HomeMy WebLinkAbout20240121.tiffRESOLUTION
RE: APPROVE INTERGOVERNMENTAL AGREEMENT FOR CASE MANAGEMENT
AGENCY (CMA) SERVICES AND AUTHORIZE CHAIR TO SIGN AND SUBMIT
ELECTRONICALLY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an 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 upon full execution of signatures, and ending June 30, 2024, 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 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 electronically sign and submit said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 17th day of January, A.D., 2024.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, rni nRQDO
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Weld County Clerk to the Board
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Deputy Clerk to the Board
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Kevin
Perry L.L. Buo-Tem
Mike Fr-eman
K. James
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BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS AROUND TITLE: Intergovernmental Agreement between Weld County Department of Human Services
and the Colorado Department of Health Care Policy and Financing
DEPARTMENT: Human Services
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
DATE: January 9, 2024
Brief description of the problem/issue: In response to the Case Management Agency (CMA) Request for
Proposal (RFP) and award, known to the Board as Tyler ID# 2023-0543, the Department is requesting to enter
into an Intergovernmental Agreement with the Colorado Department of Health Care Policy and Financing (HCPF)
to serve as a CMA. Under this agreement, WCDHS will perform case management activities such as intake,
screening, referral, disability determination, delay determination, waiting list management, Level of Care
assessments, and needs assessments and administer three (3) State General Fund programs within the Defined
Service Area.
What options exist for the Board?
Approval of the Intergovernmental Agreement between WCDHS and HCPF.
Deny approval of the Intergovernmental Agreement between WCDHS and HCPF.
Consequences: WCDHS will not have an Intergovernmental Agreement to become a Case
Management Agency.
Impacts: If WCDHS does not engage these services, HCPF will have to seek an alternative agency
beyond Weld County. This scenario could result in residents of Weld County being served by
a provider unfamiliar with the region and the services available within it.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
Total cost = Program reimbursement will be based on the CMA Rates Table outlined as Exhibit C within
the IGA.
Funded as a Subrecipient of Federal Funding through the Colorado Department of HCPF.
Recommendation:
• Approval of the Intergovernmental Agreement and authorize the Chair to sign electronically.
Perry L. Buck, Pro-Tem
Mike Freeman
Scott K. James
Kevin D. Ross, Chair
Lori Saine
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
/G
Pass -Around Memorandum; January 9, 2024 — CMS ID 7733
2024-0121
STATE OF COLORADO INTERGOVERNMENTAL
AGREEMENT
COVER PAGE
State Agency
Department of Health Care Policy and Financing
Contract Number
C24-188034
Contractor
Weld County Department of Human Services
Contract Performance Beginning Date
The later of the Effective Date or March 1, 2023
Contract Maximum Amount
No Maximum for any SFY
Initial Contract Expiration Date
June 30, 2024
Contract Authority
Authority to enter into this Contract exists in C.R.S. §25.5-1-
101, et seq. and C.R.S. §25.5-6-1703, et seq.
Contract Purpose
For the Contractor to serve as a Case Management Agency (CMA) to perform case management activities such as intake,
screening, referral, disability determination, delay determination, waiting list management, Level of Care assessments, and
needs assessment and administer three State General Fund programs within the Defined Service Area.
Exhibits and Order of Precedence
The following Exhibits and attachments are included with this Contract:
1. Exhibit A — HIPAA Business Associates Addendum
2. Exhibit B — Statement of Work
3. Exhibit C — Rates
4. Exhibit D — Terminology
5. Exhibit E — Contractor's Administrative Requirements
6. Exhibit F — Sample Option Letter
7. Exhibit G — Federal Provisions
8. Exhibit H — PII Certification
9. Exhibit I — Supplemental Provisions for Federal Awards
10. Exhibit J — Subrecipient of Federal Award Status
In the event of a conflict or inconsistency between this Contract and any Exhibit or attachment, such conflict or inconsistency
shall be resolved by reference to the documents in the following order of priority:
1. Exhibit A, HIPAA Business Associates Addendum
2. Exhibit G, Federal Provisions
3. Exhibit I - Supplemental Provisions for Federal Awards
4. Colorado Special Provisions in §18 of the main body of this Contract
5. The provisions of the other sections of the main body of this Contract
6. Exhibit B, Statement of Work
7. Exhibit C, Terminology
8. Exhibit D, Contractor's Administrative Requirements
9. Exhibit E, Rates
10. Exhibit H, PII Certification
11. Exhibit F, Sample Option Letter
12. Exhibit J — Subrecipient of Federal Award Status
Principal Representatives
For the State: For Contractor:
Sarah McDonnell Kevin D. Ross, Board of County Commissioner Chair
Department of Health Care Policy and Financing Weld County Department of Human Services
303 E. 17th Ave 315 N 11th Avenue, Building C
Denver, CO 80203 Greeley, Colorado 80632
Sarah.McDonnell@state.co.us BOCC-Contracts@co.weld.co.us
c20024/o/�/
DocuSign Envelope ID: 069FD490-1BC2-4451-6588-F26CA8A5C4E8
SIGNATURE PAGE
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
Each person signing this Contract represents and warrants that the signer is duly authorized to execute this Contract and to
bind the Party authorizine such signature.
CONTRACTOR
Kevin D. Ross, Chair, Board of County Commissioners
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By: �r:anBe80,s �OSS
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STATE OF COLORADO
Jared S. Potts, Governor
Department of Health Care Policy and Financing
Kim Bimestefer, Executive Director
DocuSigned by:
By:
1/17/2024 I 11:14 PST
Date:
OBoA8w7a7EA8a93. ..
1/17/2024 I 11:36 PST
Date:
LEGAL REVIEW
Phil Weiser, Attorney General
By: N/A
Date:
In accordance with §24-30-202, C.R.S., this Contract is not valid until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
DocuSigned by:
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By: 76rO.1272643A...
1/17/2024 I 12:27 PST
Effective Date:
TABLE OF CONTENTS
1. PARTIES 2
2. TERM AND EFFECTIVE DATE 2
3. DEFINITIONS 3
4. STATEMENT OF WORK 6
5. PAYMENTS TO CONTRACTOR 6
6. REPORTING - NOTIFICATION 7
7. CONTRACTOR RECORDS 8
8. CONFIDENTIAL INFORMATION -STATE RECORDS 8
9. CONFLICTS OF INTEREST 10
10. INSURANCE 11
11. BREACH OF CONTRACT 13
12. REMEDIES 13
13. DISPUTE RESOLUTION 15
14. NOTICES AND REPRESENTATIVES 15
15. RIGHTS IN WORK PRODUCT AND OTHER INFORMATION 15
16. GENERAL PROVISIONS 17
17. COLORADO SPECIAL PROVISIONS (COLORADO FISCAL RULE 3-3) 19
EXHIBIT A, HIPAA BUSINESS ASSOCIATES ADDENDUM 1
EXHIBIT B, STATEMENT OF WORK 1
EXHIBIT C, RATES 1
EXHIBIT D, TERMINOLOGY 1
EXHIBIT E, CONTRACTOR'S ADMINISTRATIVE REQUIREMENTS 1
EXHIBIT F, SAMPLE OPTION LETTER 1
EXHIBIT G, FEDERAL PROVISIONS 1
EXHIBIT H, PII CERTIFICATION 1
EXHIBIT I, SUPPLEMENTAL PROVISIONS FOR FEDERAL AWARDS 1
EXHIBIT J, SUBRECIPIENT OF FEDERAL AWARD STATUS 1
Contract Number: C24-188034
Page 1 of 21 Version 0521
1. PARTIES
This Contract is entered into by and between the STATE OF COLORADO acting by and through
the State agency named on the Cover Page for this Contract (the "State," the "Department," or
"HCPF") and Contractor named on the Cover Page for this Contract (the "Contractor"). Contractor
and the State agree to the terms and conditions in this Contract.
2. TERM AND EFFECTIVE DATE
A. Effective Date
This Contract shall not be valid or enforceable until the Effective Date. The State shall not
be bound by any provision of this Contract before the Effective Date and shall have no
obligation to pay Contractor for any Work performed or expense incurred before the Effective
Date or after the expiration or sooner termination of this Contract.
B. Initial Term
The Parties' respective performances under this Contract shall commence on the Contract
Performance Beginning Date shown on the Cover Page for this Contract and shall terminate
on the Initial Contract Expiration Date shown on the Cover Page for this Contract (the "Initial
Term") unless sooner terminated or further extended in accordance with the terms of this
Contract.
C. Extension Terms - State's Option
The State, at its discretion, shall have the option to extend the performance under this
Contract beyond the Initial Term for a period, or for successive periods, of one year or less
at the same rates and under the same terms specified in the Contract (each such period an
"Extension Term"). In order to exercise this option, the State shall provide written notice to
Contractor in a form substantially equivalent to the Sample Option Letter attached to this
contact. Except as stated in §2.D, the total duration of this Contract, including the exercise
of asy options to extend, shall not exceed five years from its Effective Date absent prior
approval from the Chief Procurement Officer in accordance with the Colorado Procurement
Code.
D. End of Term Extension
If this Contract approaches the end of its Initial Term, or any Extension Term then in place,
the State, at its discretion, upon written notice to Contractor as provided in §14, may
unilaterally extend such Initial Term or Extension Term for a period not to exceed two months
(an "End of Term Extension"), regardless of whether additional Extension Terms are
available or not. The provisions of this Contract in effect when such notice is given shall
remain in effect during the End of Term Extension. The End of Term Extension shall
autcanatically terminate upon execution of a replacement contract or modification extending
the total term of this Contract.
E. Early Termination in the Public Interest
The State is entering into this Contract to serve the public interest of the State of Colorado as
determined by its Governor, General Assembly, or Courts. If this Contract ceases to further
the public interest of the State, the State, in its discretion, may terminate this Contract in
whole or in part. A determination that this Contract should be terminated in the public interest
shall not be equivalent to a State right to terminate for convenience. This subsection shall not
apply to a termination of this Contract by the State for breach by Contractor, which shall be
Contract Number: C24188034
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governed by §12.
Method and Content
The State shall notify Contractor of such termination in accordance with §14. The
notice shall specify the effective date of the termination and whether it affects all or a
portion of this Contract, and shall include, to the extent practicable, the public interest
justification for the termination.
ii. Obligations and Rights
Upon receipt of a termination notice for termination in the public interest, Contractor
shall be subject to the rights and obligations set forth in §12.
iii. Payments
If the State terminates this Contract in the public interest, the State shall pay Contractor
an amount equal to the percentage of the total reimbursement payable under this
Contract that corresponds to the percentage of Work satisfactorily completed and
accepted, as determined by the State, less payments previously made. Additionally, if
this Contract is less than 60% completed, as determined by the State, the State may
reimburse Contractor for a portion of actual out-of-pocket expenses, not otherwise
reimbursed under this Contract, incurred by Contractor which are directly attributable
to the uncompleted portion of Contractor's obligations, provided that the sum of any
and all reimbursement shall not exceed the maximum amount payable to Contractor
hereunder.
3. DEFINITIONS
The following terms shall be construed and interpreted as follows:
A. "Breach of Contract" means the failure of a Party to perform any of its obligations in
accordance with this Contract, in whole or in part or in a timely or satisfactory manner. The
institution of proceedings under any bankruptcy, insolvency, reorganization or similar law,
by or against Contractor, or the appointment of a receiver or similar officer for Contractor or
any of its property, which is not vacated or fully stayed within 30 days after the institution of
such proceeding, shall also constitute a breach. If Contractor is debarred or suspended under
§24-109-105, C.R.S. at any time during the term of this Contract, then such debarment or
suspension shall constitute a breach.
B. "Business Day" means any day other than Saturday, Sunday, or a Legal Holiday as listed in
C.R.S. §24-11-101(1).
C. "Chief Procurement Officer" means the individual to whom the Executive Director has
delegated his or her authority, pursuant to C.R.S. §24-102-202, to procure or supervise the
procurement of all supplies and services needed by the State.
D. "Contract" means this agreement, including all attached Exhibits, all documents
incorporated by reference, all referenced statutes, rules and cited authorities, and any future
modifications thereto.
E. "Contract Funds" means the funds that have been appropriated, designated, encumbered, or
otherwise made available for payment by the State under this Contract.
F. "Contractor Pre -Existing Material" means material, code, methodology, concepts,
process, systems, technique, trade or service marks, copyrights, or other intellectual property
Contract Number: C24-188034
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developed, licensed or otherwise acquired by Contractor prior to the Effective Date of this
Contact and independent of any services rendered under any other contract with the State.
G. "Colorado Open Records Act (CORA)" means C.R.S. §24-72-200.1, et. seq.
H. "Deliverable" means the outcome to be achieved or output to be provided, in the form of a
tangible object or software that is produced as a result of Contractor's Work that is intended
to be delivered to the State by Contractor.
I. "Effective Date" means the date on which this Contract is approved and signed by the
Cola -ado State Controller or designee, as shown on the Signature Page for this Contract. If
this Contract is for a Major Information Technology Project, as defined in §24-37.5-102(2.6),
C.R S., then the Effective Date of this Contract shall be the later of the date on which this
Contact is approved and signed by the State's Chief Information Officer or authorized
delegate or the date on which this Contract is approved and signed by the State Controller or
authorized delegate, as shown on the Signature Page for this Contract.
J. "End of Term Extension" means the time period defined in §2.D
K. "Exhibits" means the exhibits and attachments included with this Contract as shown on the
Cover Page for this Contract.
L. "Extension Term" means the time period defined in §2.C
M. "Federal Award" means an award of Federal financial assistance or a cost -reimbursement
contract, under the Federal Acquisition Regulations or by a formula or block grant, by a
Federal Awarding Agency to the Recipient. "Federal Award" also means an agreement
setting forth the terms of the Federal Award. The term does not include payments to a
contractor or payments to an individual that is a beneficiary of a Federal program.
N. "Federal Award Agency" means a Federal agency providing a Federal Award to a
Recipient. United States Department of Health and Human Services (HHS) is the Federal
Awading Agency for the Federal Award which is the subject of this Contract.
O. "Goods" means any movable material acquired, produced, or delivered by Contractor as set
forth in this Contract and shall include any movable material acquired, produced, or delivered
by Contractor in connection with the Services.
P. "Incident" means any accidental or deliberate event that results in or constitutes an imminent
threat of the unauthorized access, loss, disclosure, modification, disruption, or destruction of
any communications or information resources of the State, which are included as part of the
Work, as described in C.R.S. §24-37.5-401, et. seq. Incidents include, without limitation, (i)
suc.ssful attempts to gain unauthorized access to a State system or State Records regardless
of vdhere such information is located; (ii) unwanted disruption or denial of service; (iii) the
unauthorized use of a State system for the processing or storage of data; or (iv) changes to
State system hardware, firmware, or software characteristics without the State's knowledge,
instruction, or consent.
