HomeMy WebLinkAbout20240681.tiffRESOLUTION
RE: APPROVE AUTHORIZATION FORM FOR CERTIFICATION OF ACCESS MANAGERS
FOR MEDICARE AND MEDICAID SERVICES (CMS), AND AUTHORIZE CHAIR TO
SIGN - CENTERS FOR MEDICARE/MEDICAID
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 an Authorization Form for Certification of
Access Managers for Medicare and Medicaid Services (CMS) 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 Public Health and Environment, and the Centers for Medicare/Medicaid,
commencing upon full execution of signatures, with further terms and conditions being as stated
in said form, and
WHEREAS, after review, the Board deems it advisable to approve said form, 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 Authorization Form for Certification of Access Managers for
Medicare and Medicaid Services (CMS) 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
Public Health and Environment, and the Centers for Medicare/Medicaid, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said form.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 20th day of March, A.D., 2024.
ATTEST: di,„44,
Jll�.a:
Weld County Clerk to the Board
BY: In•(J(/lO7
Deputy Clerk to the Board
APP' lVED A O FORM:
County A orneyl
Date of signature: 3r�ri
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY
7C___ 0 ..�
Key' ta-D oss, Chair
Perry L.
ck, Pro-Tem
Mike Freeman
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2024-0681
HL0057
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BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) ACCESS
DEPARTMENT: PUBLIC HEALTH AND ENVIRONMENT DATE: FEBRUARY 22, 2024
PERSON REQUESTING: JASON CHESSHER, EXECUTIVE DIRECTOR
SHAUN MAY, PUBLIC HEALTH SERVICES DIRECTOR
Brief description of the problem/issue:
The Clinical Services Division is currently unable to fully bill for some Medicare and Medicaid services because
staff is unable to update our list of providers in CMS. To resolve this, we seek authorization from the BOCC to
update the enclosed "CMS Authorization" form that will enable staff to update the list of clinical providers
(registered nurses, nurse practitioners, and physicians) to enable the department to bill for services provided.
Additionally, we seek to update the authorization of "Access Managers" as the two individuals current
authorized no longer work for the department. Sonya Oster, Business Operations Manager,.aeel-Sheer,
Rebus -H , will be designated as the new "Access Managers". Authorization by the
BOCC Chair will allow current staff to update and add new providers into the CMS system.r-'
What options exist for the Board? . (h,,4 -t ,
Consequences: Previous staff with current access to the CMS account need to be removed. Updating the
"Access Managers" will allow current staff will allow to obtain NPI numbers for new clinical staff (registered
nurses, nurse practitioners, and physicians) so that we can bill Medicaid for covered services provided to
patients.
Impacts: Without approval from the Board, the department is unable to fully receive reimbursement for
services provided. This results in a missed opportunity for additional revenue to offset County costs.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
There is no cost associated with making this change, but the change will result in an increase in revenue due
to more effective billing for services provided.
Recommendation: I recommend approval/authorization by the Board to update the CMS Authorization form.
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
Via &qui
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2024-0681
3/2,
Karla Ford
From:
Sent:
To:
Cc:
Subject:
Approve thanks
** Sent from my iPhone **
ScotttJames
Thursday, February 22, 2024 8:10 AM
Karla Ford
Kevin Ross; Lori Saine
Re:Please Reply= Health' CMsS.pass'around
Scott K. James
Weld County Commissioner, District 2
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
970.336.7204 (Office)
970.381.7496 (Cell)
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning
the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
On Feb 22, 2024, at 7:52 AM, Karla Ford <kford@weld.gov> wrote:
Please advise if you support recommendation and to have department place on the agenda.
Karla Ford X
Office Manager, Board of Weld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kford@weldgov.com :: www.weldgov.com :.
**please note my working hours are Monday -Thursday 7:00a.m. 5:00p.m.*"
<image003.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings ore intended only for the person or entity to
which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you hove received
this communication in error, please immediately notify sender by return a -moil and destroy the communication. Any disclosure, copying,
distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named
recipient is strictly prohibited.
Karla Ford
From:
Sent:
To:
Subject:
Yes apprgve
Kevin Ross
KeViriiRoss
Thursday, February 22, 2024 8:03 AM
Karla Ford; Scott James; Lori Saine
Re Please=Reply, .Health CMS pass around :
From: Karla Ford <kford@weld.gov>
Sent: Thursday, February 22, 2024 7:52:05 AM
To: Kevin Ross <kross@weld.gov>; Scott James <sjames@weld.gov>; Lori Saine <Isaine@weld.gov>
Subject: Please Reply - Health CMS pass around
Please advise if you support recommendation and to have department place on the agenda.
Karla Ford X
Office Manager, Board of Obld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kfordOwetdgov.com :: www.weldgov.com :.
**Please note my working#tours are Monday -Thursday 7:OOa.m.-5:OOp.m."
Confidentiality Notice: This electronic transmission and any attached documents or other writings ore intended only for the person or entity to which it is addressed
and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender by return a -mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of
this communication or any attachments by anyone other than the named recipient is strictly prohibited
From: Jason Chessher <jchessher@weld.gov>
Sent: Thursday, February 22, 2024 7:26 AM
To: Karla Ford <kford@weld.gov>
Cc: Shaun May <smay@wetd.gov>
Subject: CMS pass around
Good morning again,
This is the first of two pass arounds for the Board. Let me know if you need anything on my end.
