HomeMy WebLinkAbout20242887.tiffRESOLUTION
RE: APPROVE CASE MANAGEMENT AGENCY (CMA) SERVICE AGREEMENT TERMS
AND CONDITIONS, AND AUTHORIZE CHAIR TO SIGN - WADSWORTH MEDICAL
ARTS PHARMACY, DBA WARD ROAD PHARMACY
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 Case Management Agency (CMA)
Service Agreement Terms and Conditions 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 Wadsworth Medical Arts Pharmacy, dba Ward Road Pharmacy,
commencing October 1, 2024, and ending June 30, 2025, with further terms and conditions being
as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Case Management Agency (CMA) Service Agreement Terms
and Conditions 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
Wadsworth Medical Arts Pharmacy, dba Ward Road Pharmacy, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 30th day of October, A.D., 2024, nunc pro tunc October 1, 2024.
BOARD OF COUNTY COMMISSIONERS
WELD CO O
ATTEST: L., GI ...v7x4;4
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Weld County Clerk to the Board
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Deputy Clerk to the Board
ounty A orney
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Date of signature:
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Kevi.�! Ross, Chair
Perry L. Bu
Pro-Tem
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It/V24
2024-2887
HR0096
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Case Management Agency Service Agreement with Wadsworth Medical Arts Pharmacy
dba Ward Road Pharmacy
DEPARTMENT: Human Services DATE: October 22, 2024
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: On March 1, 2024, the Weld County Department of Human Services
began serving as the region's Case Management Agency (CMA) as a result of an awarded Request for Proposal
(RFP) through the Colorado Department of Health Care Policy & Financing (HCPF). In order to offer services to
clients as the CMA, the Department is requesting approval of a CMA Service Agreement with the Provider listed
below.
The Service Agreement and Exhibit A have been approved by Legal (B. Howell) and reflect a term date of October
1, 2024 through June 30, 2025 and may be extended upon written agreement by both parties.
CMS ID
Provider
Location
Rate
Approved Services
TBD
Wadsworth Medical Arts
Pharmacy dba Ward Road
Pharmacy
Arvada, Colorado
Approved State
Rate
Specialized Medical Supplies
Specialized Medical Equipment
What options exist for the Board?
Approval of the Case Management Agency Service Agreement.
Deny approval of the Case Management Agency Service Agreement.
Consequences: WCDHS will not have a contract with this provider.
Impacts: WCDHS will not be able to serve the individuals on our caseload.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
Total cost = State approved rates for services.
Pass-thru funding from the Colorado Department of Health Care Policy & Financing (HCPF).
Pass -Around Memorandum; October 22, 2024 - CMS ID 8801
2024-2887
Ili/30 H206th
Recommendation:
• Approval of the Case Management Agency Service Agreement and authorize the Chair to sign.
Support Recommendation Schedule
place on BOCC Agenda Work Session Other/Comments;
Perry L. Buck, Pro-Tem
Mike Freeman
Scott K. James
Kevin D. Ross, Chair
Lori Saine
6.
_____y___,Af-o______
K
Pass Around Memorandum; October 22, 2024 - CMS ID 8801
Case Management Agency (CMA)
Service Agreement Terms and Conditions
This Service Agreement (SA) is made this day OCkO bey 36, ZOZm , by and between Weld
County Department of Human Services, hereinafter referred to as "CMA", having its principal place of
business at 315 North 11th Avenue, Greeley, Colorado 80631, and Wadsworth Medical Arts Pharmacy
dba Ward Road Pharmacy, hereinafter referred to as the "VENDOR," whose business address is 6590
Holman Street, Unit 203, Arvada, Colorado 80004,. NOW THEREFORE, in consideration of the promises
and covenants contained herein, the parties agree as follows:
I. Work and Payment
The VENDOR should not commence services under this Agreement until Services have been approved in
the individual's Service Plan. Services to be provided are detailed in the Individual's State Supported
Living Services (SLS) or OBRA Service Plan which dictates the type of service as well as timing and
frequency of service to be performed. Rates paid for State SLS and OBRA services can be found on the
State Health Care Policy and Financing Website https://hcpf.colorado.gov/provider-rates-fee-schedule
see State General Fund Programs Direct Service Rates Fee Schedule. Reimbursement for all supplies
and equipment will be provided based on the actual purchase price of the item. The VENDOR shall
include in their monthly invoice the date and duration of services performed.
Specific work performance expectations that are deemed appropriate and necessary in order to receive
compensation for the work must meet specified State Regulations. Services covered in this agreement
are listed in Exhibit B, Scope of Services and Rates. The VENDOR affirms the following requirements are
met, as defined by the State of Colorado:
The service to be delivered shall meet all applicable state licensing requirements for the
performance of the support or service being provided.
Certificate: The service to be delivered shall meet all applicable state certification requirements for
the performance of the support or service being provided and program approval.