Q. "Initial Term" means the time period defined in §2.B
R. "Party" means the State or Contractor, and "Parties" means both the State and Contractor.
S. "Personal Health Information (PHI)" means any protected health information, including,
without limitation any information whether oral or recorded in any form or medium: (i) that
relalis 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
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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. PHI includes, but is not limited to, any information defined as Individually
Identifiable Health Information by the federal Health Insurance Portability and
Accountability Act.
T. "Personally Identifiable Information (PII)" means personally identifiable information
including, without limitation, any information maintained by the State about an individual
that can be used to distinguish or trace an individual's identity, such as name, social security
number, date and place of birth, mother's maiden name, or biometric records; and any other
information that is linked or linkable to an individual, such as medical, educational, financial,
and employment information. PII includes, but is not limited to, all information defined as
personally identifiable information in C.R.S. §24-72-501 and 24-73-101, C.R.S. "PII" shall
also mean "personal identifying information" as set forth at § 24-74-102, et seq., C.R.S.
U. "Provider" means any health care professional or entity that has been accepted as a provider
in the Colorado Medicaid program, Colorado's CHP+ program, or the Colorado Indigent
Care Program, as determined by the Department.
V. "Recipient" means the State agency shown on the Signature and Cover Page of this
Contract, for the purpose of this Federal Award.
W. "Services" means the services to be performed by Contractor as set forth in this Contract,
and shall include any services to be rendered by Contractor in connection with the Goods.
X. "State Confidential Information" means any and all State Records not subject to disclosure
under CORA. State Confidential Information shall include, but is not limited to, PII, PHI,
PCI, Tax Information, CJI, and State personnel records not subject to disclosure under
CORA. State Confidential Information shall not include information or data concerning
individuals that is not deemed confidential but nevertheless belongs to the State, which has
been communicated, furnished, or disclosed by the State to Contractor which (i) is subject to
disclosure pursuant to CORA; (ii) is already known to Contractor without restrictions at the
time of its disclosure to Contractor; (iii) is or subsequently becomes publicly available
without breach of any obligation owed by Contractor to the State; (iv) is disclosed to
Contractor, without confidentiality obligations, by a third party who has the right to disclose
such information; or (v) was independently developed without reliance on any State
Confidential Information.
Y. "State Fiscal Rules" means the fiscal rules promulgated by the Colorado State Controller
pursuant to C.R.S. §24-30-202(13)(a).
Z. "State Fiscal Year" means a 12 -month period beginning on July 1 of each calendar year and
ending on June 30 of the following calendar year. If a single calendar year follows the term,
then it means the State Fiscal Year ending in that calendar year.
AA. "State Records" means any and all State data, information, and records, regardless of
physical form, including, but not limited to, information subject to disclosure under CORA.
BB. "Subcontractor" means any third party, if any, engaged by Contractor to aid in performance
of the Work.
CC. "Subrecipient" means a non -Federal entity that receives a sub -award from a Recipient to
carry out part of a Federal program but does not include an individual that is a beneficiary of
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suchprogram. A Subrecipient may also be a recipient of other Federal Awards directly from
a Federal Awarding Agency. For the purposes of this Contract, Contractor is a Subrecipient.
DD. "Uniform Guidance" means the Office of Management and Budget Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 CFR Part 200,
commonly known as the "Super Circular, which supersedes requirements from OMB
Circulars A-21, A-87, A-110, A-122, A-89, A-102, and A-133, and the guidance in Circular
A-50 on Single Audit Act follow-up.
EE. "Work" means the Goods delivered and Services performed pursuant to this Contract.
FF. "Work Product" means the tangible and intangible results of the Work, whether finished or
unfinished, including drafts. Work Product includes, but is not limited to, documents, text,
software (including source code), research, reports, proposals, specifications, plans, notes,
studies, data, images, photographs, negatives, pictures, drawings, designs, models, surveys,
maps, materials, ideas, concepts, know-how, and any other results of the Work. "Work
Product" does not include any material that was developed prior to the Effective Date that is
used, without modification, in the performance of the Work.
Any other -term used in this Contract that is defined in an Exhibit shall be construed and interpreted
as defined in that Exhibit, including the terminology in Exhibit D.
4. STATEMENT OF WORK
Contracto- shall complete the Work as described in this Contract and in accordance with the
provisions of Exhibit B, and Exhibit E. The State shall have no liability to compensate Contractor
for the delivery of any goods or the performance of any services that are not specifically set forth
in this Contract.
The State, at its discretion, shall have the option to increase or decrease the statewide quantity of
Goods and Services based upon rates established in this Contract, and increase the maximum
amount payable accordingly. In order to exercise this option, the State shall provide written notice
to Contractor in a form substantially equivalent to the Sample Option Letter attached to this
contract Delivery of Goods and performance of Services shall continue at the same rates and terms
as described in this Contract.
5. PAYMENTS TO CONTRACTOR
A. Maximum Amount
Payments to Contractor are limited to the payment described in Exhibit B, and are based in
the cuantity of services performed and the number of Members served by the Contractor. The
State shall not pay Contractor any amount under this Contract that exceeds the Contract
Maximum for that State Fiscal Year shown on the Cover Page for this Contract.
B. Payment Procedures
i. Invoices and Payment
a. The State shall pay Contractor in the amounts and in accordance with the schedule
and other conditions set forth in Exhibit B, Statement of Work and Exhibit C,
Rates.
b. The State shall pay the Contractor for activities completed in accordance with the
conditions set forth in Exhibit B, Statement of Work and Exhibit C, Rates within
45 days following the State's review of the activities completed for the previous
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month, so long as the documented activities correctly represents Work completed
by Contractor and previously accepted by the State during the term that the
payment covers. If the State determines that the amount of any payment is not
correct, then Contractor shall make all changes necessary to correct that payment.
c. The processing of a payment shall not constitute acceptance of the completion of
requirements or quality any Work performed, or deliverables provided under this
Contract.
ii. Interest
Amounts not paid by the State within 45 days of the State's acceptance of the invoice
shall bear interest on the unpaid balance beginning on the 45th day at the rate of one
percent per month, as required by C.R.S. §24-30-202(24)(a), until paid in full; provided,
however, that interest shall not accrue on unpaid amounts that the State disputes in
writing. Contractor shall invoice the State separately for accrued interest on delinquent
amounts, and the invoice shall reference the delinquent payment, the number of day's
interest to be paid and the interest rate.
iii. Payment Disputes
If Contractor disputes any calculation, determination or amount of any payment,
Contractor shall notify the State in writing of its dispute within 30 days following the
earlier to occur of Contractor's receipt of the payment or notification of the
determination or calculation of the payment by the State. The State will review the
information presented by Contractor and may make changes to its determination based
on this review. The calculation, determination or payment amount that results from the
State's review shall not be subject to additional dispute under this subsection. No
payment subject to a dispute under this subsection shall be due until after the State has
concluded its review, and the State shall not pay any interest on any amount during the
period it is subject to dispute under this subsection.
iv. Available Funds -Contingency -Termination
The State is prohibited by law from making commitments beyond the term of the
current State Fiscal Year. Payment to Contractor beyond the current State Fiscal Year
is contingent on the appropriation and continuing availability of Contract Funds in any
subsequent year (as provided in the Colorado Special Provisions). If federal funds or
funds from any other non -State funds constitute all or some of the Contract Funds, the
State's obligation to pay Contractor shall be contingent upon such non -State funding
continuing to be made available for payment. Payments to be made pursuant to this
Contract shall be made only from Contract Funds, and the State's liability for such
payments shall be limited to the amount remaining of such Contract Funds. If State,
federal or other funds are not appropriated, or otherwise become unavailable to fund
this Contract, the State may, upon written notice, terminate this Contract, in whole or
in part, without incurring further liability. The State shall, however, remain obligated
to pay for Services and Goods that are delivered and accepted prior to the effective date
of notice of termination, and this termination shall otherwise be treated as if this
Contract were terminated in the public interest as described in §2.E.
6. REPORTING - NOTIFICATION
A. Litigation Reporting
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If Contractor is served with a pleading or other document in connection with an action before
a court or other administrative decision -making body, and such pleading or document relates
to this Contract or may affect Contractor's ability to perform its obligations under this
Contract, Contractor shall, within 10 days after being served, notify the State of such action
and deliver copies of such pleading or document to the State's principal representative
identified on the Cover Page of this Contract.
7. CONTRACTOR RECORDS
A. Maintenance
Contractor shall maintain a file of all documents, records, communications, notes and other
materials relating to the Work (the "Contractor Records"). Contractor Records shall include
all documents, records, communications, notes and other materials maintained by Contractor
that relate to any Work performed by Subcontractors, and Contractor shall maintain all
records related to the Work performed by Subcontractors required to ensure proper
performance of that Work. Contractor shall maintain Contractor Records until the last to
occir of: (i) the date three years after the date this Contract expires or is terminated, (ii) final
payment under this Contract is made, (iii) the resolution of any pending Contract matters, or
(iv) if an audit is occurring, or Contractor has received notice that an audit is pending, the
date such audit is completed and its findings have been resolved (the "Record Retention
Period").
B. Inspection
Contractor shall permit the State, the federal government, and any other duly authorized agent
of a governmental agency to audit, inspect, examine, excerpt, copy and transcribe Contractor
Records during the Record Retention Period. Contractor shall make Contractor Records
available during normal business hours at Contractor's office or place of business, or at other
mutually agreed upon times or locations, upon no fewer than two Business Days' notice from
the State, unless the State determines that a shorter period of notice, or no notice, is necessary
to protect the interests of the State.
C. Motitoring
The State, the federal government, and any other duly authorized agent of a governmental
agency in its discretion, may monitor Contractor's performance of its obligations under this
Conrad using procedures as determined by the State or that governmental entity. The State
shall monitor Contractor's performance in a manner that does not unduly interfere with
Contractor's performance of the Work.
D. Final Audit Report
Contractor shall promptly submit to the State a copy of any final audit report of an audit
performed on Contractor's records that relates to or affects this Contract or the Work, whether
the audit is conducted by Contractor or a third party.
8. CONFIDENTIAL INFORMATION -STATE RECORDS
A. Confidentiality
Conractor shall keep confidential, and cause all Subcontractors to keep confidential, all State
Records, unless those State Records are publicly available. Contractor shall not, without prior
written approval of the State, use, publish, copy, disclose to any third party, or permit the use
by any third party of any State Records, except as otherwise stated in this Contract, permitted
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by law or approved in writing by the State. Contractor shall provide for the security of all
State Confidential Information in accordance with all applicable laws, rules, policies,
publications, and guidelines. If Contractor or any of its Subcontractors will or may receive
the following types of data, Contractor or its Subcontractors shall provide for the security of
such data according to the following: (i) the most recently promulgated IRS Publication 1075
for all Tax Information and in accordance with the Safeguarding Requirements for Federal
Tax Information attached to this Contract as an Exhibit, if applicable, (ii) the most recently
issued version of the U.S. Department of Justice, Federal Bureau of Investigation, Criminal
Justice Information Services Security Policy for all CJI, and (iii) the federal Health Insurance
Portability and Accountability Act for all PHI and the HIPAA Business Associate Agreement
attached to this Contract, if applicable. Contractor shall immediately forward any request or
demand for State Records to the State's Principal Representative.
B. Other Entity Access and Nondisclosure Agreements
Contractor may provide State Records to its agents, employees, assigns and Subcontractors
as necessary to perform the Work, but shall restrict access to State Confidential Information
to those agents, employees, assigns and Subcontractors who require access to perform their
obligations under this Contract. Contractor shall ensure all such agents, employees, assigns,
and Subcontractors sign agreements containing nondisclosure provisions at least as protective
as those in this Contract, and that the nondisclosure provisions are in force at all times the
agent, employee, assign or Subcontractor has access to any State Confidential Information.
Contractor shall provide copies of those signed nondisclosure provisions to the State upon
execution of the nondisclosure provisions if requested by the State.
C. Use, Security, and Retention
Contractor shall use, hold and maintain State Confidential Information in compliance with
any and all applicable laws and regulations only in facilities located within the United States,
and shall maintain a secure environment that ensures confidentiality of all State Confidential
Information. Contractor shall provide the State with access, subject to Contractor's
reasonable security requirements, for purposes of inspecting and monitoring access and use
of State Confidential Information and evaluating security control effectiveness. Upon the
expiration or termination of this Contract, Contractor shall return State Records provided to
Contractor or destroy such State Records and certify to the State that it has done so, as
directed by the State. If Contractor is prevented by law or regulation from returning or
destroying State Confidential Information, Contractor warrants it will guarantee the
confidentiality of, and cease to use, such State Confidential Information.
D. Incident Notice and Remediation
If Contractor becomes aware of any Incident, Contractor shall notify the State immediately
and cooperate with the State regarding recovery, remediation, and the necessity to involve
law enforcement, as determined by the State. Unless Contractor can establish that Contractor
and its Subcontractors are not the cause or source of the Incident, Contractor shall be
responsible for the cost of notifying each person who may have been impacted by the
Incident. After an Incident, Contractor shall take steps to reduce the risk of incurring a similar
type of Incident in the future as directed by the State, which may include, but is not limited
to, developing and implementing a remediation plan that is approved by the State at no
additional cost to the State. The State may adjust or direct modifications to this plan in its
sole discretion, and Contractor shall make all modifications as directed by the State. If
Contractor cannot produce its analysis and plan within the allotted time, the State, in its sole
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discretion, may perform such analysis and produce a remediation plan, and Contractor shall
reimburse the State for the actual costs thereof. The State may, in its sole discretion and at
Contractor's sole expense, require Contractor to engage the services of an independent,
qualified, State -approved third party to conduct a security audit. Contractor shall provide the
State with the results of such audit and evidence of Contractor's planned remediation in
response to any negative findings. Data Protection and Handling
Contractor shall ensure that all State Records and Work Product in the possession of
Contractor or any Subcontractors are protected and handled in accordance with the
requirements of this Contract, including the requirements of any Exhibits hereto, at all times.
E. Safeguarding PII
If Contractor or any of its Subcontractors will or may receive PII under this Contract,
Contractor shall provide for the security of such PII, in a manner and form acceptable to the
State, including, without limitation, State non -disclosure requirements, use of appropriate
technology, security practices, computer access security, data access security, data storage
encryption, data transmission encryption, security inspections, and audits. Contractor shall
be a"Third-Party Service Provider" as defined in §24-73-103(1)(i), C.R.S. and shall maintain
security procedures and practices consistent with §§24-73-101 et seq., C.R.S. In addition, as
set firth in § 24-74-102, et seq., C.R.S., Contractor, including, but not limited to, Contractor's
employees, agents and Subcontractors, agrees not to share any PII with any third parties for
the purpose of investigating for, participating in, cooperating with, or assisting with Federal
immigration enforcement. If Contractor is given direct access to any State databases
containing PII, Contractor shall execute, on behalf of itself and its employees, the certification
attached hereto as Exhibit H on an annual basis Contractor's duty and obligation to certify as
set iorth in Exhibit H shall continue as long as Contractor has direct access to any State
databases containing PII. If Contractor uses any Subcontractors to perform services requiring
direct access to State databases containing PII, the Contractor shall require such
Subcontractors to execute and deliver the certification to the State on an annual basis, so long
as the Subcontractor has access to State databases containing PII.
