2.3.5. All of Contractor's Key Personnel and Other Personnel that attend any meeting with
the Department or other Department stakeholders shall be present at the meeting
through video conference, telephonic, or in -person depending on the purpose and intent
of the meeting. If Contractor has any personnel attend by telephone or video
conference, Contractor shall provide all additional equipment necessary for attendance,
including any virtual meeting space or telephone conference lines.
2.3.6. Contractor shall respond to all telephone calls, voicemails, and emails from the
Department within two Business Days of receipt by Contractor.
2.4. Other Personnel Responsibilities
2.4.1. Contractor shall use its discretion to determine the number of Other Personnel
necessary to perform the Work in accordance with the requirements of this Contract. If
the Department determines that Contractor has not provided sufficient Other Personnel
to perform the Work in accordance with the requirements of this Contract, Contractor
shall provide all additional Other Personnel necessary to perform the Work in
accordance with the requirements of this Contract at no additional cost to the
Department.
Exhibit E-1, Contractor's Administrative Requirements Page 20 of 23
2.4.2. Contractor shall ensure that all Other Personnel have sufficient training and experience
to complete all portions of the Work assigned to them. Contractor shall provide all
necessary training to its Other Personnel, except for State -provided training specifically
described in this Contract.
2.4.3. Contractor may subcontract to complete a portion of the Work required by the Contract.
The conditions for using a Subcontractor or Subcontractors are as follows:
2.4.3.1. Contractor shall not subcontract more than 40% of the Work.
2.4.3.2. Contractor shall provide the organizational name of each Subcontractor and all
items to be worked on by each Subcontractor to the Department for approval prior
to commencement of Work.
2.4.3.2.1. DELIVERABLE: Name of each Subcontractor, description of work being
completed, and percentage of work being completed by the Subcontractor.
2.4.3.2.2. DUE: Annually, by July 15th
2.4.3.3. Contractor shall notify the Department of any changes to Subcontractors within 10
Business Days of the change.
2.4.3.4. Contractor shall obtain prior consent and written approval for any use of
Subcontractor(s).
3. INFORMATION TECHNOLOGY RELATED REQUIREMENTS
3.1. Protection of System Data
3.1.1. In addition to the requirements of the main body of this Contract, if Contractor or any
Subcontractor is given access to State Records by the State or its agents in connection
with Contractor's performance under the Contract, Contractor shall protect all State
Records in accordance with this Exhibit. All provisions of this Exhibit that refer to
Contractor shall apply equally to any Subcontractor performing work in connection
with the Contract.
3.1.2. For the avoidance of doubt, the terms of this Exhibit shall apply to the extent that any
of the following statements is true in regard to Contractor access, use, or disclosure of
State Records:
3.1.2.1. Contractor provides physical or logical storage of State Records.
3.1.2.2. Contractor creates, uses, processes, discloses, transmits, or disposes of State
Records.
3.1.2.3. Contractor is otherwise given physical or logical access to State Records in order
to perform Contractor's obligations under this Contract.
3.1.3. Contractor shall, and shall cause its Subcontractors, to do all of the following:
3.1.3.1. Provide physical and logical protection for all hardware, software, applications, and
data that meets or exceeds industry standards and the requirements of this Contract.
3.1.3.2. Maintain network, system, and application security, which includes, but is not
limited to, network firewalls, intrusion detection (host and network), annual
Exhibit E-1, Contractor's Administrative Requirements Page 21 of 23
security testing, and improvements or enhancements consistent with evolving
industry standards.
3.1.3.3. Comply with State and federal rules and regulations related to overall security,
privacy, confidentiality, integrity, availability, and auditing.
3.1.3.4. Provide that security is not compromised by unauthorized access to workspaces,
computers, networks, software, databases, or other physical or electronic
environments.
3.1.3.5. Promptly report all Incidents, including Incidents that do not result in unauthorized
disclosure or loss of data integrity, to the State.
3.1.4. Subject to Contractor's reasonable access security requirements and upon reasonable
prior notice, Contractor shall provide the State with scheduled access for the purpose
of inspecting and monitoring access and use of State Records, maintaining State
systems, and evaluating physical and logical security control effectiveness.