Jason Chessher
Executive Director
Weld County Department of Public Health & Environment
1555 N 17th Ave, Greeley, CO 80631
970-400-2293
Karla Ford
From:
Sent:
To:
Subject:
:yes,
Lori Saine
Weld County Commissioner, District 3
1150 O Street
PO Box 758
Greeley CO 80632
Phone: 970-400-4205
Fax: 970-336-7233
Email: Isaineweldeov.com
Website: www.co.weld.co.us
In God We Trust
113ri Saine
Thursday, February 22, 2024 8:19 AM
Karla Ford
R€ Please Reply -,Health. CMS pass around
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Karla Ford <kford@weld.gov>
Sent: Thursday, February 22, 2024 7:52 AM
To: Kevin Ross <kross@weld.gov>; Scott James <sjames@weld.gov>; Lori Saine <Isaine@weld.gov>
Subject: Please Reply - Health CMS pass around
Importance: High
Please advise if you support recommendation and to have department place on the agenda.
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
Creation Date :02/07/2024
Tracking Id: D10715233
Certification of Access Manager for an Organization
YOU MUST PRINT ALL PAGES, COMPLETE ALL FIELDS, FOLLOW ALL INSTRUCTIONS
BELOW, AND SUBMIT ALL PAGES TO CMS.
SECTION 1 - PURPOSE AND INSTRUCTIONS:
The purpose of this Access Manager Certification is for the Authorized Official listed below to confirm that they
are aware that the individual identified as the Access Manager has requested access to act on behalf of the
Organization listed below, and that the Authorized Official approves this individual may act on the
Organization's behalf when accessing CMS computer systems, including but not limited to Provider Enrollment,
Chain and Ownership System (PECOS).
For the purposes of this Certification, the following definitions apply:
. Authorized Official: An appointed official of the Organization with the legal authority to conduct business
related to the Organization, including if applicable enrollment of the Organization in Medicare in accordance
with Medicare statutes, regulations, and instructions.
. Individual Provider: An individual provider that submits claims to the Medicare Part B programs and provides
Medicare -covered medical items and services to Medicare beneficiaries.
. Organizational Provider: An organizational entity (including a group practice) that submits claims to the
Medicare Part A and/or Part B Medicare programs and provides Medicare -covered medical items and services
to Medicare beneficiaries.
. Organization: An Organizational Provider or other organizational entity registered in a CMS computer systems
for the sole purpose of acting on behalf of a Individual or Organizational Providers with respect to the Medicare
Program.
When you have completed and confirmed all information below you submit all pages, and a copy of the CP575
for the Organization to CMS via CMS External User Services.
Please contact the CMS External User Services (EUS) Help Desk should you have any questions regarding this
Access Manager Certification. Please return all pages and completed and signed to: CMS External User
Services (EUS) Help Desk, PO Box 792750, San Antonio TX 78279, Phone Number: (866) 484-8049
SECTION 2 - CONFIRMATION OF UNDERSTANDING AND PENALTIES FOR FALSIFYING
INFORMATION FOR INDIVIDUAL OR ORGANIZATION PROVIDER
By signing below and submitting this information to CMS the individual identified in Section 3B ("Authorized
Official") confirms that they are an Authorized Official as defined above for the Organization identified in
Section 3A ("Organization"), and that: i) the individual identified in Section 3C ("Access Manager") is a
representative of the Organization; ii) is employed by the Organization; iii) has been authorized by the
Organization to access CMS computer systems on its behalf and modify or view any information contained
therein that the Organization may have permission or right to access; and iv) to conduct business with the
Medicare program in accordance with Medicare statutes, regulations, and instructions. The signatures below
further confirm that both the Authorized Official and Access Manager have read, understand, and agree to all
statements herein, including the following:
18 U.S.C. I/A 1001 authorizes criminal penalties against an individual who, in any matter within the
jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals or
covers up by any trick, scheme or device a material fact, or makes any false, fictitious or fraudulent statements
or representations, or makes any false writing or document knowing the same to contain any false, fictitious or
fraudulent statement or entry. Individual offenders are subject to fines of up to $250,000 and imprisonment for
0.2002 fG O.1 s/
up to five years. Offenders that are organizations are subject to fines of up to $500,000(18 U.S.C. ii'/z 3571).
Section 3571(d) also authorizes fines of up to twice the gross gain derived by the offender if it is greater than the
amount specifically authorized by the sentencing statute.
Any deliberate omission, misrepresentation, or falsification of any information contained in this application or
contained in any communication supplied to Medicare or its contractors, or any deliberate alteration of any text
on this confirmation, may be punishable by criminal, civil, or administrative penalties including, but not limited
to, the denial or revocation of Medicare billing privileges and/or imposition of fines, civil damages, and/or
imprisonment.