9. CONFLICTS OF INTEREST
A. Actual Conflicts of Interest
Contractor shall not engage in any business or activities or maintain any relationships that
confict in any way with the full performance of the obligations of Contractor under this
Contract. Such a conflict of interest would arise when a Contractor's or Subcontractor's
employee, officer or agent were to offer or provide any tangible personal benefit to an
employee of the State, or any member of his or her immediate family or his or her partner,
related to the award of, entry into or management or oversight of this Contract.
B. Apparent Conflicts of Interest
Contractor acknowledges that, with respect to this Contract, even the appearance of a conflict
of interest shall be harmful to the State's interests. Absent the State's prior written approval,
Contractor shall refrain from any practices, activities or relationships that reasonably appear
to be in conflict with the full performance of Contractor's obligations under this Contract.
C. Disclosure to the State
If a conflict or the appearance of a conflict arises, or if Contractor is uncertain whether a
confict or the appearance of a conflict has arisen, Contractor shall submit to the State a
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disclosure statement setting forth the relevant details for the State's consideration. Failure to
promptly submit a disclosure statement or to follow the State's direction in regard to the
actual or apparent conflict constitutes a breach of this Contract.
D. Contractor acknowledges that all State employees are subject to the ethical principles
described in §24-18-105, C.R.S. Contractor further acknowledges that State employees may
be subject to the requirements of (24-18-105, C.R.S. with regard to this Contract.
10. INSURANCE
Contractor shall obtain and maintain, and ensure that each Subcontractor shall obtain and maintain,
insurance as specified in this section at all times during the term of this Contract. All insurance
policies required by this Contract that are not provided through self-insurance shall be issued by
insurance companies as approved by the state.
A. Contractor Insurance
The Contractor is a "public entity" within the meaning of the Colorado Governmental
Immunity Act, §24-10-101, et seq., C.R.S. (the "GIA") and shall maintain at all times during
the term of this Contract such liability insurance, by commercial policy or self-insurance, as
is necessary to meet its liabilities under the GIA.
B. Subcontractor Requirements
Contractor shall ensure that each Subcontractor that is a public entity within the meaning of
the GIA, maintains at all times during the terms of this Contract, such liability insurance, by
commercial policy or self-insurance, as is necessary to meet the Subcontractor's obligations
under the GIA. Contractor shall ensure that each Subcontractor that is not a public entity
within the meaning of the GIA, maintains at all times during the terms of this Contract all of
the following insurance policies:
i. Workers' Compensation
Workers' compensation insurance as required by state statute, and employers' liability
insurance covering all Contractor or Subcontractor employees acting within the course
and scope of their employment.
ii. General Liability
Commercial general liability insurance covering premises operations, fire damage,
independent contractors, products and completed operations, blanket contractual
liability, personal injury, and advertising liability with minimum limits as follows:
a. $1,000,000 each occurrence;
b. $1,000,000 general aggregate;
c. $1,000,000 products and completed operations aggregate; and
d. $50,000 and 1 fire.
iii. Automobile Liability
Automobile liability insurance covering any auto (including owned, hired and non -
owned autos) with a minimum limit of $1,000,000 each accident combined single limit.
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iv. Protected Information
Liability insurance covering all loss of State Confidential Information, such as PII, PHI,
and claims based on alleged violations of privacy rights through improper use or
disclosure of protected information with minimum limits as follows:
a. $1,000,000 each occurrence; and
b. $2,000,000 general aggregate.
v. Professional Liability Insurance
Professional liability insurance covering any damages caused by an error, omission or
any negligent act with minimum limits as follows:
a. $1,000,000 each occurrence; and
b. $1,000,000 general aggregate.
vi. Crime Insurance
Crime insurance including employee dishonesty coverage with minimum limits as
follows:
a. $1,000,000 each occurrence; and
b. $1,000,000 general aggregate.
C. Additional Insured
The State shall be named as additional insured on all commercial general liability policies
(leases and construction contracts require additional insured coverage for completed
operations) required of Contractor and Subcontractors.
D. Primacy of Coverage
Coverage required of Contractor and each Subcontractor shall be primary over any insurance
or stlf-insurance program carried by Contractor or the State.
E. Cancellation
All commercial insurance policies shall include provisions preventing cancellation or non -
renewal, except for cancellation based on non-payment of premiums, without at least 30 days
pricr notice to Contractor and Contractor shall forward such notice to the State in accordance
with §14 within 7 days of Contractor's receipt of such notice.
F. Subrogation Waiver
All commercial insurance policies secured or maintained by Contractor or its Subcontractors
in relation to this Contract shall include clauses stating that each carrier shall waive all rights
of recovery under subrogation or otherwise against Contractor or the State, its agencies,
instiutions, organizations, officers, agents, employees, and volunteers.
G. Certificates
For each commercial insurance plan provided by Contractor under this Contract, Contractor
shall provide to the State certificates evidencing Contractor's insurance coverage required in
this Contract within 7 Business Days following the Effective Date. Contractor shall provide
to tie State certificates evidencing Subcontractor insurance coverage required under this
Contract within 7 Business Days following the Effective Date, except that, if Contractor's
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subcontract is not in effect as of the Effective Date, Contractor shall provide to the State
certificates showing Subcontractor insurance coverage required under this Contract within 7
Business Days following Contractor's execution of the subcontract. No later than 15 days
before the expiration date of Contractor's or any Subcontractor's coverage, Contractor shall
deliver to the State certificates of insurance evidencing renewals of coverage. At any other
time during the term of this Contract, upon request by the State, Contractor shall, within 7
Business Days following the request by the State, supply to the State evidence satisfactory to
the State of compliance with the provisions of this §10.
11. BREACH OF CONTRACT
In the event of a Breach of Contract, the aggrieved Party shall give written notice of breach to the
other Party. If the notified Party does not cure the Breach of Contract, at its sole expense, within
30 days after the delivery of written notice, the Party may exercise any of the remedies as described
in §12 for that Party. Notwithstanding any provision of this Contract to the contrary, the State, in
its discretion, need not provide notice or a cure period and may immediately terminate this Contract
in whole or in part or institute any other remedy in this Contract in order to protect the public
interest of the State; or if Contractor is debarred or suspended under §24-109-105, C.R.S., the State,
in its discretion, need not provide notice or cure period and may terminate this Contract in whole
or in part or institute any other remedy in this Contract as of the date that the debarment or
suspension takes effect.
12. REMEDIES
A. State's Remedies
If Contractor is in breach under any provision of this Contract and fails to cure such breach,
the State, following the notice and cure period set forth in §11, shall have all of the remedies
listed in this section, in addition to all other remedies set forth in this Contract or at law. The
State may exercise any or all of the remedies available to it, in its discretion, concurrently or
consecutively.
i. Termination for Breach of Contract
In the event of Contractor's uncured breach, the State may terminate this entire Contract
or any part of this Contract. Contractor shall continue performance of this Contract to
the extent not terminated, if any.
a. Obligations and Rights
To the extent specified in any termination notice, Contractor shall not incur further
obligations or render further performance past the effective date of such notice
and shall terminate outstanding orders and subcontracts with third parties.
However, Contractor shall complete and deliver to the State all Work not
cancelled by the termination notice and may incur obligations as necessary to do
so within this Contract's terms. At the request of the State, Contractor shall assign
to the State all of Contractor's rights, title, and interest in and to such terminated
orders or subcontracts. Upon termination, Contractor shall take timely, reasonable
and necessary action to protect and preserve property in the possession of
Contractor but in which the State has an interest. At the State's request, Contractor
shall return materials owned by the State in Contractor's possession at the time of
any termination. Contractor shall deliver all completed Work Product and all
Work Product that was in the process of completion to the State at the State's
request.
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b. Payments
Notwithstanding anything to the contrary, the State shall only pay Contractor for
accepted Work received as of the date of termination. If, after termination by the
State, the State agrees that Contractor was not in breach or that Contractor's action
or inaction was excusable, such termination shall be treated as a termination in
the public interest, and the rights and obligations of the Parties shall be as if this
Contract had been terminated in the public interest under §2.E.
c. Damages and Withholding
Notwithstanding any other remedial action by the State, Contractor shall remain
liable to the State for any damages sustained by the State in connection with any
breach by Contractor, and the State may withhold payment to Contractor for the
purpose of mitigating the State's damages until such time as the exact amount of
damages due to the State from Contractor is determined. The State may withhold
any amount that may be due Contractor as the State deems necessary to protect
the State against loss including, without limitation, loss as a result of outstanding
liens and excess costs incurred by the State in procuring from third parties
replacement Work as cover.
ii. Remedies Not Involving Termination
The State, in its discretion, may exercise one or more of the following additional
remedies:
a. Suspend Performance
Suspend Contractor's performance with respect to all or any portion of the Work
pending corrective action as specified by the State without entitling Contractor to
an adjustment in price or cost or an adjustment in the performance schedule.
Contractor shall promptly cease performing Work and incurring costs in
accordance with the State's directive, and the State shall not be liable for costs
incurred by Contractor after the suspension of performance.
b. Withhold Payment
Withhold payment to Contractor until Contractor corrects its Work.
c. Deny Payment
Deny payment for Work not performed, or that due to Contractor's actions or
inactions, cannot be performed or if they were performed are reasonably of no
value to the state; provided, that any denial of payment shall be equal to the value
of the obligations not performed.
d. Removal
Demand immediate removal of any of Contractor's employees, agents, or
Subcontractors from the Work whom the State deems incompetent, careless,
insubordinate, unsuitable, or otherwise unacceptable or whose continued relation
to this Contract is deemed by the State to be contrary to the public interest or the
State's best interest.
e. Intellectual Property
If any Work infringes, or if the State in its sole discretion determines that any
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Work is likely to infringe, a patent, copyright, trademark, trade secret or other
intellectual property right, Contractor shall, as approved by the State (i) secure
that right to use such Work for the State and Contractor; (ii) replace the Work
with noninfringing Work or modify the Work so that it becomes noninfringing;
or, (iii) remove any infringing Work and refund the amount paid for such Work
to the State.
B. Contractor's Remedies
If the State is in breach of any provision of this Contract and does not cure such breach,
Contractor, following the notice and cure period in §11 and the dispute resolution process in
§13 shall have all remedies available at law and equity.
13. DISPUTE RESOLUTION
A. Initial Resolution
Except as herein specifically provided otherwise, disputes concerning the performance of this
Contract which cannot be resolved by the designated Contract representatives shall be
referred in writing to a senior departmental management staff member designated by the State
and a senior manager designated by Contractor for resolution.
B. Resolution of Controversies
If the initial resolution described in §13.A fails to resolve the dispute within 10 Business
Days, Contractor shall submit any alleged breach of this Contract by the State to the
Procurement Official of the State Agency named on the Cover Page of this Contract as
described in §24-102-202(3), C.R.S. for resolution in accordance with the provisions of
C.R.S. §24-106-109, C.R.S., and §§24-109-101.l through 24-109-505, C.R.S., (the
"Resolution Statutes"), except that if Contractor wishes to challenge any decision rendered
by the Procurement Official, Contractor's challenge shall be an appeal to the Executive
Director of the Department of Personnel and Administration, or their delegate, under the
Resolution Statutes before Contractor pursues any further action as permitted by such
statutes. Except as otherwise stated in this Section, all requirements of the Resolution Statutes
shall apply including, without limitation, time limitations.
14. NOTICES AND REPRESENTATIVES
Each individual identified as a Principal Representative on the Cover Page for this Contract shall
be the principal representative of the designating Party. All notices required or permitted to be
given under this Contract shall be in writing, and shall be delivered (A) by hand with receipt
required, (B) by certified or registered mail to such Party's principal representative at the address
set forth on the Cover Page of this Contract or (C) as an email with read receipt requested to the
principal representative at the email address, if any, set forth on the Cover Sheet of this Contract.
If a Party delivers a notice to another through email and the email is undeliverable, then, unless the
Party has been provided with an alternate email contact, the Party delivering the notice shall deliver
the notice by hand with receipt required or by certified or registered mail to such Party's principal
representative at the address set forth on the Cover Page for this Contract. Either Party may change
its principal representative or principal representative contact information by notice submitted in
accordance with this section without a formal amendment to this Contract. Unless otherwise
provided in this Contract, notices shall be effective upon delivery of the written notice.
15. RIGHTS IN WORK PRODUCT AND OTHER INFORMATION
A. Work Product
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Copyrights
To the extent that the Work Product (or any portion of the Work Product) would not be
considered works made for hire under applicable law, Contractor hereby assigns to the
State, the entire right, title, and interest in and to copyrights in all Work Product and all
works based upon, derived from, or incorporating the Work Product; all copyright
applications, registrations, extensions, or renewals relating to all Work Product and all
works based upon, derived from, or incorporating the Work Product; and all moral
rights or similar rights with respect to the Work Product throughout the world. To the
extent that Contractor cannot make any of the assignments required by this section,
Contractor hereby grants to the State a perpetual, irrevocable, royalty -free license to
use, modify, copy, publish, display, perform, transfer, distribute, sell, and create
derivative works of the Work Product and all works based upon, derived from, or
incorporating the Work Product by all means and methods and in any format now
known or invented in the future. The State may assign and license its rights under this
license.
ii. Patents
In addition, Contractor grants to the State (and to recipients of Work Product distributed
by or on behalf of the State) a perpetual, worldwide, no -charge, royalty -free,
irrevocable patent license to make, have made, use, distribute, sell, offer for sale,
import, transfer, and otherwise utilize, operate, modify and propagate the contents of
the Work Product. Such license applies only to those patent claims licensable by
Contractor that are necessarily infringed by the Work Product alone, or by the
combination of the Work Product with anything else used by the State.
iii. Assignments and Assistance
Whether or not Contractor is under contract with the State at the time, Contractor shall
execute applications, assignments, and other documents, and shall render all other
reasonable assistance requested by the State, to enable the State to secure patents,
copyrights, licenses and other intellectual property rights related to the Work Product.
To the extent that Work Product would fall under the definition of "works made for
hire" under 17 U.S.C.S. §101, the Parties intend the Work Product to be a work made
for hire. Contractor assigns to the State and its successors and assigns, the entire right,
title, and interest in and to all causes of action, either in law or in equity, for past,
present, or future infringement of intellectual property rights related to the Work
Product and all works based on, derived from, or incorporating the Work Product.
B. Exclusive Property of the State
Except to the extent specifically provided elsewhere in this Contract, all State Records,
documents, text, software (including source code), research, reports, proposals,
specifications, plans, notes, studies, data, images, photographs, negatives, pictures, drawings,
desins, models, surveys, maps, materials, ideas, concepts, know-how, and information
provided by or on behalf of the State to Contractor are the exclusive property of the State
(collectively, "State Materials"). Contractor shall not use, willingly allow, cause or permit
WA( Product or State Materials to be used for any purpose other than the performance of
Contractor's obligations in this Contract without the prior written consent of the State. Upon
termination of this Contract for any reason, Contractor shall provide all Work Product and
State Materials to the State in a form and manner as directed by the State.