3.1.5. Contractor shall perform background checks on all of its respective employees and
agents performing services or having access to State Records provided under this
Contract. A background check performed during the hiring process shall meet this
requirement. Contractor shall perform a background check on any employee if
Contractor becomes aware of any reason to question the employability of an existing
employee. Contractor shall require all Subcontractors to meet the standards of this
requirement.
3.2. Data Handling
3.2.1. The State, in its sole discretion, may securely deliver State Records directly to
Contractor. Contractor shall maintain these State Records only within facilities or
locations that Contractor has attested are secure, including for the authorized and
approved purposes of backup and disaster recovery purposes. Contractor may not
maintain State Records in any data center or other storage location outside the United
States for any purpose without the prior express written consent of the State.
3.2.2. Contractor shall not allow remote access to State Records from outside the United
States, including access by Contractor's employees or agents, without the prior express
written consent of OIS. Contractor shall communicate any request regarding non-U.S.
access to State Records to the Security and Compliance Representative for the State.
The State shall have sole discretion to grant or deny any such request.
3.2.3. Upon request by the State made any time prior to 60 Business Days following the
termination of this Contract for any reason, whether or not the Contract is expiring or
terminating, Contractor shall make available to the State a complete and secure
download file of all data that is encrypted and appropriately authenticated. This
download file shall be made available to the State within 10 Business Days of the
State's request, and shall contain, without limitation, all State Records, Work Product,
and system schema and transformation definitions, or delimited text files with
documents, detailed schema definitions along with attachments in its native format.
Upon the termination of Contractor's provision of data processing services, Contractor
shall, as directed by the State, return all State Records provided by the State to
Contractor, and the copies thereof, to the State or destroy all such State Records and
Exhibit E-1, Contractor's Administrative Requirements Page 22 of 23
certify to the State that it has done so. If legislation imposed upon Contractor prevents
it from returning or destroying all or part of the State Records provided by the State to
Contractor, Contractor shall guarantee the confidentiality of all State Records provided
by the State to Contractor and will not actively process such data anymore.
3.2.4. The State retains the right to use the established operational services to access and
retrieve State Records stored on Contractor's infrastructure at its sole discretion and
at any time. Upon request of the State or of the supervisory authority, Contractor shall
submit its data processing facilities for an audit of the measures referred to in this
Exhibit in accordance with the terms of this Contract.
Exhibit E-1, Contractor's Administrative Requirements Page 23 of 23
DocuSign Envelope ID: 883B3D7D-3D94-40DA-BD53-0BF5B5C47232
STATE OF COLORADO
THIRD PARTY ENTITY / ORGANIZATION CERTIFICATION FOR ACCESS
TO PII THROUGH A DATABASE OR AUTOMATED NETWORK
Kevin D. Ross Weld County
Pursuant to § 24-74-105, C.R.S., I, , on behalf of
(the "Organization"), hereby certify under the penalty of perjury that the
Organization has not and will not use or disclose any Personal Identifying
Information, as defined by § 24-74-102(1), C.R.S., for the purpose of investigating for,
participating in, cooperating with, or assisting Federal Immigration Enforcement,
including the enforcement of civil immigration laws, and the Illegal Immigration and
Immigrant Responsibility Act, which is codified at 8 U.S.C. §§ 1325 and 1326, unless
required to do so to comply with Federal or State law, or to comply with a court -issued
subpoena, warrant or order.
I hereby represent and certify that I have full legal authority to execute this
certification on behalf of the Organization.
DocuSigned b,
Signature: rv.ss
2DOCACODAC.4D3...