Electronic Visit Verification (EW) is not a requirement for billing State SLS / OBRA services. More
information can be found on the HCPF website https://hcpf.colorado.gov/electronic-visit-verification-
program-manual#coEWX
II. Intent of the Parties:
It is the expressed intent of the parties that the Contractor is a VENDOR and not the agent, employee, or
servant of CMA and that:
a. The VENDOR does not have the express or implied authority to act for CMA or to bind CMA to any
agreements, liability, or understanding except as expressly set forth herein.
b. The VENDOR shall be accountable to CMA for the ultimate results of its actions but shall not be
subject to direction and control of CMA herein.
c. Neither the VENDOR nor any agent or employee of the VENDOR shall be or shall be deemed to be an
agent or employee of CMA.
d. The VENDOR shall pay when due all required employment taxes and Income Tax Withholdings,
including all Federal and State Income Tax and Local Tax on any monies paid pursuant to this service
authorization.
e. The VENDOR acknowledges that the VENDOR and its employees are not entitled to unemployment
insurance benefits unless the VENDOR, or a Third Party provides such coverage, and that CMA does
not pay for or otherwise provide such coverage.
f. The VENDOR shall provide and keep in force Worker's Compensation and show proof of such
insurance; and unemployment compensation insurance in the amounts required by law and shall be
solely and entirely responsible for the acts of the VENDOR, its employees, and agents. The VENDOR
shall furnish CMA with written certification of the existence of such coverage prior to the finalization
of service authorization provisions.
III. VENDOR Responsibilities:
a. COMPLIANCE WITH THE LAW: The VENDOR agrees to perform its duties and obligations hereunder
in strict conformity with relevant federal law, all pertinent federal regulations promulgated pursuant
to federal law, the Home and Community -Based Services for Persons with Developmental Disabilities
Act; 10 Code of Colorado Regulations (CCR) 2505-10 8.500; 10 CCR 2505-10 8.600 Colorado Revised
Statute (CRS); Title 25.5 Article 10 et seq., relevant State law, and all pertinent regulations of the
Colorado Department of Human Services, Colorado Department of Health Care Policy and Financing,
and Colorado Department of Public Health and Environment, as they currently exist or may hereafter
be amended.
b. LICENSES AND CERTIFICATIONS: The VENDOR represents and warrants to CMA that it and its
employees have the requisite training, skills, experience, qualifications, all necessary provider
numbers, licenses, certifications, approvals, etc. required to properly provide the services or goods
covered by this authorization.
c. RECORDS: The VENDOR shall maintain a complete file of all records, communications, documents,
and other written materials that pertain to the operation of programs or the delivery of services
under this SA and shall maintain such records for a period of six (6) years after the date of
termination of this SA as per State requirements, or for such further period as may be necessary to
resolve any matters which may be pending. All files shall be kept at the VENDOR's place of business,
and the VENDOR shall furnish copies of such files, or portions thereof, as requested by CMA or its
designee.
d. INSPECTIONS AND PERFORMANCE MONITORING: The VENDOR shall permit CMA, the State of
Colorado, the Colorado Department of Health Care Policy and Financing, the U.S. Department of
Health and Human Services, and any other duly authorized agent or governmental agency (including
the Medicaid Fraud Control Unit) to monitor all activities authorized under this SA. Such monitoring
may consist of internal evaluation procedures, examination of data, formal audit, on -site checking, or
any other reasonable procedure. Any amounts which have been paid by CMA, and which are found
to be improper in accordance with the terms of this SA shall be immediately returned to CMA or may
be withheld from future payments. 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.
e. ASSIGNMENT/DELEGATION/SUBCONTRACTORS: The VENDOR shall not assign, delegate, nor
subcontract services in this SA without the express prior written consent of CMA.
f. INSURANCE:
i. The VENDOR agrees that it will keep in force an insurance policy or policies, issued by a
company authorized to do business in Colorado, in the kinds and minimum amounts specified
below unless specifically waived herein. In the event of cancellation of any such coverage, the
VENDOR shall immediately notify CMA of such cancellation.
ii. The VENDOR shall have CMA and State of Colorado Health Care Policy and Financing listed as
"Additional Insured" on VENDOR's insurance policies.
iii. Standard Worker's Compensation and Employers' Liability as required by State statute,
including occupational disease, covering all employees on or off the work site acting within the
course and scope of their employment.
iv. General, Personal Injury, Professional, Automobile Liability (including bodily injury, personal
injury, and property damage) minimum coverages:
v. Occurrence basis policy: combined single limit of $1,000,000 or Claims -Made policy: combined
single limit of $1,000,000; plus, an endorsement, certificate, or other evidence that extends
coverage two years beyond the performance period of the service authorization.
vi. Annual Aggregate Limit policy: Not less than $1,000,000 plus an agreement that the IC will
purchase additional insurance to replenish the limit to $1,000,000 if claims reduce the annual
aggregate below $1,000,000.
vii. The insurance shall include provisions preventing cancellation without thirty (30) calendar days
prior written notice to CMA by certified mail.
viii. The VENDOR shall provide certificates of adequate insurance coverage to CMA within ten (10)
days of receipt of this service authorization.