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C. Exclusive Property of Contractor
Contractor retains the exclusive rights, title, and ownership to any and all pre-existing
materials owned or licensed to Contractor including, but not limited to, all pre-existing
software, licensed products, associated source code, machine code, text images, audio and/or
video, and third -party materials, delivered by Contractor under the Contract, whether
incorporated in a Deliverable or necessary to use a Deliverable (collectively, "Contractor
Property"). Contractor Property shall be licensed to the State as set forth in this Contract or a
State approved license agreement: (i) entered into as exhibits to this Contract; (ii) obtained
by the State from the applicable third -party vendor; or (iii) in the case of open source
software, the license terms set forth in the applicable open source license agreement.
16. GENERAL PROVISIONS
A. Assignment
Contractor's rights and obligations under this Contract are personal and may not be
transferred or assigned without the prior, written consent of the State. Any attempt at
assignment or transfer without such consent shall be void. Any assignment or transfer of
Contractor's rights and obligations approved by the State shall be subject to the provisions of
this Contract
B. Subcontracts
Contractor shall not enter into any subcontract in connection with its obligations under this
Contract without the prior, written approval of the State. Contractor shall submit to the State
a copy of each such subcontract upon request by the State. All subcontracts entered into by
Contractor in connection with this Contract shall comply with all applicable federal and state
laws and regulations, shall provide that they are governed by the laws of the State of
Colorado, and shall be subject to all provisions of this Contract.
C. Binding Effect
Except as otherwise provided in §16.A., all provisions of this Contract, including the benefits
and burdens, shall extend to and be binding upon the Parties' respective successors and
assigns.
D. Authority
Each Party represents and warrants to the other that the execution and delivery of this
Contract and the performance of such Party's obligations have been duly authorized.
E. Captions and References
The captions and headings in this Contract are for convenience of reference only, and shall
not be used to interpret, define, or limit its provisions. All references in this Contract to
sections (whether spelled out or using the § symbol), subsections, exhibits or other
attachments, are references to sections, subsections, exhibits or other attachments contained
herein or incorporated as a part hereof, unless otherwise noted.
F. Counterparts
This Contract may be executed in multiple, identical, original counterparts, each of which
shall be deemed to be an original, but all of which, taken together, shall constitute one and
the same agreement.
G. Entire Understanding
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This Contract represents the complete integration of all understandings between the Parties
related to the Work, and all prior representations and understandings related to the Work, oral
or written, are merged into this Contract. Prior or contemporaneous additions, deletions, or
other changes to this Contract shall not have any force or effect whatsoever, unless embodied
herein.
H. Digital Signatures
If any signatory signs this agreement using a digital signature in accordance with the
Colorado State Controller Contract, Grant and Purchase Order Policies regarding the use of
digital signatures issued under the State Fiscal Rules, then any agreement or consent to use
digital signatures within the electronic system through which that signatory signed shall be
incorporated into this Contract by reference.
I. Modification
Except as otherwise provided in this Contract, any modification to this Contract shall only be
effmtive if agreed to in a formal amendment to this Contract, properly executed and approved
in accordance with applicable Colorado State law and State Fiscal Rules. Modifications
permitted under this Contract, other than contract amendments, shall conform to the policies
issued by the Colorado State Controller.
J. Statutes, Regulations, Fiscal Rules, and Other Authority.
Any reference in this Contract to a statute, regulation, State Fiscal Rule, fiscal policy or other
authority shall be interpreted to refer to such authority then current, as may have been
changed or amended since the Effective Date of this Contract.
K. External Terms and Conditions
Notwithstanding anything to the contrary herein, the State shall not be subject to any
provision included in any terms, conditions, or agreements appearing on Contractor's or a
Subcontractor's website or any provision incorporated into any click -through or online
agreements related to the Work unless that provision is specifically referenced in this
Contract.
L. Severability
The invalidity or unenforceability of any provision of this Contract shall not affect the validity
or enforceability of any other provision of this Contract, which shall remain in full force and
effect, provided that the Parties can continue to perform their obligations under this Contract
in accordance with the intent of this Contract.
M. Survival of Certain Contract Terms
Any provision of this Contract that imposes an obligation on a Party after termination or
expiration of this Contract shall survive the termination or expiration of this Contract and
shal be enforceable by the other Party.
N. Taxes
The State is exempt from federal excise taxes under I.R.C. Chapter 32 (26 U.S.C., Subtitle
D, Ch. 32) (Federal Excise Tax Exemption Certificate of Registry No. 84-730123K) and from
State and local government sales and use taxes under §§39-26-704(1), et seq., C.R.S.
(Colorado Sales Tax Exemption Identification Number 98-02565). The State shall not be
liable for the payment of any excise, sales, or use taxes, regardless of whether any political
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subdivision of the state imposes such taxes on Contractor. Contractor shall be solely
responsible for any exemptions from the collection of excise, sales or use taxes that
Contractor may wish to have in place in connection with this Contract.
O. Third Party Beneficiaries
Except for the Parties' respective successors and assigns described in §16.A., this Contract
does not and is not intended to confer any rights or remedies upon any person or entity other
than the Parties. Enforcement of this Contract and all rights and obligations hereunder are
reserved solely to the Parties. Any services or benefits which third parties receive as a result
of this Contract are incidental to this Contract, and do not create any rights for such third
parties.
P. Waiver
A Party's failure or delay in exercising any right, power, or privilege under this Contract,
whether explicit or by lack of enforcement, shall not operate as a waiver, nor shall any single
or partial exercise of any right, power, or privilege preclude any other or further exercise of
such right, power, or privilege.
Q. CORA Disclosure
To the extent not prohibited by federal law, this Contract and the performance measures and
standards required under C.R.S. §24-106-107, if any, are subject to public release through
the CORA.
R. Standard and Manner of Performance
Contractor shall perform its obligations under this Contract in accordance with the highest
standards of care, skill and diligence in Contractor's industry, trade, or profession.
S. Licenses, Permits, and Other Authorizations.
Contractor shall secure, prior to the Effective Date, and maintain at all times during the term
of this Contract, at its sole expense, all licenses, certifications, permits, and other
authorizations required to perform its obligations under this Contract, and shall ensure that
all employees, agents and Subcontractors secure and maintain at all times during the term of
their employment, agency or subcontract, all license, certifications, permits and other
authorizations required to perform their obligations in relation to this Contract.
T. Additional Provisions
Contractor shall comply with all requirements shown Exhibit A and Exhibit G.
17. COLORADO SPECIAL PROVISIONS (COLORADO FISCAL RULE 3-3)
These Special Provisions apply to all contracts except where noted in italics.
A. STATUTORY APPROVAL. C.R.S. §24-30-202(1)
This Contract shall not be valid until it has been approved by the Colorado State Controller
or designee. If this Contract is for a Major Information Technology Project, as defined in
§24-37.5-102(2.6), then this Contract shall not be valid until it has been approved by the
State's Chief Information Officer or designee.
B. FUND AVAILABILITY. C.R.S. §24-30-202(5.5)
Financial obligations of the State payable after the current State Fiscal Year are contingent
upon funds for that purpose being appropriated, budgeted, and otherwise made available.
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C. GOVERNMENTAL IMMUNITY.
Liability for claims for injuries to persons or property arising from the negligence of the
Parties, its departments, boards, commissions committees, bureaus, offices, employees and
officials shall be controlled and limited by the provisions of the Colorado Governmental
Immunity Act, §24-10-101, et seq., C.R.S.; the Federal Tort Claims Act, 28 U.S.C. Pt. VI,
Ch. 171 and 28 U.S.C. 1346(b), and the State's risk management statutes, §§24-30-1501, et
seq. C.R.S. No term or condition of this Contract shall be construed or interpreted as a
wailer, express or implied, of any of the immunities, rights, benefits, protections, or other
provisions, contained in these statutes.
D. INDEPENDENT CONTRACTOR.
Contractor shall perform its duties hereunder as an independent contractor and not as an
employee. Neither Contractor nor any agent or employee of Contractor shall be deemed to
be an agent or employee of the State. Contractor shall not have authorization, express or
implied, to bind the State to any agreement, liability or understanding, except as expressly
set forth herein. Contractor and its employees and agents are not entitled to
unemployment insurance or workers compensation benefits through the State and the
State shall not pay for or otherwise provide such coverage for Contractor or any of its
agents or employees. Contractor shall pay when due all applicable employment taxes
and income taxes and local head taxes incurred pursuant to this Contract. Contractor
shal (i) provide and keep in force workers' compensation and unemployment
compensation insurance in the amounts required by law, (ii) provide proof thereof when
requested by the State, and (iii) be solely responsible for its acts and those of its
employees and agents.
E. COMPLIANCE WITH LAW.
Contractor shall strictly comply with all applicable federal and State laws, rules, and
regulations in effect or hereafter established, including, without limitation, laws applicable
to ctscrimination and unfair employment practices.
F. CHJICE OF LAW, JURISDICTION, AND VENUE.
Colorado law, and rules and regulations issued pursuant thereto, shall be applied in the
interpretation, execution, and enforcement of this Contract. Any provision included or
incorporated herein by reference which conflicts with said laws, rules, and regulations shall
be mall and void. All suits or actions related to this Contract shall be filed and proceedings
held in the State of Colorado and exclusive venue shall be in the City and County of Denver.
G. PROHIBITED TERMS.
Any term included in this Contract that requires the State to indemnify or hold Contractor
hornless; requires the State to agree to binding arbitration; limits Contractor's liability for
damages resulting from death, bodily injury, or damage to tangible property; or that conflicts
will- this provision in any way shall be void ab initio. Nothing in this Contract shall be
construed as a waiver of any provision of §24-106-109 C.R.S.
H. SOFTWARE PIRACY PROHIBITION.
Star✓ or other public funds payable under this Contract shall not be used for the acquisition,
operation, or maintenance of computer software in violation of federal copyright laws or
applicable licensing restrictions. Contractor hereby certifies and warrants that, during the
tear of this Contract and any extensions, Contractor has and shall maintain in place
Contract Number: C24188034
Page 20 of 21 Version 0521
appropriate systems and controls to prevent such improper use of public funds. If the State
determines that Contractor is in violation of this provision, the State may exercise any remedy
available at law or in equity or under this Contract, including, without limitation, immediate
termination of this Contract and any remedy consistent with federal copyright laws or
applicable licensing restrictions.
I. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST. C.R.S. §§24-18-
201 and 24-50-507
The signatories aver that to their knowledge, no employee of the State has any personal or
beneficial interest whatsoever in the service or property described in this Contract. Contractor
has no interest and shall not acquire any interest, direct or indirect, that would conflict in any
manner or degree with the performance of Contractor's services and Contractor shall not
employ any person having such known interests.
Contract Number: C24-188034 Page 21 of 21
Version 0521
EXHIBIT A, HIPAA BUSINESS ASSOCIATES ADDENDUM
This HIPAA Business Associate Agreement ("Agreement") between the State and Contractor is agreed to
in connection with, and as an exhibit to, the Contract. For purposes of this Agreement, the State is referred
to as "Covered Entity" and the Contractor is referred to as "Business Associate". Unless the context clearly
requires a distinction between the Contract and this Agreement, all references to "Contract" shall include
this Agreement.
1. PURPOSE
Covered Entity wishes to disclose information to Business Associate, which may include Protected Health
Information ("PHI"). The Parties intend to protect the privacy and security of the disclosed PHI in
compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Pub. L. No.
104-191 (19%) as amended by the Health Information Technology for Economic and Clinical Health Act
("HITECH Art") enacted under the American Recovery and Reinvestment Act of 2009 ("ARRA") Pub. L.
No. 111-5 (ZJ09), implementing regulations promulgated by the U.S. Department of Health and Human
Services at 45 C.F.R. Parts 160, 162 and 164 (the "HIPAA Rules") and other applicable laws, as amended.
Prior to the disclosure of PHI, Covered Entity is required to enter into an agreement with Business Associate
containing specific requirements 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 all other applicable laws and regulations,
all as may bemmended.
2. DEFINITIONS
The following terms used in this Agreement shall have the same meanings as in the HIPAA Rules: Breach,
Data Aggreption, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum
Necessary, Notice of Privacy Practices, Protected Health Information, Required by Law, Secretary, Security
Incident, Subcontractor, Unsecured Protected Health Information, and Use.
The following terms used in this Agreement shall have the meanings set forth below:
a. Business Associate. "Business Associate" shall have the same meaning as the term "business
associate" at 45 C.F.R. 160.103, and shall refer to Contractor.
b. Covered Entity. "Covered Entity" shall have the same meaning as the term "covered entity" at
�i C.F.R. 160.103, and shall refer to the State.
c. Information Technology and Information Security. "Information Technology" and
Information Security" shall have the same meanings as the terms "information technology"
and "information security", respectively, in §24-37.5-102, C.R.S.
Capitalized terms used herein and not otherwise defined herein or in the HIPAA Rules shall have the
meanings ascribed to them in the Contract.
3. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE
Exhibit A, HIPAAEBAA
Page 1 of 9 Revised 8/18
a. Permitted Uses and Disclosures.
i. Business Associate shall use and disclose PHI only to accomplish Business Associate's
obligations under the Contract.
i. To the extent Business Associate carries out one or more of Covered Entity's
obligations under Subpart E of 45 C.F.R. Part 164, Business Associate shall comply
with any and all requirements of Subpart E that apply to Covered Entity in the
performance of such obligation.
ii. Business Associate may disclose PHI to carry out the legal responsibilities of Business
Associate, provided, that the disclosure is Required by Law or Business Associate
obtains reasonable assurances from the person to whom the information is disclosed
that:
A. the information will remain confidential and will be used or disclosed only as
Required by Law or for the purpose for which Business Associate originally
disclosed the information to that person, and;
B. the person notifies Business Associate of any Breach involving PHI of which
it is aware.
iii. Business Associate may provide Data Aggregation services relating to the Health Care
Operations of Covered Entity. Business Associate may de -identify any or all PHI
created or received by Business Associate under this Agreement, provided the de -
identification conforms to the requirements of the HIPAA Rules.
b. Minimum Necessary. Business Associate, its Subcontractors and agents, shall access, use, and
disclose only the minimum amount of PHI necessary to accomplish the objectives of the
Contract, in accordance with the Minimum Necessary Requirements of the HIPAA Rules
including, but not limited to, 45 C.F.R. 164.502(b) and 164.514(d).
c. Impermissible Uses and Disclosures.
i. Business Associate shall not disclose the PHI of Covered Entity to another covered
entity without the written authorization of Covered Entity.
ii. Business Associate shall not share, use, disclose or make available any Covered Entity
PHI in any form via any medium with or to any person or entity beyond the boundaries
or jurisdiction of the United States without express written authorization from Covered
Entity.
d. Business Associate's Subcontractors.
i. Business Associate shall, in accordance with 45 C.F.R. 164.502(e)(1)(ii) and
164.308(b)(2), ensure that any Subcontractors who create, receive, maintain, or
transmit PHI on behalf of Business Associate agree in writing to the same restrictions,
Exhibit A, HIPAA BAA
Page 2 of 9 Revised 8/18
conditions, and requirements that apply to Business Associate with respect to
safeguarding PHI.
ii. Business Associate shall provide to Covered Entity, on Covered Entity's request, a list
of Subcontractors who have entered into any such agreement with Business Associate.
iii. Business Associate shall provide to Covered Entity, on Covered Entity's request,
copies of any such agreements Business Associate has entered into with
Subcontractors.
e.
f.
g•
Access to System. If Business Associate needs access to a Covered Entity Information
Technology system to comply with its obligations under the Contract or this Agreement,
Business Associate shall request, review, and comply with any and all policies applicable to
Covered Entity regarding such system including, but not limited to, any policies promulgated
by the Office of Information Technology and available at http://oit.state.co.us/about/policies.