Kevin D. Ross
Printed Name:
Chairman Board of commissioners
Title:
6/12/2024 I 14:39 PDT
Date:
DocuSign Envelope ID: 883B3D7D-3D94-40DA-BD53-0BF5B5C47232
FY24-25 Case Management Agency Contracts
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Document Set Properties
FY24-25 Case
Management Agency
Contracts
Requesting approval for the Case
Management Agency (CMA) Contract
Amendments for FY 2024-25 as part of Case
Management Redesign. These Contracts
were originally approved as a part of CMA
RFP 2023000170. Once approved,
procurement will complete the individual
CMA mail merger using the unique
information for each agency within the mail
merge spreadsheet. The Contract
Amendments for transition phase 1 and 2
CMAs and new Contracts for phase 3 CMAs:
1. Adult Care Management, Inc., dba A&I
Avenues DSA #8 2. Community Connections,
Inc. for DSA #20 3. Developmental Pathways,
Inc. for DSA #5 4. Foothills Gateway Inc. DSA
#10 5. Garfield County Department of
Human Services DSA #15 6. Jefferson
County Human Services DSA #7 7. Las
Animas County Department of Human
Services DSA #4 8. Montrose County Human
Services DSA #19 9. Northeastern Colorado
Association of Local Governments' Area
Agency on Aging DSA #110.Otero County
Department of Human Services for DSA #3
11. Prowers County Public Health and
Environment for DSA #212. Rocky Mountain
Health Organization dba Rocky Mountain
Health Plans DSA #13, #14, #16, #17, #18
13. Rocky Mountain Human Services for DSA
#614. The Resource Exchange, I nc for DSA a
#11, #12 15. Weld County Department of
Human Services DSA #9
FY24-25 Case Management Agency Contracts
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DEPARTMENT VALUES
Person-Centeredness • Accountability • Continuous Improvement • Employee Engagement • Integrity • Transparency
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Executive Director Contract Summary and Checklist — New Contract
Contract
Manager
Sarah McDonnell, CMA Contract
Manager, OCL
Contract
Manager
Email
Sarah.McDonnell@state.co.us
ELT Member
Yasmin Gardner, Operations and
Administration Division Director
Contact
Phone #
303-866-5668
SET Member
Bonnie Silva, Office of Community
Living Director
Type of
Document
Contract
Contractor Name
1. Adult Care Management, Inc., dba A&I Avenues DSA #8
2. Community Connections, Inc. for DSA #20
3. Developmental Pathways, Inc. for DSA #5
4. Foothills Gateway Inc. DSA #10
5. Garfield County Department of Human Services DSA #15
6. Jefferson County Human Services DSA #7
7. Las Animas County Department of Human Services DSA #4
8. Montrose County Human Services DSA #19
9. Northeastern Colorado Association of Local Governments' Area
Agency on Aging DSA #1
10. Otero County Department of Human Services for DSA #3
11. Prowers County Public Health and Environment for DSA #2
12. Rocky Mountain Health Organization dba Rocky Mountain Health
Plans DSA #13, #14, #16, #17, #18
13. Rocky Mountain Human Services for DSA #6
14. The Resource Exchange, Inc for DSA a #11,1112
15. Weld County Department of Human Services DSA #9
Summary of Services
Provided
OCL is contracting with not -for-profit and county -based agencies
throughout the state for the following activities:
• Administrative case management functions for the following
programs:
o HCBS Children with a Life Limiting Illness Waiver (HCBS-
CLLI)
o HCBS Children's Extensive Supports Waiver (HCBS-CES)
o HCBS Children's Habilitation Residential Program Waiver
(HCBS-CHRP)
o HCBS Community Mental Health Supports Waiver (HCBS-
CMHS)
o HCBS Complimentary and Integrative Health Waiver
(HCBS-CIH)
o HCBS Developmental Disabilities Waiver (HCBS-DD)
o HCBS Persons who are Elderly, Blind and Disabled Waiver
(HCBS-EBD)
o HCBS Persons with Brain Injury Waiver (HCBS-BI)
o HCBS Supported Living Services Waiver (HCBS-SLS)
DocuSign Envelope ID: 883B3D7D-3D94-40DA-BD53-0BF5B5C47232
o Hospital Back -Up Program (HBU)
o Intermediate Care Facilities -Intellectual and
Developmental Disabilities (ICF-IDD)
o Long Term Home Health (LTHH)
o Nursing Facilities (NF)
o Program for All -Inclusive Care for the Elderly (PACE)
Activities include but are not limited to:
o Intake and Referral
o Developmental Disability Determination
o Level of Care Assessment
o Human Rights Committee
o Critical Incident Reporting, Investigations
o Supports Intensity Scale Assessment
o Support Need Level Assessment
o Waiting List Management
Case management, administration, and direct service provision for
the three State General Funded programs including the:
o Family Support Services Program (FSSP)
o State Supported Living Services Program (State SLS)
o Omnibus Reconciliation Act of 1987 Specialized Services
Program (OBRA-SS)
Activities include but are not limited to:
o Intake and Referral
o Developmental Disability and Delay Determination
o Ongoing Case Management
o Assessment
o Service Plan Development
o Monitoring
o Waiting List Management
o Direct Service Provision
Total Contract Amount
(Include each SFY and
the total)
Performance metrics can be
found throughout Exhibit B,
Statement of Work on pages
1 through 51 and within
Exhibit E, Contractor's
FY2024-25 GAE for all CMAs:
Medicaid Admit: No Contract Maximum, Estimate $25,000,000
SGF Programs: $21,791,621
Grand Estimate Total: $46,791,621
The CMA Contract will have one GAE.
Wt°e
Performance Metrics
ureme►1t
What sections of the contract describe performance metrics for the Contractor?
DocuSign Envelope ID: 883B3D7D-3O94-40DA-BD53-OBF5B5C47232
Administrative Requirements
on pages 1 through 22. The
contract outlines specific
performance standards,
deliverables, and timelines
that must be met by the
contractor.
Program expectations can be
found throughout Exhibit B,
Statement of Work on pages
1 through 51 and within
Exhibit E, Contractor's
Administrative Requirements
on pages 1 through 22. The
contract outlines specific
performance standards,
deliverables, and timelines
Where are HCPF Program staff and their Management program expectations
that must be met by the
contractor. Each waiver and
program has specific actions
required to include how the
activity must be completed,
the timeframe, and
requirements for data entry
into the Care and Case
clearly included in the contract?
Management system or
submissions to HCPF.
Exhibit 5, Statement of Work:
Section 9, Compensation and
Invoicing on pages 43 through
45. Reductions to the State
General Fund program
allocation if performance
measures at not met, if
enrollments decrease, or
funding is not utilized.
Section 9.7, Detailed Invoicing
and Payment Procedures on
pages 45 through 51. Specific
payment criteria to ensure
the work is complete,
documented, and approved
as required prior to payment.
Which performance metrics have financial repercussions for failing to meet the
metric?
Section 1.8, Critical Incidents
on pages 11 through 12.
Performance based payments
that are only received if the
specific performance
standards are met each
quarter.
Section 4, State General Fund
Program Obligations on pages
28 - 40. Include specific
requirements for collecting
DocuSign Envelope ID: 883B3D7D-3D94-40DA-BD53-OBF5B5C47232
and maintaining service
documentation. Services
without required
documentation are subject to
recovery.
Specific Provisions
Boilerplate, Section 11,
Breach of Contract on pages
13 through 15.
Exhibit E, Contractor's
Administrative Requirements,
Section 12.23, Corrective
Action Plan on pages 14
through 15
Exhibit E, Contractor's
Administrative Requirements,
Section 12.24 on page 15
What sections of the contract contain requirements that would allow the
Department to readily terminate and replace this contractor if they fail to
perform?
Yes, Exhibit E, Contractor's
Administrative Requirements,
Section 14 Information
Technology Related
Requirements on pages 20
through 22
Does the contract include the appropriate cybersecurity clauses for the risk level
of the contract? If "yes", what sections are these in? If "no", why not?
Payment
Exhibit B, Statement of Work,
Section 9, Detailed Invoicing
and Payment Procedures on
pages 43 through 45. The
contract has specific payment
criteria to ensure the work is
complete, documented, and
approved as required prior to
payment. All payments are
tied to an activity,
performance standard, or
deliverable being completed
prior to payment.