IV. Payment for Services and Term:
a. This contract shall be for a term commencing October 1, 2024 through June 30, 2025 and may be
extended upon written agreement of both parties.
b. Monthly Invoicing for Services: The VENDOR shall invoice CMA within four (4) working days of the
end of the month in which the services were performed, except at the end of the fiscal year when
invoices are due two (2) working days from the end of the fiscal year. Invoices received within this
time frame will be paid Net 30 unless otherwise noted on the invoice. Invoices may be sent via email
to wccmabilling@weld.gov
c. Vendor must include the following detail on invoices in order to be paid for services:
i. Name of individual in services
ii. Dates of Service
iii. For services paid in 15 -minute increments, invoice must show the amount of time services
were provided in hours or 15 -minute increment
iv. Rate per 15 -minute increment or Rate per hour (per State General Fund fee schedule)
v. Total Amount Due
vi. "No shows" are not billable to Medicaid and will not be reimbursed. Do not include "No
shows" in your billing ("No shows" include family cancelling or provider cancelling)
d. Invoicing for Supplies/Equipment: The VENDOR shall invoice CMA within sixty (60) days of the end of
the month in which the client received the supplies/equipment, except at the end of the fiscal year
when invoices are due two (2) working days from the end of the fiscal year for all State General Fund
invoices. Invoices received within this time frame will be paid Net 30 unless otherwise noted on the
invoice. Invoices may be sent via email to wccmabilling@weld.gov
e. Vendor must include the following detail on invoices in order to be paid for services:
i. Name of individual in services
ii. Dates of Supply delivery/pickup
iii. Total Amount Due
f. In order to comply with HCPF State General Funds reporting requirements, no invoices received from
the VENDOR after July 3, 2025, for Fiscal Year July 1, 2024 thru June 30, 2025 will be accepted or paid
by CMA, the date of July 3, 2025 is subject to change pending Fiscal Year 24-25 holiday schedule.
g. Services may be increased or decreased during the term of this agreement by either party due to
increased or decreased State funding levels or adjustments to service levels, with the agreement by
both parties.
h. In the event that overpayments are made by CMA due to the VENDOR's omission, error, fraud, or
defalcation; or in the event that the State or Federal government seeks to recover from CMA any
sums of money based upon a claim on behalf of the VENDOR after said funds have been paid to the
VENDOR, the VENDOR shall immediately reimburse such funds to CMA as allowed by law. The
parties understand and agree that CMA shall have the right to offset against payments due to the
VENDOR hereunder, or by other legal means recover any debts owed by the VENDOR to CMA or to
the State.
V. General Terms and Conditions:
a. TERMINATION: Except as otherwise agreed in Section I, if the VENDOR refuses or fails to perform any
of the provisions of this SA in a timely manner, CMA may notify the VENDOR in writing of
nonperformance and may terminate VENDOR's right to proceed with the SA. In addition, either party
shall have the right to terminate this SA, without cause, by giving the other party 30 days written
notice. If notice is so given, this SA shall terminate on the expiration of the thirty (30) days, and the
liability of the parties hereunder for further performance of the terms of this agreement shall
thereupon cease, but the parties shall not be released from the duty to perform their obligations up
to the date of termination.
b. COMPLETE SERVICE AUTHORIZATION: This SA contains the entire agreement of the parties.
c. INDEMNIFICATION: To the extent authorized by law, the VENDOR shall indemnify, save, and hold
harmless CMA, its employees, and agents against any and all claims, damages, liability, and court
awards including costs, expenses, and attorney fees incurred as a result of any act or omission by the
VENDOR or its employees, agents, subcontractors, or assignees pursuant to the terms of this SA.
d. NON-DISCRIMINATION: The VENDOR agrees to comply with the letter and spirit of all applicable
State and federal laws respecting discrimination and unfair employment practices.
e. CONFIDENTIALITY OF RECORDS: The VENDOR shall protect the confidentiality of all records
containing personal identifying information that are maintained in accordance with this SA. No such
information shall be released except for program administration purposes or with the subject
individual's prior written consent.
f. CONFLICT OF INTEREST: The VENDOR shall fully disclose to CMA any relationship(s) it has with a third
party where such relationship is in opposition or conflict to its relationship with CMA under this SA.
g. Health Insurance Portability & Accountability Act of 1996 ("HIPAA"). Federal law governing the
privacy of certain health information requires a "Business Associate" service authorization between
CMA and the VENDOR. 45 CFR Section 164.504(e). Attached and incorporated herein by reference as
Exhibit A is a HIPAA Business Associate Addendum for HIPAA compliance.
h. BACKGROUND CHECKS: As per C.R.S. 27-90-111, the VENDOR shall conduct background (criminal
record) and reference checks prior to hiring staff and volunteers or contracting with other providers.
The VENDOR shall not employ, contract with, or accept volunteer services from individuals who
would have unsupervised contact with or access to persons receiving services under this service
authorization, or their property and who have been convicted of abuse, neglect, or mistreatment of
a child, adult or person receiving services, or of a misdemeanor or felony involving physical harm or
violence to another individual, or distribution of controlled substances.