Access to PHI. Business Associate shall, within ten days of receiving a written request from
Covered Entity, make available PHI in a Designated Record Set to Covered Entity as necessary
to satisfy Covered Entity's obligations under 45 C.F.R. 164.524.
Amendment of PHI.
Business Associate shall within ten days of receiving a written request from Covered
Entity make any amendment to PHI in a Designated Record Set as directed by or agreed
to by Covered Entity pursuant to 45 C.F.R. 164.526, or take other measures as
necessary to satisfy Covered Entity's obligations under 45 C.F.R. 164.526.
ii. Business Associate shall promptly forward to Covered Entity any request for
amendment of PHI that Business Associate receives directly from an Individual.
h. Accounting Rights. Business Associate shall, within ten days of receiving a written request
from Covered Entity, maintain and make available to Covered Entity the information necessary
for Covered Entity to satisfy its obligations to provide an accounting of Disclosure under 45
C.F.R. 164.528.
i. Restrictions and Confidential Communications.
i. Business Associate shall restrict the Use or Disclosure of an Individual's PHI within
ten days of notice from Covered Entity of:
A. a restriction on Use or Disclosure of PHI pursuant to 45 C.F.R. 164.522; or
B. a request for confidential communication of PHI pursuant to 45 C.F.R.
164.522.
ii. Business Associate shall not respond directly to an Individual's requests to restrict the
Use or Disclosure of PHI or to send all communication of PHI to an alternate address.
Exhibit A, HIPAA BAA
Page 3 of 9 Revised 8/18
iii. Business Associate shall refer such requests to Covered Entity so that Covered Entity
can coordinate and prepare a timely response to the requesting Individual and provide
direction to Business Associate.
J.
Governmental Access to Records. Business Associate shall make its facilities, internal
practices, books, records, and other sources of information, including PHI, available to the
Secretary for purposes of determining compliance with the HIPAA Rules in accordance with
45 C.F.R. 160.310.
k. Audit, Inspection and Enforcement.
Business Associate shall obtain and update at least annually a written assessment
performed by an independent third party reasonably acceptable to Covered Entity,
which evaluates the Information Security of the applications, infrastructure, and
processes that interact with the Covered Entity data Business Associate receives,
manipulates, stores and distributes. Upon request by Covered Entity, Business
Associate shall provide to Covered Entity the executive summary of the assessment.
ii. Business Associate, upon the request of Covered Entity, shall fully cooperate with
Covered Entity's efforts to audit Business Associate's compliance with applicable
HIPAA Rules. If, through audit or inspection, Covered Entity determines that Business
Associate's conduct would result in violation of the HIPAA Rules or is in violation of
the Contract or this Agreement, Business Associate shall promptly remedy any such
violation and shall certify completion of its remedy in writing to Covered Entity.
1. Appropriate Safeguards.
i. Business Associate shall use appropriate safeguards and comply with Subpart C of 45
C.F.R. Part 164 with respect to electronic PHI to prevent use or disclosure of PHI other
than as provided in this Agreement.
ii. Business Associate shall safeguard the PHI from tampering and unauthorized
disclosures.
iii. Business Associate shall maintain the confidentiality of passwords and other data
required for accessing this information.
iv. Business Associate shall extend protection beyond the initial information obtained
from Covered Entity to any databases or collections of PHI containing information
derived from the PHI. The provisions of this section shall be in force unless PHI is de -
identified in conformance to the requirements of the HIPAA Rules.
m. Safeguard During Transmission.
i. Business Associate shall use reasonable and appropriate safeguards including, without
limitation, Information Security measures to ensure that all transmissions of PHI are
authorized and to prevent use or disclosure of PHI other than as provided for by this
Agreement.
Exhibit A, HIPAA BAA
Page 4 of 9 Revised 8/18
ii. Business Associate shall not transmit PHI over the internet or any other insecure or
open communication channel unless the PHI is encrypted or otherwise safeguarded
with a FIPS-compliant encryption algorithm.
Qeporting of Improper Use or Disclosure and Notification of Breach.
i. Business Associate shall, as soon as reasonably possible, but immediately after
discovery of a Breach, notify Covered Entity of any use or disclosure of PHI not
provided for by this Agreement, including a Breach of Unsecured Protected Health
Information as such notice is required by 45 C.F.R. 164.410 or a breach for which
notice is required under §24-73-103, C.R.S.
ii. Such notice shall include the identification of each Individual whose Unsecured
Protected Health Information has been, or is reasonably believed by Business
Associate to have been, accessed, acquired, or disclosed during such Breach.
iii. Business Associate shall, as soon as reasonably possible, but immediately after
discovery of any Security Incident that does not constitute a Breach, notify Covered
Entity of such incident.
iv. Business Associate shall have the burden of demonstrating that all notifications were
made as required, including evidence demonstrating the necessity of any delay.
Business Associate's Insurance and Notification Costs.
i. Business Associate shall bear all costs of a Breach response including, without
limitation, notifications, and shall maintain insurance to cover:
A. loss of PHI data;
B. Breach notification requirements specified in HIPAA Rules and in §24-73-
103, C.R.S.; and
C. claims based upon alleged violations of privacy rights through improper use
or disclosure of PHI.
ii. All such policies shall meet or exceed the minimum insurance requirements of the
Contract or otherwise as may be approved by Covered Entity (e.g., occurrence basis,
combined single dollar limits, annual aggregate dollar limits, additional insured status,
and notice of cancellation).
iii. Business Associate shall provide Covered Entity a point of contact who possesses
relevant Information Security knowledge and is accessible 24 hours per day, 7 days
per week to assist with incident handling.
iv. Business Associate, to the extent practicable, shall mitigate any harmful effect known
to Business Associate of a Use or Disclosure of PHI by Business Associate in violation
of this Agreement.
Exhibit A, H1PAA BAA
Page 5 of 9 Revised 8/18
P.
q.
Subcontractors and Breaches.
Business Associate shall enter into a written agreement with each of its Subcontractors
and agents, who create, receive, maintain, or transmit PHI on behalf of Business
Associate. The agreements shall require such Subcontractors and agents to report to
Business Associate any use or disclosure of PHI not provided for by this Agreement,
including Security Incidents and Breaches of Unsecured Protected Health Information,
on the first day such Subcontractor or agent knows or should have known of the Breach
as required by 45 C.F.R. 164.410.
ii. Business Associate shall notify Covered Entity of any such report and shall provide
copies of any such agreements to Covered Entity on request.
Data Ownership.
i. Business Associate acknowledges that Business Associate has no ownership rights
with respect to the PHI.
ii. Upon request by Covered Entity, Business Associate immediately shall provide
Covered Entity with any keys to decrypt information that the Business Association has
encrypted and maintains in encrypted form, or shall provide such information in
unencrypted usable form.
r. Retention of PHI. Except upon termination of this Agreement as provided in Section 5 below,
Business Associate and its Subcontractors or agents shall retain all PHI throughout the term of
this Agreement, and shall continue to maintain the accounting of disclosures required under
Section 3.h above, for a period of six years.
4. OBLIGATIONS OF COVERED ENTITY
b. Safeguards During Transmission. Covered Entity shall be responsible for using appropriate
safeguards including encryption of PHI, to maintain and ensure the confidentiality, integrity,
and security of PHI transmitted pursuant to this Agreement, in accordance with the standards
and requirements of the HIPAA Rules.
c. Notice of Changes.
i. Covered Entity maintains a copy of its Notice of Privacy Practices on its website.
Covered Entity shall provide Business Associate with any changes in, or revocation of,
permission to use or disclose PHI, to the extent that it may affect Business Associate's
permitted or required uses or disclosures.
ii. Covered Entity shall notify Business Associate of any restriction on the use or disclosure
of PHI to which Covered Entity has agreed in accordance with 45 C.F.R. 164.522, to the
extent that it may affect Business Associate's permitted use or disclosure of PHI.
5. TERMINATION
Exhibit A, HIPAA BAA
Page 6 of 9 Revised 8/18
d. Breach.
i. In addition to any Contract provision regarding remedies for breach, Covered Entity
shall have the right, in the event of a breach by Business Associate of any provision of
this Agreement, to terminate immediately the Contract, or this Agreement, or both.
ii. Subject to any directions from Covered Entity, upon termination of the Contract, this
Agreement, or both, Business Associate shall take timely, reasonable, and necessary
action to protect and preserve property in the possession of Business Associate in
which Covered Entity has an interest.
b. Effect of Termination.
i. Upon termination of this Agreement for any reason, Business Associate, at the option
of Covered Entity, shall return or destroy all PHI that Business Associate, its agents,
or its Subcontractors maintain in any form, and shall not retain any copies of such PHI.
ii. If Covered Entity directs Business Associate to destroy the PHI, Business Associate
shall certify in writing to Covered Entity that such PHI has been destroyed.
iii. If Business Associate believes that returning or destroying the PHI is not feasible,
Business Associate shall promptly provide Covered Entity with notice of the
conditions making return or destruction infeasible. Business Associate shall continue
to extend the protections of Section 3 of this Agreement to such PHI, and shall limit
further use of such PHI to those purposes that make the return or destruction of such
PHI infeasible.
6. INJUNCTIVE RELIEF
Covered Entity and Business Associate agree that irreparable damage would occur in the event Business
Associate or any of its Subcontractors or agents use or disclosure of PHI in violation of this Agreement, the
HIPAA Rules or any applicable law. Covered Entity and Business Associate further agree that money
damages would not provide an adequate remedy for such Breach. Accordingly, Covered Entity and
Business Associate agree that Covered Entity shall be entitled to injunctive relief, specific performance,
and other equitable relief to prevent or restrain any Breach or threatened Breach of and to enforce
specifically the terms and provisions of this Agreement.
7. LIMITATION OF LIABILITY
Any provision in the Contract limiting Contractor's liability shall not apply to Business Associate's liability
under this Ageement, which shall not be limited.
S. DISCLAIMER
Covered Entity makes no warranty or representation that compliance by Business Associate with this
Agreement or the HIPAA Rules will be adequate or satisfactory for Business Associate's own purposes.
Exhibit A, HIPAA BAA
Page 7 of 9 Revised 8/18
Business Associate is solely responsible for all decisions made and actions taken by Business Associate
regarding the safeguarding of PHI.
9. CERTIFICATION
Covered Entity has a legal obligation under HIPAA Rules to certify as to Business Associate's Information
Security practices. Covered Entity or its authorized agent or contractor shall have the right to examine
Business Associate's facilities, systems, procedures, and records, at Covered Entity's expense, if Covered
Entity determines that examination is necessary to certify that Business Associate's Information Security
safeguards comply with the HIPAA Rules or this Agreement.
10. AMENDMENT
e. Amendment to Comply with Law. The Parties acknowledge that state and federal laws and
regulations relating to data security and privacy are rapidly evolving and that amendment of
this Agreement may be required to provide procedures to ensure compliance with such
developments.
i. In the event of any change to state or federal laws and regulations relating to data
security and privacy affecting this Agreement, the Parties shall take such action as
is necessary to implement the changes to the standards and requirements of
HIPAA, the HIPAA Rules and other applicable rules relating to the confidentiality,
integrity, availability and security of PHI with respect to this Agreement.
ii. Business Associate shall provide to Covered Entity written assurance satisfactory
to Covered Entity that Business Associate shall adequately safeguard all PHI, and
obtain written assurance satisfactory to Covered Entity from Business Associate's
Subcontractors and agents that they shall adequately safeguard all PHI.
iii. Upon the request of either Party, the other Party promptly shall negotiate in good faith
the terms of an amendment to the Contract embodying written assurances consistent
with the standards and requirements of HIPAA, the HIPAA Rules, or other applicable
rules.
iv. Covered Entity may terminate this Agreement upon 30 days' prior written notice in the
event that:
A. Business Associate does not promptly enter into negotiations to amend the
Contract and this Agreement when requested by Covered Entity pursuant to
this Section; or
B. Business Associate does not enter into an amendment to the Contract and this
Agreement, which provides assurances regarding the safeguarding of PHI
sufficient, in Covered Entity's sole discretion, to satisfy the standards and
requirements of the HIPAA, the HIPAA Rules and applicable law.
Exhibit A, HIPAA BAA
Page 8 of 9 Revised 8/18
b. Amendment of Appendix. The Appendix to this Agreement may be modified or amended by
fie mutual written agreement of the Parties, without amendment of this Agreement. Any
modified or amended Appendix agreed to in writing by the Parties shall supersede and replace
asy prior version of the Appendix.
11. ASSISTANCE IN LITIGATION OR ADMINISTRATIVE PROCEEDINGS
Covered EntIy shall provide written notice to Business Associate if litigation or administrative proceeding
is commenced against Covered Entity, its directors, officers, or employees, based on a claimed violation by
Business Associate of HIPAA, the HIPAA Rules or other laws relating to security and privacy or PHI.
Upon receipt of such notice and to the extent requested by Covered Entity, Business Associate shall, and
shall cause its employees, Subcontractors, or agents assisting Business Associate in the performance of its
obligations under the Contract to, assist Covered Entity in the defense of such litigation or proceedings.
Business Associate shall, and shall cause its employees, Subcontractor's and agents to, provide assistance,
to Covered Entity, which may include testifying as a witness at such proceedings. Business Associate or
any of its employees, Subcontractors or agents shall not be required to provide such assistance if Business
Associate is a named adverse party.
12. INTERPRETATION AND ORDER OF PRECEDENCE
Any ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is consistent
with the HIPAA Rules. In the event of an inconsistency between the Contract and this Agreement, this
Agreement thall control. This Agreement supersedes and replaces any previous, separately executed
HIPAA business associate agreement between the Parties.
13. SURVIVAL
Provisions ofthis Agreement requiring continued performance, compliance, or effect after termination shall
survive termination of this contract or this agreement and shall be enforceable by Covered Entity.
Exhibit A, HIPAA BAA
Page 9 of 9 Revised 8/18
APPENDIX TO HIPAA BUSINESS ASSOCIATE AGREEMENT
This Appendix ("Appendix") to the HIPAA Business Associate Agreement ("Agreement") is s an appendix
to the Contract and the Agreement. For the purposes of this Appendix, defined terms shall have the
meanings ascribed to them in the Agreement and the Contract.