Describe how payments are tied to one of the following:
1. Meeting specific performance standards;
2. Completing deliverables; or
3. Recovering funds for the Department?
The Fee for Service Rates
Division developed the rates
for this Contract. This
included considering caseload
size, activities completed, the
time it takes to complete said
activities, the staff who
completes those activities,
etc.
How were the rates and payments for this contract determined? How do we
know they are competitive and that we are getting a good price for the services
provided?
Partnership
Yes, all requirements and the
draft contract were included
in the request for proposal.
Staff from OCL have also
walked through the contract
How has the contract manager ensured that the contractor understands the
expectations of the Department's business owner?
DocuSign Envelope ID: 883B3D7D-3D94-40DA-BD53-0BF5B5C47232
with all CMAs to ensure they
understand all requirements.
Additionally, OCL holds
quarterly CFO/Contract calls
to discuss contract
requirements, deliverable
expectations, payments,
financial review results, and
subrecipient requirements.
OCL also holds quarterly Case
Management Agency
meetings with case managers,
supervisors, and directors to
discuss contract
requirements, changes to
case management
requirements, outcomes of
performance and quality
reviews, and other impacts to
their agencies. Additionally,
staff from OCL provide
ongoing technical assistance,
training, and guidance
individual and across all
agencies as needed.
Federal and State Compliance
Yes, the CMA Contracts have
been accounted for within
the PACAP. All payments are
tracked by program within
the GAE for CMS 64 reporting.
OCL has worked closely with
Jerrod and Gabriela within
the Accounting Division on
this project.
Has the contract manager verified with Accounting that the contract is
documented in the Public Assistance Cost Allocation Plan (PACAP) or Medicaid
Administrative Claiming (MAC) plan and this documentation includes a description
of the administrative costs, the associated cost allocation (i.e., director indirect)
methodology, the federal financial participation rate, and the benefitting federal
and/or State programs?
The Program Contact, ELT Member, and SET Member listed above document their approval of this form
by approving the eClearance folder containing it.
Contract Form
Entity Information
Entity Name* Entity ID*
DEPARTMENT OF HEALTH CARE @00023890
POLICIES & FINANCIAL
Contract Name* Contract ID
AMENDMENT #1 TO THE INTERGOVERNMENTAL 8296
AGREEMENT C24-188034
Contract Status
CTB REVIEW
Contract Lead *
COBBXXLK
❑ New Entity?
Parent Contract ID
20240121
Requires Board Approval
YES
Contract Lead Email Department Project #
cobbxxlk@co.weld.co.us
Contract Description*
AMEND #1 TO THE INTERGOVERNMENTAL AGREEMENT FOR WCDHS TO SERVE AS A CASE MANAGEMENT AGENCY
TO PERFORM CASE MANAGEMENT ACTIVITIES FOR THE AAA PROGRAM.
THE CMA RFP AND AWARD IS KNOWN TO THE BOARD AS TYLER# 2023-0543.
Contract Description 2
2024-2025 CONTRACT FUNDING AMOUNT TO COVER ADMINISTRATIVE COST OF CONTRACTED WORK RELATED
TO CMA ACTIVITY = $1,579,756.82
Contract Type* Department Requested BOCC Agenda Due Date
AMENDMENT HUMAN SERVICES Date* 06/15/2024
06/19/2024
Amount* Department Email
$1,579,756.82 CM- Will a work session with BOCC be required?*
HumanServices@weldgov. NO
Renewable*
com
NO Does Contract require Purchasing Dept. to be
Automatic Renewal
Grant
IGA
Department Head Email included?
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
RN EY@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
Contact Info
Review Date*
04/30/2025
Committed Delivery Date
Renewal Date
Expiration Date*
06/30/2025
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
06/05/2024
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
06/12/2024
Finance Approver
CHERYL PATTELLI
Legal Counsel
BYRON HOWELL
Finance Approved Date Legal Counsel Approved Date
06/05/2024 06/10/2024
Tyler Ref #
AG 061224
Originator
COBBXXLK
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