CONTRACTS FOR SERVICE — ILLEGAL ALIENS: The VENDOR shall not knowingly employ or contract
with illegal aliens to perform work under this service authorization or enter into a contract with a
subcontractor that fails to certify to VENDOR that the subcontractor knowingly does not employ or
contract with illegal aliens to perform work under this service authorization. The VENDOR, if a
natural person eighteen (18) years of age or older, hereby swears or affirms under penalty of perjury
that he or she (i) is a citizen or otherwise lawfully present in the United States pursuant to federal
law, (ii) shall comply with the provisions of CRS 24-76.5-101 et seq. and (iii) shall produce
identification required by CRS 24-76.5-103 prior to the effective date of this service authorization.
j. If there is a dispute, VENDORs are to follow Section 25.5-10-212 CRS,
k. The VENDOR agrees to abide by the following CMA policies and procedures located on the CMA
website at https://www.weld.gov/Government/Departments/Human-Services/Area-Agency-on-
Aging-AAA
i. Critical Incidents
ii. Mistreatment
iii. Human Rights Committee (HRC)
FEDERAL FALSE CLAIMS ACT 31 US Code 3729: The VENDOR, its employees, subcontractors, and
agents shall comply with the Federal False Claims Act. Violations of the False Claims Act such as false
claims or attempts to defraud health care programs should be promptly reported, investigated, and
remedied, as appropriate and required by law. Detailed information regarding the False Claims Act
and CMA's policy can be found on the CMA website.
The parties have caused their duly authorized representatives to sign this Service Authorization
Agreement stated above:
CMA:
ATTEST ', -s !�:OARD OF COUNTY COMMISSIONERS
LD CO.. .
O
BY:
Deputy Clerk to the B
D. Ross, Chair
NDOR:
OC 3 0 2024
Wadsworth Medical Arts Pharmacy
dba Ward Road Pharmacy
6590 Holman Street, Unit 203
Arvada, Colorado 80004
By:Lance Barnard (Oct 15, 2024 16:51 MDT)
Lance Barnard, President
Date: Oct 15, 2024
020aaL-agg7
Exhibit A
CMA
HIPAA BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement ("Agreement") is part of federal and state requirements of
CMA For purposes of this Agreement, CMA is referred to as "Covered Entity" or "CE" and VENDOR is
referred to as the "Business Associate" or "Associate." The Associate performs, or assists in the
performance, of a function or activity, or provides services of a type for CMA that makes the Associate
a "Business Associate" for purposes of the HIPAA privacy regulations.
The CE may disclose protected health information to the Associate in conjunction with the function,
activity, or services performed or provided by the Associate. The CE and the Associate desire to enter
into an agreement as required by the HIPAA privacy regulations to provide satisfactory assurance to
CMA that the Associate will appropriately safeguard that protected health information (PHI).
RECITALS
A. CE and Associate intend to protect the privacy and provide for the security of PHI disclosed to
Associate pursuant to this Agreement in compliance with the Health Insurance Portability and
Accountability Act of 1996, 42 U.S.C. §1320d — 1320d-8 ("HIPAA"), as amended by the American
Recovery and Reinvestment Act of 2009 ("ARRA")/HITECH Act (P.L. 111-005), and its
implementing regulations promulgated by the U.S. Department of Health and Human Services,
45 C.F.R. Parts 160, 162 and 164 (the "HIPAA Rules") and other applicable laws, as amended.
B. As part of the HIPAA Rules, the CE is required to enter into an agreement containing specific
requirements with Associate prior to the disclosure of PHI, as set forth in, but not limited to,
Title 45, Sections 160.103, 164.502(e) and 164.504(e) of the Code of Federal Regulations
("C.F.R.") and contained in this Agreement.
The parties agree as follows:
1. Term. Except as otherwise provided for herein, this Agreement will continue in full force and
effect through the term of any function, activity, or services performed or provided by the Associate.
2. Definitions.
a. Except as otherwise defined herein, capitalized terms in this Agreement shall have the
definitions set forth in the HIPAA Rules at 45 C.F.R. Parts 160, 162 and 164, as amended. In the event
of any conflict between the mandatory provisions of the HIPAA Rules and the provisions of this
Agreement, the HIPAA Rules shall control.
b. "Protected Health Information" or "PHI" means any information, whether oral or
recorded in any form or medium: (i) that relates to the past, present, or future physical or mental
condition of an individual; the provision of health care to an individual; or the past, present, or future
payment for the provision of health care to an individual; and (ii) that identifies the individual or with
respect to which there is a reasonable basis to believe the information can be used to identify the
individual and shall have the meaning given to such term under the HIPAA Rules, including, but not
limited to, 45 C.F.R. Section 164.501.
c. "Protected Information" shall mean PHI provided by CE to Associate or created,
received, maintained, or transmitted by Associate on CE's behalf. To the extent Associate is a covered
entity under HIPAA and creates or obtains its own PHI for treatment, payment, and health care
operations, Protected Information under this Agreement does not include any PHI created or obtained
by Associate as a covered entity and Associate shall follow its own policies and procedures for
accounting, access and amendment of Associate's PHI.