Unless the context clearly requires a distinction between the Contract, the Agreement, and this Appendix,
all references to "Contract" or "Agreement" shall include this Appendix.
1. PURPOSE
This Appendix sets forth additional terms to the Agreement. Any sub -section of this Appendix marked as
"Reserved" shall be construed as setting forth no additional terms.
2. ADDITIONAL TERMS
a. Additional Permitted Uses. In addition to those purposes set forth in the Agreement, Business
Associate may use PHI for the following additional purposes:
i. Reserved.
b. Additional Permitted Disclosures. In addition to those purposes set forth in the Agreement,
Business Associate may disclose PHI for the following additional purposes:
i. Reserved.
c. Approved Subcontractors. Covered Entity agrees that the following Subcontractors or agents
of Business Associate may receive PHI under the Agreement:
i. Reserved.
d. Definition of Receipt of PHI. Business Associate's receipt of PHI under this Contract shall be
deemed to occur, and Business Associate's obligations under the Agreement shall commence,
as follows:
i. Reserved.
e. Additional Restrictions on Business Associate. Business Associate agrees to comply with the
following additional restrictions on Business Associate's use and disclosure of PHI under the
Contract:
i. Reserved.
f. Additional Terms. Business Associate agrees to comply with the following additional terms
under the Agreement:
i. Reserved.
Exhibit A, HIPAA BAA, APPENDIX
Page 1 of 1 Revised 8/18
EXHIBIT B, STATEMENT OF WORK
1. CASE MANAGEMENT OBLIGATIONS
1.1. Contractor's Obligations
1.1.1. The 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 Community Mental Health Supports Waiver (HCBS-CMHS)
1.1.1.6. HCBS Complimentary and Integrative Health Waiver (HCBS-CIH)
1.1.1.7. HCBS Developmental Disabilities Waiver (HCBS-DD)
1.1.1.8. HCBS Persons who are Elderly, Blind and Disabled Waiver (HCBS-EBD)
1.1.1.9. HCBS Persons with Brain Injury Waiver (HCBS-BI)
1.1.1.10. HCBS Supported Living Services Waiver (HCBS-SLS)
1.1.1.11. Hospital Back -Up Program (HBU)
1.1.1.12. Intermediate Care Facilities -Intellectual and Developmental Disabilities (ICF-IDD)
1.1.1.13. Long Term Home Health (LTHH)
1.1.1.14. Nursing Facilities (NF)
1.1.1.15. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS)
1.1.1.16. Program for All -Inclusive Care for the Elderly (PACE)
1.1.1.17. State Supported Living Services Program (State SLS)
1.1.2. The 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. FSSP 10 CCR 2505-10, Sections 8.613 et seq.,
1.1.2.6.2. Long -Term Care 10 CCR 2505-10, Sections 8.400 through 8.409 et seq.,
Exhibit B, SOW
Page 1 of 46
1.1.2.6.3.
1.1.2.6.4.
1.1.2.6.5.
1.1.2.6.6.
1.1.2.6.7.
1.1.2.6.8.
1.1.2.6.9.
1.1.2.6.10.
1.1.2.6.11.
1.1.2.6.12.
1.1.2.6.13.
1.1.2.6.14.
1.1.2.6.15.
1.1.2.6.16.
1.1.2.6.17.
1.1.3.
1.1.4.
1.1.5.
1.1.6.
1.1.7.
1.1.7.1.
1.1.7.1.1.
Long Term Care Single Entry Point System - 10 CCR 2505-10, Section 8.393 et seq.,
HCBS-BI - 10 CCR 2505-10, Section 8.515 et seq.,
HCBS-CES, 10 C.C.R. 2505-10 Section 8.503 et seq.,
HCBS-CHRP, 10 C.C.R. 2505-10 Section 8.508 et seq.,
HCBS-CIH 10 CCR 2505-10, Section 8.517 et seq.,
HCBS-CLLI 10 CCR 2505-10, Section 8.504 et seq.,
HCBS-CMHS 10 CCR 2505-10, Section 8.509 et seq.,
HCBS-DD, 10 C.C.R. 2505-10 Sections 8.500 to 8.500.80 et seq.,
HCBS-EBD 10 CCR 2505-10, Sections 8.485 through 8.486 et seq.,
HCBS-SLS, 10 C.C.R. 2505-10 Sections 8.500.90 to 8.500.102 et seq.,
PACE Section 25.5-5-412, Section 6a -b., C.R.S et seq.,
Services for Individuals with Intellectual and Developmental Disabilities, 10 CCR
2505-10 Section 8.600 et seq.,
State SLS Program, 10 CCR 2505-10, Section 8.501 et seq.,
Recipient Appeals, 10 CCR 2505-10, Section 8.057 et seq.,
Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards (Uniform Guidance), 2 CFR Chapter I, Chapter II, Part 200 et al.
The 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.
The 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.
The Contractor shall comply with written Operational Memos, policies, procedures, and
guidance issued by the Department.
The Contractor shall submit LTHH PARs in accordance with 10 CCR 2505-10 8.519.14.A.3.
The general Business Functions of the Contractor shall include, but is not limited to, all the
following:
The 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.
The 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. The 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.
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
Exhibit B, SOW Page 2 of 46
inclement weather or other emergencies. Regular business office hours must be
posted and made available to the public.
1.1.7.2. The Contractor shall have internal procedures for accommodating individuals, Members,
and families who need assistance or consultation outside regular business office hours.
1.1.7.3. The Contractor shall have an emergency on -call procedure to respond to crisis situations
sutside of regular business hours. Procedures must clearly document how the Contractor
will ensure timely response to emergency situations such as hospital discharges, risk of
homelessness, unexpected termination of residential services, etc. The Contractor shall
make the procedure available to the Department upon request. The Contractor shall notify
individuals, Members, families, providers, and community partners of the procedures and
make it readily available through a variety of methods.
1.1.7.4. The 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 the Contractor.
1.1.7.5. The 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
tie Defined Service Area to best meet the needs of individuals and members.
1.1.7.6. The Contractor shall protect Members' rights as they relate to the responsibilities of Case
Management Agencies as described in this Contract.
1.1.7.7. The Contractor shall provide access to a telephone system and trained staff to ensure
timely response to messages and telephone calls received after hours.
1.1.7.8. The 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. The Contractor shall conduct an assessment of the communication needs of the
Members they serve and ensure their interpretation and telecommunication services
s.ifficiently meet the Member's need in a timely fashion.
1.1.7.9. The 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.
1.1.7.10. The Contractor shall support the Department's National Core Indicators (NCI) efforts.
1.1.7.11. The Contractor shall support the Department's Equity, Diversity, Inclusion, and
Accessibility (EDIA) efforts to include participation in a Department led EDIA
assessment and survey. The 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. The
Contractor shall make the policy and procedure available to the Department upon request.
1.1.7.12. The Contractor shall enroll and act as a Medicaid Targeted Case Management (TCM)
provider for all HCBS waivers and enroll as a provider of CHCBS case management
services to include, but not limited to, providing ongoing case management and
monitoring activities for the Defined Service Area.
Exhibit B, SOW Page 3 of 46
1.1.7.13. The 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. The 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 the Contractor's CFCMW at any time.
1.1.7.13.3. The 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 the 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 the Contractor is supporting the recruitment of providers in their area to
remediate conflict.
1.1.7.13.4. If the contractor is denied a CFCMW for any reason, or one is revoked, the Contractor
must have documented written plans for transitioning individuals and Members. The
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.
1.2.1.1.
1.2.1.1.1.
The Contractor shall comply with written communication from the Department, provided by
the Department, between the Contractor and community partners and service providers that
outline how the Contractor will work together with these partners to coordinate care and
better serve individuals and Members. The 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. The 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:
Regional Accountable Entities (RAE)
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
Exhibit B, SOW Page 4 of 46
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.
1.2.1.1.2.
1.2.1.1.3.
1.2.1.1.4.
1.2.1.1.5.
1.2.1.1.6.
1.2.1.1.7.
1.2.1.1.8.
1.2.1.1.9.
The Contractor shall ensure collaboration with RAEs occurs for all shared Members
that need care coordination services for physical, mental and behavioral health
services. The Contractor shall identify which community agencies are responsible for
facilitation, follow-up, and solution focused on next steps for each Member
collaboration.
The 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.
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.
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.
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.
The 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 members needs to ensure
holistic case management and care coordination.
The Contractor shall honor Member's preferences for case management and care
coordination, when applicable, while ensuring collaboration with the RAE occurs.
The Contractor shall work with the Department to identify a Key Performance
Indicator (KPI) to measure the effectiveness of coordination between Contractor and
RAE.
1.2.2. 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-
18, 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 -
Exhibit B, SOW Page 5 of 46
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. The Contractor shall ensure collaboration with all county and Medical Assistance sites
pertaining to application, renewal, case changes or re -application status for members in
the Contractor's designated service area.
1.2.2.3. The Contractor shall collaborate with the appropriate counties and/or Medical Assistance
sites in order 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. The 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
1.3.1. 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.
1.3.2. The Contractor shall ensure all case managers meet the qualification requirements established
in 10 C.C.R. 2505-10, Section 8.519 et seq.
1.3.3. The 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.
1.3.4. The 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 the Contractor.
1.3.5. 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. The Contractor shall utilize training materials
provided by the Department.
1.3.6. Required Case Management Training includes, but is not limited to:
1.3.6.1. Applicable Federal and State laws and regulations for LTSS programs
1.3.6.2. Critical Incident Reporting
1.3.6.3. Determination of Developmental Disability or Delay
Exhibit B, SOW Page 6 of 46
1.3.6.4.
1.3.6.5.
1.3.6.6.
1.3.6.7.
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
1.3.6.8. Long -Term Home Health (LTHH)
1.3.6.9. Long -Term Services and Supports Eligibility
1.3.6.10. Mandatory Reporting
1.3.6.11. Notices and Appeals
1.3.6.12. Nursing Facility Admissions
1.3.6.13. Participant Directed Training
1.3.6.14. Person -Centered Support Planning and Person -Centered Support Plan
1.3.6.15. Pre -Admission Screening and Resident Review (PASRR)
1.3.6.16. State General Fund Program Ongoing Case Management
1.3.6.17. State General Fund Program Requirements and Services
1.3.6.18. System Documentation
1.3.6.19. Waiver Requirements and Services
1.3.7. DELIVERABLE: Case Management Training
1.3.8. DUE: Semi -Annually, trainings held between July 1St and December 31a are due January
15tt, and trainings held between January 1St through June 29th are due June 30th.
1.3.9. The 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,
date the training was held, case managers in attendance, and trainer sign off showing the case
macager 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. The 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, the Contractor may assign independent case
management activities once the Contractor has verified that the Case Manager's training
requirements were previously met.
Exhibit B, SOW
Page 7 of 46
1.3.14. The 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. The 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. The 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. The 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 shall be maintained by
the 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. The 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.
1.4.1.1. Staff employed by the 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: No later than June 15th
1.5. Complaints
1.5.1. The 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. The Contractor shall receive, document and track any complaint received by the 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. The Contractor shall submit all complaints to the Community Advisory Committee for
review, feedback and input on resolving complaints..
Exhibit B, SOW Page 8 of 46
1.5.4. The 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 the 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 the 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
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. The 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 the Contractor received no complaints during the quarter, the 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, the 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. The 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 151h, January 15th, April 15th and June 15th of each year.
1.6. Continuous Quality Improvement Plan
1.6.1. The 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 a4escription of the following:
Exhibit B, SOW Page 9 of 46
1.6.1.1. How the 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 the Contractor reviews work to determine whether the work is being completed in
a correct and high -quality manner.
1.6.1.3. How the Contractor identifies and addresses Case Management performance issues.
1.6.1.4. How the Contractor notifies the Department of identified performance issues.
1.6.1.5. How the 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 the Contractor yearly.
1.6.1.6. The Contractor shall participate in the Department hosted Quality Community of
Practice.
1.6.2. The 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 the Contractor to review and discuss the CQI Plan, data, and agency specific quality
dashboard. The 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. The Contractor shall review its Continuous Quality Improvement Plan on an annual basis and
update the plan as appropriate to account for any changes. The 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
1.6.3.2. DUE: Annually, by October 1st
1.7. Appeals
1.7.1. The 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. The Contractor shall coordinate with the Department for any adverse actions
necessitating Department attendance at a hearing.
1.7.1.1. The Contractor shall identify and disclose to the Department immediately, and no later
than 45 days prior to a scheduled appeal hearing, any conflict of interest that would
interfere with the Contractor's ability to represent the Department in any appeal.
1.7.2. The 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. The 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. The Contractor shall develop an Appeals Packet which contains all relevant documentation
to support the Contractor's denial or adverse action.
Exhibit B, SOW Page 10 of 46
1.7.5. The Contractor shall develop an Appeals Packet no later than 20 Business Days prior to the
date of a scheduled hearing.
1.7.6. The Contractor shall submit exceptions when applicable and include all relevant information.
1.7.7. The Contractor shall cooperate with the Office of the State Attorney General for any case in
which it is involved.
1.7.8. The Contractor shall document all appeals where the Contractor attends any hearing in an
Administrative Law Court.
1.7.9. The Contractor shall make the Appeal Packets available to the Department upon request.
1.7.10. The Contractor shall document all Appeals Creation of the Packet and Attendance at the
Hewing 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. The 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.
1.8.1.2. The Contractor shall ensure all suspected incidents of abuse, neglect, and exploitation are
mmediately 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. The 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. The 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.
Exhibit B, SOW Page 11 of 46
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 .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 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 each quarter.
1.9. Investigations
1.9.1. The Contractor shall insure all allegations of abuse, neglect, and exploitation for members
enrolled in HCBS-CES, HCBS-CHRP, HCBS-DD, HCBS-SLS, State SLS, OBRA-SS, and
FSSP are investigated and documented according to the Department's prescribed system.
1.9.2. Investigations shall include, but is not limited to: examination of Critical Incident Reports,
log notes, and medical documentation related to the member; documented interviews with
the waiver participant, guardian, and support staff as appropriate; documentation regarding
any questions not resolved by a law enforcement or county investigation (e.g., provider
training, program management supervision, etc.); documentation of follow-up, preventative
strategies and outcomes of reviews and assessments regarding the allegations and incident;
the examination incident report and preliminary results of the investigation, a summary of
the investigative procedures utilized, the full investigative finding, the actions taken, and
Human Rights Committee review of the investigative report and the action taken on
recommendations made by the committee.
1.10. Human Rights Committee (HRC)
1.10.1.
1.10.2.
1.10.2.1.
1.10.2.2.
1.10.3.
1.10.3.1.
1.10.3.2.
1.10.4.
The 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. The Contractor shall
maintain qualifications for each member of the HRC and make it available to the Department
upon request.
The Contractor shall submit a list of HRC members annually.
DELIVERABLE: HRC Member List
DUE: Annually, by August 15th
The Contractor shall notify the Department of any changes to the HRC members within 10
Business Days of the date of change.