Section 3A - Organization Information: Tracking Id:D10715233
Organization's Legal Business Name: WELD COUNTY BOARD OF COMMISSIONERS,
ON BEHALF OF THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
EIN:
846000813
NPI:
N/A
Section 3B -Authorized Official for Organization: Tracking Id:D10715233
I, the undersigned, certify that I have read and agree to all statements within the confirmation, and that all
information contained herein is true, correct, and complete. I agree that if I become aware that any information
contained herein is not true, correct, or complete, I shall notify the CMS EUS Help Desk of this fact
immediately.
Authorized Official Full Name (First, Middle, Last, Jr., Sr., M.D., D.O., etc):
Kevin D. Ross, Chair
Phone Number:
970-400-4228
E-mail Address:
BOC �weld.gov
SSN:
(J'it‘.D--"-ei/2 (14)
Authorized Official Signature: X (:),
Date Signed: 03/20/2024
«—
Section 3C - Access Manager Information: Tracking Id:D10715233
I, the undersigned, certify that I have read and agree to all statements within the confirmation, and that all
information contained herein is true, correct, and complete. I agree that if I become aware that any information
contained herein is not true, correct, or complete, I shall notify the CMS EUS Help Desk of this fact
immediately.
Access Manager Full Name (First, Middle, Last, Jr., Sr., M.D., D.O., etc):
Sonya Oster
Phone Number:
303-868-0087
E-mail Address:
sosteK weld.gov
SSN:
XX'Y XX-9940
Access Manager Signature:
Sari (34.amt.
Date Signed (MM/DD/YYYY):
03/04/2024
02002 D�8
Esther Gesick
From:
Sent:
To:
Cc:
Subject:
Hi Shaun,
Houstan Aragon
Monday, March 18, 2024 11:34 AM
Bill Fritz; Health Contracts
CTB; Shaun May
RE: Contract ID #7908
Thank you for the phone call explaining at this time the Authorization Form is only to reflect Sonya. I will be on
the lookout for the updated PA to reflect that change.
Best,
Houstan Aragon
Deputy Clerk to the Board
Clerk to the Board's Office
Weld County
1150 O Street
Greeley, CO 80631
Tel: (970) 400-4224
Email: harapon@weld.gov
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended
only for the person or entity to which it is addressed and may contain information that is privileged, confidential
or otherwise protected from disclosure. If you have received this communication in error, please immediately
notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the
taking of any action concerning the contents of this communication or any attachments by anyone other than
the named recipient is strictly prohibited.
From: Houstan Aragon
Sent: Monday, March 18, 2024 11:22 AM
To: Bill Fritz <bfritz@weld.gov>; Health Contracts <Health-Contracts@weld.gov>
Cc: CTB <CTB@co.weld.co.us>; Shaun May <smay@weld.gov>
Subject: Contract ID #7908
Good morning Bill and Health Contracts Team,
Sonya Oster and Shaun May are to be designated as Access Managers, according to the PA that
accompanied the Authorization Form for Certification of Access Managers for Medicare and Medicaid Services
(CMS); however, the Form only reflects Ms. Oster and not Mr. May.
Please provide a secondary form filled out with Mr. May's information and signature. I will add that to the
current form to have both approved with one resolution. Since both legal and finance have review and
approved the form, there will be no need to have this second one routed. Please reach out if you have
questions.
Best,
Houstan Aragon
Deputy Clerk to the Board
Clerk to the Board's Office
Weld County
1150 O Street
Greeley, CO 80631
Tel: (970) 400-4224
Email: haragon(@weld.gov
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended
only for the person or entity to which it is addressed and may contain information that is privileged, confidential
or otherwise protected from disclosure. If you have received this communication in error, please immediately
notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the
taking of any action concerning the contents of this communication or any attachments by anyone other than
the named recipient is strictly prohibited.
2
Contract For
Entity Information
Entity Name* Entity ID*
CENTER FOR MEDICARE/MEDICAID @00048141
SVCS (CMS)
❑ New Entity?
Contract Name* Contract ID
CENTER FOR MEDICARE/MEDICAID SVCS (CMS) 7908
Contract Status
CTB REVIEW
Contract Description *
CENTER FOR MEDICARE/MEDICAID SVCS (CMS)
Contract Description 2
Contract Type*
AGREEMENT
Amount*
$0.00
Renewable*
YES
Automatic Renewal
YES
Grant
IGA
Department
HEALTH
Department Email
CM-Health@weldgov.com
Department Head Email
CM-Health-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Contract Lead *
BFRITZ
Contract Lead Email
bfritz@weld.gov;Health-
Contracts@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
Requested BOCC Agenda Due Date
Date* 03/16/2024
03/20/2024
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 *
01/01/2025
Renewal Date*
03/04/2025
Committed Delivery Date Expiration Date
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JASON CHESSHER
DH Approved Date
03/06/2024
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
03/20/2024
Finance Approver
CHERYL PATTELLI
Legal Counsel
BRUCE BARKER
Finance Approved Date Legal Counsel Approved Date
03/07/2024 03/13/2024
Tyler Ref #
AG 032024
Originator
BFRITZ
Hello