3. Obligations of Associate.
a. Permitted Uses. Associate shall not use Protected Information except for the purpose of
performing Associate's obligations as permitted under this Agreement. Further, Associate shall not use
Protected Information in any manner that would constitute a violation of the HIPAA Rules if so used by
CE, except that Associate may use Protected Information: (i) for the proper management and
administration of Associate; (ii) to carry out the legal responsibilities of Associate; or (iii) for Data
Aggregation purposes for the Health Care Operations of CE. Associate agrees to defend and indemnify
the CE against third party claims arising from Associate's breach of this Agreement.
b. Permitted Disclosures. Associate shall not disclose Protected Information in any manner
that would constitute a violation of the HIPAA Rules if disclosed by CE, except that Associate may
disclose Protected Information: (i) in a manner permitted pursuant to this Agreement; (ii) for the
proper management and administration of Associate; (iii) as required by law; (iv) for Data Aggregation
purposes for the Health Care Operations of CE; or (v) to report violations of law to appropriate federal
or state authorities, consistent with 45 C.F.R. Section 164.502(j)(1).
c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are
necessary to prevent the use or disclosure of Protected Information other than as permitted by this
Agreement. Associate shall comply with the requirements of the HIPAA Security Rule at 45 C.F.R.
Sections 164.308, 164.310, 164.312, and 164.316. Associate shall maintain a comprehensive written
information privacy and security program that includes administrative, technical, and physical
safeguards appropriate to the size and complexity of the Associate's operations and the nature and
scope of its activities. Associate shall review, modify, and update documentation of its safeguards as
needed to ensure continued provision of reasonable and appropriate protection of Protected
Information.
d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing any use
or disclosure of Protected Information other than as provided for by this Agreement within five (5)
business days of becoming aware of such use or disclosure.
e. Accounting Rights. Associate and its agents shall make available to CE, within ten (10)
business days of notice by CE, the information required to provide an accounting of disclosures to
enable CE to fulfill its obligations under the HIPAA Rules, including, but not limited to, 45 C.F.R. Section
164.528. In the event that the request for an accounting is delivered directly to Associate or its agents,
Associate shall within five (5) business days of the receipt of the request, forward it to CE in writing. It
shall be CE's responsibility to prepare and deliver any such accounting requested. Associate shall not
disclose any Protected Information except as set forth in Section 2(b) of this Agreement.
f. Governmental Access to Records. Associate shall keep records and make its internal
practices, books and records relating to the use and disclosure of Protected Information available to
the Secretary of the U.S. Department of Health and Human Services (the "Secretary,") in a time and
manner designated by the Secretary, for purposes of determining CE's or Associate's compliance with
the HIPAA Rules. Associate shall provide to CE a copy of any Protected Information that Associate
provides to the Secretary concurrently with providing such Protected Information to the Secretary
when the Secretary is investigating CE. Associate shall cooperate with the Secretary if the Secretary
undertakes an investigation or compliance review of Associate's policies, procedures or practices to
determine whether Associate is complying with the HIPAA Rules, and permit access by the Secretary
during normal business hours to its facilities, books, records, accounts, and other sources of
information, including Protected Information, that are pertinent to ascertaining compliance.
g. Minimum Necessary. Associate (and its agents) shall only request, use, and disclose the
minimum amount of Protected Information necessary to accomplish the purpose of the request, use,
or disclosure, in accordance with the Minimum Necessary requirements of the HIPAA Rules, including,
but not limited to, 45 C.F.R. Sections 164.502(b( and 164.514(d).
h. Data Ownership. Associate acknowledges that Associate has no ownership rights with
respect to the Protected Information.
i. Retention of Protected Information. Except upon termination of all functions, activities,
or services performed or provided by the Associate, Associate or agents shall retain all Protected
Information and shall continue to maintain the information for a period of six (6) years.
j. Notification of Breach. During the term of this Agreement, Associate shall notify CE
within five (5) business days of any suspected or actual breach of security, intrusion or unauthorized
use or disclosure of Protected Information and/or any actual or suspected use or disclosure of data in
violation of any applicable federal or state laws or regulations. Associate shall not initiate notification
to affected individuals per the HIPAA Rules without prior notification and approval of CE. Information
provided to CE shall include the identification of each individual whose unsecured PHI has been, or is
reasonably believed to have been accessed, acquired or disclosed during the breach. Associate shall
take (i) prompt corrective action to cure any such deficiencies and (ii) any action pertaining to such
unauthorized disclosure required by applicable federal and state laws and regulations.
k. Safeguards During Transmission. Associate shall be responsible for using appropriate
safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and
security of Protected Information transmitted to CE pursuant to the Agreement, in accordance with
the standards and requirements of the HIPAA Rules.
I. Restrictions and Confidential Communications. Associate will not respond directly to an
individual's requests to restrict the use or disclosure of Protected Information or to send all
communication of Protected Information to an alternate address. Associate will refer such requests to
the CE so that the CE can coordinate and prepare a timely response to the requesting individual and
provide direction to Associate.