DELIVERABLE: HRC Member Updates
DUE: Within 10 Business Days of the date of change to the HRC members
The 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,
Exhibit B, SOW Page 12 of 46
OBRA-SS, and FSSP. The HRC is an advisory and review body to the administration of the
Contractor.
1.10.5. The Contractor shall develop policies and procedures to assure that all potential conflicts of
interest are addressed. The Contractor shall utilize the Department's required universal
documents for all HRC reviews.
1.10.6. The 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. The Contractor shall provide the HRC with the necessary staff support to facilitate its
functions.
1.10.8. The Contractor shall keep proper documentation and record of all HRC recommendations
and assure that all documentation is a part of the individual's master record.
1.10.9. The Contractor shall maintain and submit HRC meeting minutes, attendance logs, and
supporting documentation related to an HRC meeting to the Department within 10 Business
Days of receiving the request.
1.10.10. The Contractor shall notify the Department in writing of any changes to the HRC membership
within 10 Business Days.
1.10.11. The 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. Intake, Screening and Referral
2.1.1. The Contractor shall perform all intake, screening and referral 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)
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)
Exhibit B, SOW Page 13 of 46
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)
2.1.2. The Contractor shall perform all intake, screening and referral functions/activities in
accordance with §25.5-6-104, C.R.S. and 10 CCR 2505-10, Sections 8.500.1 and 8.393.2.B.
et seq., shall include, but not limited to, the following:
2.1.2.1. Facilitating the Medicaid application process and responding to all referrals of potentially
eligible individuals within two Business Days of receipt of the referral.
2.1.2.2. Processing information regarding an individual's Medicaid eligibility within two
Business Days of receipt from the eligibility site.
2.1.2.3. Ask referring agencies to complete and submit an intake and screening form to initiate
the process.
2.1.2.4. Providing information and referral to other agencies as needed.
2.1.2.5. Making initial contact with individuals to include a preliminary screening in the following
areas:
2.1.2.5.1.
2.1.2.5.2.
2.1.2.5.3.
2.1.2.5.4.
2.1.2.5.5.
2.1.2.5.6.
An individual's need for LTSS.
An individual's need for referral to other programs or services.
An individual's eligibility status for financial and program assistance.
The need for a Level of Care Screen and Needs Assessment.
Maintain individual and Member records including documentation of the referrals and
outcome utilizing the Department's prescribed system.
The Contractor shall ensure documentation includes the individual's need for LTSS
and/or the individual's request for a Level of Care Screen and Needs Assessment,
even though the intake screening indicates the individual may not be eligible for
LTSS.
2.1.2.5.7. Individuals shall be notified at the time of the decision of their application for publicly
funded LTSS that they have the right to appeal actions of the 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.
2.1.2.6. PERFORMANCE STANDARD: 100% of Referrals are entered into the Department
prescribed system within two Business Days of the Referral receipt date.
2.2. Individual/Member Records
2.2.1. The Contractor shall:
2.2.1.1. 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
Exhibit B, SOW Page 14 of 46
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. The Contractor shall
also have access to member eligibility, PAR, and claims data through reporting provided
through a COGNOS data query application.
2.2.1.2. Maintain individual and Member records within the Department's prescribed systems for
the purposes of individual and Member information management.
2.2.1.3. Maintain accurate and detailed documentation of all case management and State General
Fund Program activities required through the Contract.
2.2.1.4. 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.
2.2.1.5. Correct 100% of data errors, discovered by the Department, and confirm the accuracy of
the data it enters into the Department prescribed system within 10 Business Days of
notification from the Department of an error.
2.2.1.5.1. PERFORMANCE STANDARD: 100% of data errors corrected within 10 Business
Days of notification.
2.3. Developmental Disability and Delay Determinations
2.3.1. The 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. The Contractor may expedite psychological or adaptive behavior testing for Developmental
Disability Determinations requested to complete PASRR Level II assessments for individuals
residing in skilled nursing facilities when there are delays due to issues identifying a provider
or scheduling testing with a provider.
2.3.2.1. The Contractor shall maintain all supporting documentation related to the expedited
testing for DD Determination and make it available to the Department upon request.
2.3.3. The 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.
2.3.4. The Contractor shall maintain the individual's determination, documents, and request forms
andrnake them available to the Department upon request or to another CMA upon transfer.
2.3.5. The 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,
FSW, and OBRA-SS.
2.3.6. Individuals shall be notified at the time of the decision of the determination that they have
the right to appeal actions of the Contractor to 10 CCR 2505-10 sections 8.500.16 et seq.,
8.5,9.22 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
Exhibit B, SOW Page 15 of 46
2.4.1. The 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. The
Contractor shall not maintain a waiting list for any of the other programs included within this
Contract. When funding has been made available for an individual the contractor will remove
the person from the "As Soon As Available" (ASAA) waiting list within 10 Business Days.
2.4.2. The name of a person eligible for the program shall be placed on the waiting list by the
Contractor making the eligibility determination.
2.4.3. 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.
2.4.4. The placement date used to establish a person's order on an HCBS waiver waiting list shall
be:
2.4.4.1. The date on which the person was initially determined to have a developmental disability
by the Contractor; or
2.4.4.2. The 14th birth date if a child is determined to have a developmental disability by the
Contractor prior to the age of 14.
2.4.5. When an individual is eligible for a program and funding is not available, the Contractor
shall:
2.4.5.1. Verify demographic information.
2.4.5.2. Compile and correct data.
2.4.6. The 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.
2.4.7. The Contractor shall conduct and document, in the Department prescribed case management
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.
2.4.7.1. 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.
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 the Contractor of the individual who will be offered an enrollment by the order
of selection date.
2.5.1.2. The Contractor shall notify the individual of the enrollment offer within five Business
Days. The Contractor shall make three attempts to contact the individual within a 30 -
calendar day period. The 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, the Contractor shall change the individuals
waiting list timeline to "Safety Net".
Exhibit B, SOW Page 16 of 46
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 the 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. HOBS -DD Waiting List Enrollment Capacity Building
2.5.2.1. As appropriated and earmarked by the General Assembly, the Contractor may receive
capacity building funding to support the enrollment of members into the HCBS-DD
waiver from the waiting list.
2.5.2.2. The 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, the 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
znrollment 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, the 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. The 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. The 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
Exhibit B, SOW Page 17 of 46
2.5.5.1. The 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, the 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. The Contractor shall provide information and referrals to individuals, families and/or
guardians at the time of the annual follow-up.
2.5.5.4. The 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. The 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 the 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. The Contractor shall correct one hundred percent (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. The 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, the 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 actions of the 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. The 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
Exhibit B, SOW Page 18 of 46
2.7.4.2. DUE: Monthly, by the 15th on the template prescribed by the Department
3. SCREENING AND ASSESSMENT
3.1. The Contractor shall perform the Level of Care (100.2) Assessment as indicated in Section 3.2
or the Level of Care Screen and Needs Assessment as indicated in Section 3.3 for each Member
as directed by the Department. The Contractor shall not perform both a Level of Care Assessment
(100.2)and a Level of Care Screen and Needs Assessment for the same Member unless directed
to do so by the Department.
3.2. Level of Care Assessment (100.2)
3.2.1. The Contractor shall provide staff that meet the case manager qualifications set forth in state
statutes and regulations to perform all Level of Care Assessments.
3.2.2. The Contractor shall utilize and conduct the HCPF prescribed tools for the Initial Level of
Cary Assessment for all new applicants to the HCBS waivers, PACE, Nursing Facilities,
Hojital Back -Up, LTHH only, and ICF-IDD. Initial Level of Care Assessment include the
following Assessment Event types: Initial Review, HCBS-DD Waitlist,
DeL-istitutionalization (DI), and Reverse Deinstitutionalization. Continued Stay Review
Level of Care Assessments include the following Assessment Event types: Continued Stay
Resew and Unscheduled Review.
3.2.3. An Unscheduled Review Assessment Event Type shall be utilized when a Level of Care
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.
3.2.4. The Contractor shall conduct an Initial Level of Care Assessment in accordance with the
following timelines:
3.2.4.1. 10 Business Days for individuals residing in the community, upon completion of the DD
determination, when the individual requests HCBS waiver services, and upon verifying
Medicaid eligibility or submission of a Medicaid application.
3.2.4.2. Five Business Days from the date of referral for individuals residing in a nursing facility
or ICF-IID.
3.2.4.3. Two Business Days from the date of referral for individuals residing in a hospital.
3.2.4.4. 10 Business Days after receiving confirmation that the Medicaid application has been
received by the county Department of Human or Social Services for individuals residing
.n the community.
3.2.4.5. 10 Business Days after receiving a referral from a provider for the PACE.
3.2.4.6. 5 Business Days after receiving a completed referral from the nursing facility.
3.2.4.7. 5 Business Days after receiving a completed approval for the CLLI Waiver.
3.2.4.8. Two Business Days after receiving a completed referral from the hospital.
3.2.5. The -Contractor shall enter and verify the evaluation into the Department's prescribed system
within 10 Business Days of completing the evaluation.
3.2.5.1. PERFORMANCE STANDARD: Initial Level of Care Assessment
Exhibit B, SOW Page 19 of 46
3.2.5.2. DUE: Within 10 Business Days after completing the evaluation. Contractor shall verify
that an individual needs an institutional level of care by receiving a Professional Medical
Information Page (PMIP) signed by a medical professional and dated no earlier than six
months from the certification start date and no later than 90 days from the evaluation date
of an Initial Level of Care Assessment; and 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 Intermediate Care
Facilities for Individuals with Intellectual Disabilities (ICF-IID).Contractor shall conduct
all Level of Care Evaluations in accordance with regulations.
3.2.6. The Contractor shall conduct a 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. The Contractor shall enter the review into the
Department's prescribed system within 10 Business Days of completing the evaluation.
3.2.6.1. PERFORMANCE STANDARD: Enter and verify Continued Stay Reviews within 10
Business Days after completing the assessment.
3.2.7. The Contractor shall enter and verify the Continued Stay Review into the Department's
prescribed system within 10 Business Days of completing the assessment. 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.
3.2.7.1. The 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.
3.2.7.2. The Contractor shall bear the sole financial responsibility of 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.
3.2.8. The 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. The 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:
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. The 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 days from the evaluation
Exhibit B, SOW Page 20 of 46
3.3.2.3.2.
Exhibit B, SOW
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 Level of Care 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
3.3.2.2. The Contractor shall conduct an Initial Level of Care Screen prior to enrolling in the
hollowing programs:
3.3.2.2.1. HCBS Waivers
3.3.2.2.2. PACE
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. The Contractor shall conduct an Initial Level of Care Screen in accordance with the
bllowing timelines:
3.3.2.3.1. Within 10 Business Days after receiving confirmation that the Medicaid application
has been received by the county Department of Human or Social Services for
individuals residing in the community.
Within 10 Business Days after receiving a referral from a provider for PACE.
Page 21 of 46
3.3.2.3.3.
3.3.2.3.4.
3.3.2.3.5.
3.3.2.3.6.
3.3.2.4.
3.3.2.4.1.
3.3.2.4.2.
3.3.2.4.3.
Within five Business Days after receiving a completed referral from the nursing
facility.
Within five Business Days from the date of referral for individuals residing in a
nursing facility or ICF-IID.
Within five Business Days after receiving a completed approval for the CLLI Waiver.
Within two Business Days after receiving a completed referral from the hospital.
The Initial Level of Care Screen shall include, but is not limited to the following:
A review of financial eligibility information
A review of the Level of Care Screen information
A review of relevant medical, educational, social, or other assessment records or
information when applicable.
3.3.3. Annual Level of Care Screen Reassessment
3.3.3.1. The Contractor shall conduct an Annual Reassessment Level of Care Screen no earlier
than 90 days prior to and no later than 30 days prior to the current Level of Care Screen
certification end date.
3.3.3.2. 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.
3.3.3.2.1. In the event the Contractor fails to conduct the Annual Reassessment Level of Care
Screen for a Member enrolled in a HCBS waiver, the Contractor shall be responsible
for reimbursing any providers for services rendered during the gap in eligibility.
3.3.3.2.2. The 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.
3.3.3.2.3. The Contractor shall take action regarding Member Medicaid eligibility within one
Business Day of receipt from the eligibility site.
3.3.3.2.4. In the event the Contractor fails to discontinue waiver services for a Member found
ineligible for a HCBS waiver, the Contractor shall be responsible for reimbursing any
providers for services rendered.
3.3.4. 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.
3.3.4.1. Members shall be notified at the time of the eligibility decision that they have the right to
appeal actions of the 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.
3.3.5. Needs Assessment
Exhibit B, SOW Page 22 of 46
3.3.5.1.1.
3.3.5.2.
3.3.5.2.1.
3.3.5.2.2.
3.3.5.1. The Contractor shall conduct an Initial and Annual Needs Assessment for the following
programs:
HCBS Waivers
The 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, choose to enroll in
HCBS waiver services, and meet the required Level of Care for LTSS, and waiver Target
Criteria for one of more HCBS waivers must have a Needs Assessment conducted.
The Contractor shall conduct a Needs Assessment with Members to determine the
level of support needed and identify personal preferences and goals.
The 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. The 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. Supports Intensity Scale -A Assessment
3.4.1. The 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. The Contractor shall not be reimbursed for a SIS
assessment prior to the individual being determined eligible for a waiver through the Level
of Care Screen and confirmation of financial eligibility. The Contractor shall not be
reimbursed for SIS reassessments without prior authorization from the Department to conduct
the SIS reassessment.
3.4.2. The Contractor shall conduct all initial SIS Assessments within 60 calendar days from the
date of the Initial Level of Care Screen. The Contractor shall conduct all SIS reassessments
within 60 calendar days from the date of approval from the Department.
3.4.3. The Contractor shall enter the SIS Assessment into SIS-A Online within 65 calendar days of
completing the Level of Care Screen.
3.4.4. The Contractor shall complete the SIS-A assessment and enter it into SIS-A Online prior to
the Prior Authorization Review (PAR) Date.
3.5. HCBS-CES Applications
Exhibit B, SOW Page 23 of 46
3.5.1. The Contractor shall complete initial and CSR applications for persons applying for the
HCBS-CES waiver as set forth by the Department's prescribed guidelines.
3.5.2. 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.
3.5.3. 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.
3.5.4. The Contractor shall maintain all HCBS-CES applications and supporting documentation and
make it available to the Department upon request.
3.6. Support Need Level Assessment
3.6.1. The 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.
3.6.2. The Contractor shall conduct an initial Support Need Level Assessment within forty-five (45)
calendar days from the date of the Initial Level of Care Screen. The Contractor shall conduct
all reassessments as necessary individual's needs change.
3.6.3. The Contractor shall submit a list of all completed HCBS-CHRP Support Need Level
Assessments on a template prescribed by the Department.
3.6.3.1. DELIVERABLE: Completed HCBS-CHRP Support Need Level Assessment List
3.6.3.2. DUE: Monthly, by the 15th
3.6.4. The Contractor shall maintain all Support Need Level Assessments and supporting
documentation and make it available to the Department upon request.