4. Obligations of CE.
a. Safeguards During Transmission. CE shall be responsible for using appropriate
safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and
security of Protected Information transmitted pursuant to this Agreement, in accordance with the
standards and requirements of the HIPAA Rules.
b. Notice of Changes. CE maintains a copy of its Notice of Privacy Practices on its website.
CE shall provide Associate with any changes in, or revocation of, permission to use or disclose Protected
Information, to the extent that it may affect Associate's permitted or required uses or disclosures. To
the extent that it may affect Associate's permitted use or disclosure of PHI, CE shall notify Associate of
any restriction on the use or disclosure of Protected Information that CE has agreed to in accordance
with 45 C.F.R. Section 164.522.
5. Reasonable Steps to Cure Breach.
a. If CE knows of a pattern of activity or practice of Associate that constitutes a material
breach or violation of the Associate's obligations under the provisions of this Agreement or another
arrangement, then CE shall take reasonable steps to cure such breach or end such violation. If Associate
knows of a pattern of activity or practice of an agent that constitutes a material breach or violation of
agent's obligations under the written agreement between Associate and the agent, Associate shall take
reasonable steps to cure such breach or end such violation, if feasible.
6. Disposition of the PHI upon Termination or Expiration.
a. Upon termination or expiration of any agreement for services between the Parties, the
Associate will either return or destroy, at CE's sole discretion and in accordance with any instructions
by CE, all PHI in the possession or control of the Associate and its agents. However, if the Associate
determines that neither the return nor destruction of the PHI is feasible, the Associate may retain the
PHI provided that the Associate complies with those reasonable restrictions imposed by the CE.
7. Disclaimer. CE makes no warranty or representation that compliance by Associate with this
Agreement or the HIPAA Rules will be adequate or satisfactory for Associate's own purposes. Associate
is solely responsible for all decisions made by Associate regarding the safeguarding of PHI.
8. Assistance in Litigation or Administrative Proceedings. Associate shall make itself and any
employees or agents assisting Associate in the performance of its obligations under the Agreement,
available to CE, at no cost to CE, up to a maximum of thirty (30) hours, to testify as witnesses or
otherwise, in the event of litigation or administrative proceedings being commenced against CE, its
directors, officers, or employees based upon a claimed violation of the HIPAA Rules or other laws
relating to security and privacy or PHI, in which the actions of Associate are at issue, except where
Associate or its employee or agent is a named adverse party.
9. Interpretation and Order of Precedence. The provisions of this Agreement shall be interpreted
as broadly as necessary to implement and comply with the HIPAA Rules. The parties agree that any
ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is consistent
with the HIPAA Rules.
10. Survival of Certain Agreement Terms. Notwithstanding anything herein to the contrary,
Associate's obligations under this Agreement shall survive termination of this Agreement and shall be
enforceable by CE as provided herein in the event of such failure to perform or comply by the Associate.
11. Representatives and Notice. For the purpose of the Agreement, the individuals identified on
Page 1 of 4 Pages of this agreement shall be the representatives of the respective parties. All required
notices shall be hand delivered or given by certified or registered mail to the representatives at the
addresses listed at the top of this form.
Exhibit B
Scope of Services and Rates
1. Scope of Services
a. Services to be provided are detailed in the Individual's State Supported Living Services (SLS)
or OBRA Service Plan which dictates the type of service as well as timing and frequency of
service to be performed.
b. Approved VENDOR State SLS and OBRA services provided under this agreement:
❑ D2999: State SLS — Dental
❑ G0176: State SLS — Movement Therapy
❑ H1010: CES — Parent Education
❑ H2019: State SLS — Behavioral Consultation
❑ H2019: DD — Behavioral Counseling Individual
❑ H2019: SLS — Behavioral Counseling Individual
❑ H2019: OBRA—Counseling Individual
❑ H2019: State SLS — Counseling Services Individual
❑ H2021: State SLS - Mentorship
❑ H2023: State SLS — Supp Employment -Job Development
❑ 55130: SLS — Homemaker Basic
❑ S5130: State SLS — Homemaker Basic
❑ S5130: State SLS — Homemaker Enhanced
❑ S5150: State SLS — Respite Individual per 15 minutes
❑ S5151: State SLS — Respite Individual Per Day
❑ S5160: State SLS — Installation of Personal Emergency
❑ S5161: State SLS — Personal Emergency
❑ S5161: SLS — Personal Emergency Response Services
❑ S5165: CES — Home Accessibility Adaptations
❑ S5199: CES—Adapted Therapeutic Recreational Fees
❑ S8940: CES — Hippotherapy - Individual
❑ S8940: SLS — Hippotherapy - Individual
❑ T1019: State SLS - Personal Care
❑ T1999: CES — Adapted Therapeutic Recreational Equipment
❑ T2003: State SLS—Transportation Mileage
❑ T2003: State SLS—Transportation Mileage nonday
❑ T2003: SLS— Transportation Mileage Band 1
❑ T2004: State SLS —Transportation Other
❑ T2004: DD — Transportation — Other (Public Conveyance)
❑ T2004: SLS — Transportation — Other (Public Conveyance)
❑ T2019: State SLS —Job Coaching (Individual)
❑ T2019: State SLS — Supportive Employment Individual
❑ T2019: State SLS — Supportive Employment Group
❑ T2021: State SLS — Day Habilitation Supported Community Connections
O T2021: State SLS — Day Habilitation Supported Community Connections per 15 minutes
❑ T2021: State SLS — Day Habilitation Specialized Habilitation
❑ T2023: State SLS — Group Overnight (Camp)
❑ T2024: State — Behavioral Assessment
® T2028: DD — Specialized Medical Supplies — Disposable
® T2028: SLS - Specialized Medical Supplies - Disposable
® T2029: CES-Specialized Medical Equipment
® T2029: DD — Specialized Medical Equipment
® T2029: SLS — Specialized Medical Equipment
❑ T2035: CES — Assistive Technology
❑ V2799: DD — Vision Services
❑ V2799: SLS — Vision Services
❑ V2799: State SLS — Vision Services
❑ 97124: CES — Massage Therapy
❑ 97124: SLS — Massage Therapy
❑ 10000: State SLS — Acquiring Pest Abatement
2. Provider Rates and Fee Schedule
a. Rates paid for State SLS and OBRA services can be found on the State Health Care Policy and
Financing Website https://hcpf.colorado.gov/provider-rates-fee-schedule, see State General
Fund Programs Direct Service Rates Fee Schedule.
Terms
1. Home and Community Based Service (HCBS) Provider Agency Billing
a. Claims for HCBS services are payable only if submitted in accordance with the
following procedures:
i. VENDOR shall verify Member eligibility prior to delivering services;
ii. VENDOR shall verify a Prior Authorization Request (PAR) has been approved for
the services in question, prior to service provision and claim submission;
iii. Claims shall be submitted to the Fiscal Agent in accordance with Department
billing manuals and policies, outlined in 10 C.C.R. 2505-10 Section 8.043;
iv. Claims shall only be submitted for services the VENDOR is enrolled to provide,
including correct HCBS specialties;
v. Claims shall only be submitted for services provided in accordance with all
applicable federal and state statutes, regulations, and other authorities;
vi. Submitted claims shall include all data elements required to complete the
National Uniform Claim Committee Form 1500 (CMS 1500).
b. Payment shall not exceed rate shown in the Health First Colorado Fee Schedule in
effect on the date services are provided.
c. Pursuant to § 25.5-4-301, C.R.S., VENDOR shall not collect copayments or seek
reimbursement from eligible Members for covered services.
2. Personnel
a. Employee and Contractor records
i. The VENDOR shall maintain records documenting the qualifications and training of
employees and Contractors who provide services to Members.
ii. The VENDOR shall maintain a personnel record for each employee or Contractor.
The record shall contain:
■ Documentation of employee/Contractor qualifications.
Documentation of trainings completed.
Documentation of supervision and performance evaluation or contractor
management.
Documentation that the employee/Contractor was informed of all policies and
procedures required by Section 8.7409.
■ Documentation of the employee's/Contractor's job description.
■ Documentation of a criminal background check and a CAPs check.
3. License/Certification
a. The VENDOR shall meet the enrollment requirements for each service it provides prior
to providing services. The VENDOR shall ensure each employee or independent
Contractor maintains the necessary and appropriate license and/or Certification to
render services. The VENDOR shall maintain documentation of current and valid
individual license(s) and Certification(s) in the personnel record.
4. Medication Administration
a. All employees and Contractors, not otherwise authorized by law to administer
medication, who assist and/or monitor Members in the administration of medications
or the filling of medication reminder boxes shall have passed a "Qualified medication
administration person" or "QMAP" competency evaluation offered by an approved
training entity, and shall be listed on the Department's list of persons who have passed
the requisite competency evaluation as defined in 6 CCR 1011-1, Chapter 24. Each
facility shall ensure the qualifications of the QMAP employee or Contractor per 6 CCR
1011-1, Chapter 24, Section 3.
5. Trainings
a. The VENDOR shall have an organized program of orientation and training of sufficient
scope for employees and Contractors to carry out their duties and responsibilities
efficiently, effectively, and competently. Training shall be provided prior to employees
or Contractors having unsupervised contact with Members. The training program shall,
at a minimum, provide for and include:
i. Training related to person -centered practices, the role of the Person -Centered
Support Plan, and the concept of dignity of risk;
ii. Training related to health, safety, and services and supports to be provided related
to the specific needs and diagnoses of Members served;
iii. Training specific to the individual(s) for whom the employees or Contractors will be
providing services and supports which includes medical or behavioral protocols,
supervision, dietary and Activities of Daily Living (ADL) needs, and Provider
agencies' internal policies and procedures.
6. Rendering Services According to the Person -Centered Support Plan
a. The VENDOR shall maintain, on file, copies of the current Person -Centered Support
Plan for all Members they serve. Staff providing direct care to Members shall have
access to or a copy of the support plan Person -Centered Support Plan and shall render
services as required in the support plan Person -Centered Support Plan.
b. The VENDOR shall render services according to the agreed upon Person -Centered
Support Plan and coordinate with other provider agencies, when applicable. Members
receiving services shall be included in developing the Person -Centered Support Plan
and have the freedom to choose a willing service vendor.
c. The VENDOR shall not condition a Member's receipt of any service on the Member's
agreement to receive other services from the service vendor.
d. The VENDOR shall not discontinue or refuse to provide agreed upon services to a
Member unless documented efforts have been made to resolve the situation that
triggers such discontinuation or refusal to provide services.
7. Incident Reporting
a. The VENDOR shall complete the timely reporting, recording, and reviewing of Incidents
which shall include, but not be limited to:
• Death of Member receiving services;
Hospitalization of Member receiving services;
Medical emergencies, above and beyond first aid, involving Member receiving
services;
Allegations of MANE;
Injury to Member or illness of Member;
Damage or theft of Member's personal property;
Errors in medication administration;
• Lost or missing person receiving services;
• Criminal activity; and
• Incidents or reports of actions by Member receiving services that are unusual
and require review.
b. The VENDOR shall submit a verbal or written report of every Incident to the HCBS
Member's Case Management Agency Case Manager within 24 hours of discovery of
the actual or alleged Incident. The report shall include:
• Name of person reporting;
Name of Member who was involved in the Incident;
• Member's Medicaid identification number;
• Name of persons involved or witnessing the Incident;
• Incident type;
• Date, time, and duration of Incident;
Location of Incident;
Persons involved;
Description of Incident;
Description of action taken;
Whether the Incident was observed directly or reported to the provider;
Name of person notified;
Follow-up action taken or where to find documentation of further
follow-up;
Name of the person responsible for follow up; and
Resolution, if applicable.
c. If any of the above information is not available and reported to the Case Management
Agency Case Manager within 24 hours of the Incident, the VENDOR must submit follow
up information as soon as it is obtained.
d. Additional follow up information may also be requested by the Case Manager, or the
Department. The VENDOR is required to submit all follow up information within the
timeframe specified by the Case Management Agency.
e. VENDOR shall review and analyze information from Incident reports to identify trends
and problematic practices which may be occurring in specific services and shall take
appropriate corrective action to address problematic practices identified.
SIGNATURE REQUESTED: Weld/Ward Road
Pharmacy CMA Service Agreement 24-25
Final Audit Report
2024-10-15
Created: 2024-10-15
By: Sara Adams (sadams@weld.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAqcc_37CIKd_9dlkAtOln5ers5Zcw81Bi
"SIGNATURE REQUESTED: Weld/Ward Road Pharmacy CMA
Service Agreement 24-25" History
5 Document created by Sara Adams (sadams@weld.gov)
2024-10-15 - 10:48:11 PM GMT- IP address: 204.133.39.9
C-1 Document emailed to lbarnard@wardroadrx.com for signature
2024-10-15 - 10:49:14 PM GMT
5 Email viewed by lbarnard@wardroadrx.com
2024-10-15 - 10:50:08 PM GMT- IP address: 96.76.167.22
4 Signer lbarnard@wardroadrx.com entered name at signing as Lance Barnard
2024-10-15 - 10:51:04 PM GMT- IP address: 96.76.167.22
4 Document e -signed by Lance Barnard (lbarnard@wardroadrx.com)
Signature Date: 2024-10-15 - 10:51:06 PM GMT - Time Source: server- IP address: 96.76.167.22
Is
Agreement completed.
2024-10-15 - 10:51:06 PM GMT
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Contract Form
Entity Information
Entity Name *
WARD ROAD PHARMACY
Entity ID*
@00049197
❑ New Entity?
Contract Name* Contract ID
WARD ROAD PHARMACY - CASE MANAGEMENT 8801
AGENCY (CMA) SERVICES AGREEMENT
Contract Status
CTB REVIEW
Contract Lead *
SADAMS
Contract Lead Email
sadams@weld.gov;cobbx
xlk@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description *
WARD ROAD PHARMACY - CASE MANAGEMENT AGENCY (CMA) SERVICES AGREEMENT. TERM 10/1/2024
THROUGH 6/30/2025.
Contract Description 2
PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB ON 10/22/2024.
Contract Type" Department Requested BOCC Agenda Due Date
AGREEMENT HUMAN SERVICES Date* 10/26/2024
10/30/2024
Amount*
$0.00
Renewable *
NO
Automatic Renewal
Grant
IGA
Department Email
CM-
HumanServices@weld.gov
Department Head Email
CM-HumanServices-
DeptHead@weld.gov
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
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
10/23/2024
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
10/30/2024
Finance Approver
CHERYL PATTELLI
Legal Counsel
BYRON HOWELL
Finance Approved Date Legal Counsel Approved Date
10/24/2024 10/28/2024
Tyler Ref #
AG 103024
Originator
SADAMS
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