3.6.4.1. PERFORMANCE STANDAND: Support Need Level Assessment
3.6.4.2. 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. The 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 the Contractor has been determined to be the only willing and qualified
provider by the Department for the Defined Service Area, the Contractor must administer the
State Programs and purchase and/or provide services and supports for persons determined to
be eligible under this Contract. The 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. The Contractor must ensure separation of case management
responsibilities and the provision of services for both State SLS and OBRA-SS.
4.1.2. The Contractor shall ensure that written notifications are provided to individuals and
Members informing them of their rights and the potential influence the Contractor has on the
Service Planning process, such as exercising free choice of providers.
4.1.3. The 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 the Contractor.
Exhibit B, SOW Page 24 of 46
4.1.4. The 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. The Contractor shall report all State SLS, FSSP, and OBRA-SS direct service expenditures
on tie 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 the Contractor at the time of discovery. If the adjustment is
identified after the close of the fiscal year the service is rendered, the 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. The 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
8.50►1.3 et seq.
4.3. State Supported Living Services (State SLS)
4.3.1. General Requirements
4.3.1.1. The Contractor shall operate the State SLS program pursuant to 10 C.C.R. 2505-10
Section 8.501et seq.
4.3.1.2. The Contractor shall not add surcharges to the purchase of covered services for State SLS.
4.3.1.3. The Contractor shall provide a list of qualified providers for all services to Members and
_amilies, during the State SLS Individual Support Plan process, and to other interested
parties upon request.
4.3.1.4. The 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 the Contractor of the target number of individuals that shall
be served through State SLS prior to the start of each State Fiscal Year (SFY). The
Contractor may choose to enroll more individuals in State SLS than authorized, 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.
4.3.2. State SLS Eligibility
4.3.2.1. The 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.
Exhibit B, SOW Page 25 of 46
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. The 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 the Contractor and with a Developmental Disability
determination at time of referral. The 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. The Contractor shall ensure the State SLS ISP is signed by all
required parties prior to implementation.
4.3.3.3.
4.3.3.4.
4.3.3.5.
4.3.3.5.1.
4.3.3.6.
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.
4.3.4.1.8.
4.3.4.1.9.
4.3.4.1.10.
4.3.4.2.
Exhibit B, SOW
The State SLS ISP shall be developed through an in -person meeting that includes, at a
minimum, the individual seeking services and the Contractor.
The Contractor shall utilize the ISP within the Department's prescribed system.
The 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.
PERFORMANCE STANDARD: The 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.
The State SLS ISP shall be effective for no more than one year and reviewed by the
Contractor at least every six months in an in person monitoring contact.
If an individual seeks additional supports or alleges a change in need, the Contractor shall
review and update the ISP prior to changing the authorized services and supports.
State SLS Ongoing Case Management
The 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
Case Management, policy and regulation training
Service records maintenance
Utilization review
The Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
Page 26 of 46
4.3.4.3. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace the Contractor's required individualized case management activities.
4.3.4.4. Monitoring
4.3.4.4.1. Monitoring shall be person centered and include at least one in person contact with
the Member at the 6 -month review in addition to the annual ISP. Two 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.
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.
The Member's selected modality must be documented within the case notes for
each monitoring contact within the Department's prescribed system.
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
The 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
The 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
The 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).
4.3.4.7. State SLS Records Maintenance
4.3.4.7.1. The Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make them available to the Department upon request as
required in 10 C.C.R. 2505-10 Section 8.130.2 et seq.
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.
Exhibit B, SOW Page 27 of 46
4.3.4.7.3. If the 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, the Contractor shall ensure all services reimbursed by
the Contractor are rendered by service providers in accordance with the State SLS
Individual Support Plan.
4.3.4.7.5. The Contractor shall attempt to resolve any discrepancies with the subcontractor/
service provider directly.
4.3.4.7.6. The 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. The 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. The 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. The 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. The 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. The Contractor shall enroll individuals into OBRA-SS, as long as 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, the 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. The 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 the contractor shall inactivate the
individual's record in the Department prescribed system.
4.4.4. OBRA-SS Individual Support Plans
4.4.4.1. The 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 the
Exhibit B, SOW Page 28 of 46
contractor and with a Developmental Disability determination at time of referral. The
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. The
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 the Contractor.
4.4.4.3. The Contractor shall utilize the ISP template within the Department's prescribed System.
4.4.4.4. The 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: The 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 the
Contractor at least every six months in a face to face monitoring contact.
4.4.4.6. If a member seeks additional supports or alleges a change in need, the Contractor shall
review and update the ISP prior to changing the authorized services and supports.
4.4.4.7. The 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. The 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. The 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 the Contractor's required individualized case management activities.
4.4.6. OBRA-SS Monitoring
Exhibit B, SOW Page 29 of 46
4.4.6.1. Monitoring shall be person centered and include at least one in person contact with the
Member at the 6 -month review in addition to the annual ISP. Two 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.
4.4.6.1.1. 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. The 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. The Contractor shall not utilize OBRA-SS funds to purchase mental health related
services. The 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. The 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. The 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. The 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, SOW Page 30 of 46
4.4.8.7.
4.4.8.7.1.
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. The Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make them available to the Department upon request as required
is 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 the 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, the Contractor shall ensure all services reimbursed by the
Contractor are rendered by service providers in accordance with the OBRA-SS Individual
Support Plan.
4.4.8.4. The Contractor shall attempt to resolve any discrepancies with the service provider
directly.
4.4.8.5. The Contractor shall notify the Department of any instances of suspected fraud and any
supporting documentation at the time of discovery.
4.4.8.6. The 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.
Mental Health Services Prohibited
The 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, SOW Page 31 of 46
4.4.8.7.2. The 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. The 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. The 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, the Contractor shall conduct an FSSP Needs
Assessment prior to authorizing services. The 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 a documented scoring criteria for the tool. The
tool shall be included in the 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. The 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. The 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. The Contractor shall maintain all Needs Assessment documentation and make them
available to the Department upon request.
4.5.2.7. The Department will notify the Contractor of the target number of individuals that shall
be served through FSSP prior to the start of each State Fiscal Year (SFY). The 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. The 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. The Contractor shall develop the FSP within 10 Business Days after an initial
Individualized Support Plan (ISP) meeting for those individuals not established with the
Contractor and with a Developmental Disability or Delay Determination at the time of
referral. The Contractor shall ensure the FSP is signed by all required parties prior to
implementation.
Exhibit B, SOW Page 32 of 46
4.5.3.3. The FSP shall be developed through a meeting that includes, at a minimum, a family
representative, and the Contractor.
4.5.3.3.1. The 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, the Contractor shall
review and update the FSP prior to changing the authorized services and supports.
4.5.3.6. The 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 the 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. The Contractor shall not charge families to provide direct services and case management
for Family Support Services.
4.5.4.3. The 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. The 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
Exhibit B, SOW Page 33 of 46
4.5.4.5. The Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
4.5.4.6. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace the Contractor's required individualized case management activities.
4.5.5. FSSP Direct Services
4.5.5.1. The 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. The 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. Correlation
between the need and the disability must be documented in the FSP.
4.5.5.3. The 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. The Contractor shall ensure that all services are authorized pursuant to the FSP.
4.5.5.5. The 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).
The Contractor shall not authorize or provide any service that is not outlined in these
regulations.
4.5.5.6. The 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. The 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. The 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. The 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. The 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. The Contractor shall provide an 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. The Contractor shall make the training and orientation materials available to
the Department upon request.
Exhibit B, SOW Page 34 of 46
4.5.6.5.
4.5.6.5.1.
4.5.6.5.2.
4.5.7.
4.5.7.1.
The Contractor shall ensure the FSC fulfills all duties outlined in 10 C.C.R. 2505-10
Section 8.613.B et seq. The Contractor shall document meeting minutes and submit them
to the Department. The Contractor shall maintain all supporting documentation related to
an FSC meeting and make it available to the Department upon request.
DELIVERABLE: FSC Meeting Minutes
DUE: Monthly, by the 15th of each month and by June 30th
FSSP Evaluation
In coordination with the FSC, the Contractor shall be responsible for evaluating the
effectiveness of the FSSP on an annual basis. The Contractor shall ensure the annual
program evaluation addresses all areas required in 10 CCR 2505-10 Section 8.613.K et
seq.
4.5.7.2. The Contractor shall provide the Annual Evaluation Report to the Department for review
and approval.
4.5.7.2.1. DELIVERABLE: Annual Evaluation Report
4.5.7.2.2. DUE: Annually, by June Pt
4.5.8. FSSP Annual Program Report
4.5.8.1. The Contractor shall create and submit an annual FSSP 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.
4.5.8.2. The Contractor shall provide the FFS Program Report to the Department for review and
approval.
4.5.8.2.1. DELIVERABLE: FSSP Program Report
4.5.8.2.2. DUE: Annually, by October 10
4.5.9. FSSP Records Maintenance
4.5.9.1. The Contractor shall maintain supporting documentation capable of substantiating all
expenditures and reimbursements made to providers, Members and/or families.
4.5.9.2. When the Contractor purchases services or items directly for Members and/or families,
the Contractor shall:
4.5.9.2.1. Maintain receipts or invoices from the service provider and documentation
demonstrating that the provider was paid by the 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 the Contractor reimburses Members and/or families for services or items, the
Contractor shall:
4.5.9.3.1. Ensure the Member and/or family provides the 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 the Contractor.
Exhibit B, SOW Page 35 of 46
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.
4.5.9.4. When the Contractor provides funding to Members and/or families for the purchase of
services or items in advance, the Contractor shall include, but is not limited to:
4.5.9.4.1. Establish policies and procedures outlining the Contractor's processes for advancing
funds, ensuring supporting documentation is received by the Member and/or family,
and remedial action steps the 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 the 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 the 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
the Contractor.
4.5.9.4.4.1.
4.5.9.4.5.
4.5.9.4.6.
4.5.9.4.7.
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.
The Contractor shall ensure the documentation received by the Member and/or
family, indicates that the amount was paid.
If a Member and/or family does not submit invoices or receipts, the Contractor shall
document all attempts to obtain receipts or paid invoices and any remedial action
taken. The Contractor shall make all supporting documentation available to the
Department upon request.
If the Contractor cannot provide supporting documentation as described in this
section, the Department may recover any unsubstantiated expenditures from the
Contractor.
4.5.9.5. The 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. The 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. ACCOUNTING
5.1. The 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.
5.2. The Contractor shall establish and maintain internal control systems and standards that apply to
the operation of the organization.
5.3. The 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
Exhibit B, SOW Page 36 of 46
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.
5.4. The Contractor shall establish any necessary cost accounting systems to identify the application
of funds and record the amounts spent.
5.5. The Ccritractor 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
5.5.1. DELIVERABLE: Transaction and Funds Documentation
5.5.2. DUE: Within 10 Business Days of the Department's Request
6. SUBRECIPIENT STATUS AND REQUIREMENTS
6.1. The 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
FederaLAwards (Uniform Guidance); Final Rule (the "Final Rule"), released December 26, 2013
and sulasequently updated, and thus shall be required to follow all requirements and guidance
contained in the Final Rule.
6.2. Single Audits
6.2.1. Under the Final Rule, all Non -Federal Entities, as defined in the Final Rule, expending
$75O,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.
6.2.2. The Contractor shall notify the State when expected or actual expenditures of federal
assistance from all sources equal or exceed $750,000.00.
6.2.3. If the expected or actual expenditures of federal assistance from all sources do not equal or
exceed $750,000.00 the Contractor shall provide an attestation to the State that they do not
qualify for a Single Audit.
6.2.4. 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.
6.2.4.1. DELIVERABLE: Single Audit
6.2.4.2. 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
6.2.5. If tie Contractor did not receive enough federal funds to require a Single Audit, the
Contractor shall submit an attestation form stating a Single Audit was not required utilizing
the Department's template.
6.2.5.1. DELIVERABLE: Attestation Form
6.2.5.2. 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
6.2.6. The audit period shall be the Contractor's fiscal year.
6.3. Treatment of Funds
Exhibit B, SOW Page 37 of 46
6.3.1. All funding identified as a subaward with matching federal dollars received through this
Contract is subject to the requirements within Uniform Guidance.
6.3.1.1. All subawards must be used on allowable expenses associated with performing the
activities outlined in this Contract and on allowable expenses per Uniform Guidance.
6.3.1.2. 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.
7. FINANCIAL TRANSPARENCY
7.1. The Contractor shall comply with all transparency requirements pursuant to C.R.S. Title 25.5-6-
1708.
7.2. Board of Director or Governing Body Changes
7.2.1. The Contractor shall notify the Department in writing of any changes to the Board of
Directors or Governing Body within 10 Business Days.
7.2.1.1. DELIVERABLE: Written notification of changes to Board of Director or Governing
Body membership
7.2.1.2. DUE: Within 10 Business Days of the effective date
7.3. Annual Financial Statements and Independent Auditor's Report
7.3.1. The Contractor shall submit a copy of the Contractor's annual Financial Statements and
Independent Auditor's Report to the Department.
7.3.1.1. DELIVERABLE: Financial Statements and Independent Auditor's Report
7.3.1.2. DUE: No later than 30 calendar days following the acceptance of the audit by the
Contractor's Board of Directors or Governing Body
7.4. IRS Form 990
7.4.1. The Contractor shall submit a copy of the Form 990 the Contractor filed with the Federal
Internal Revenue Service to the Department, if applicable.
7.4.1.1. DELIVERABLE: IRS Form 990
7.4.1.2. DUE: No later than 30 calendar days following the Contractor's filing of the form with
the Internal Revenue Service
8. COMPENSATION AND INVOICING
8.1. State General Fund Program Allocations
8.1.1. The Department will notify the Contractor in writing of the Contractor's individual allocation
for State SLS, OBRA-SS, and FSSP for each State Fiscal Year.
8.1.2. Reimbursement for activities and services performed by the Contractor shall not exceed the
maximum amount identified in the Contractor's individual allocation. Activities and services
must be rendered during the State Fiscal Year.
8.1.3. The Department, in its sole discretion, may increase or decrease the Contractor's individual
allocations under this Contract by notifying the 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 the Contractor or by amendment of the Contract. The
circumstances may include but shall not be limited to:
Exhibit B, SOW Page 38 of 46
8.1.3.1. If necessary to fully utilize program appropriations.
8.1.3.2. Adjustments to reflect prior year final contract utilization and current year expenditures.
8.1.3.3. Supplemental appropriation changes resulting in an increase or decrease in the amounts
originally appropriated and available for the purposes of this program.
8.1.3.4. Closure of programs and/or termination of related contracts.
8.1.3.5. Delay or difficulty in implementing new programs or services.
8.1.3.6. Other special circumstances as deemed necessary by the Department.
8.1.3.7. Changes in Member utilization due to changing needs, new enrollments, terminations,
and/or delays in services.
8.1.3.8. Target caseloads not being met
8.2. State General Fund Program Target Caseloads
8.2.1. The Department will notify the 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.
8.2.2. The Contractor may choose to enroll more individuals in State SLS and FSSP than
authorized, ensuring all individuals can be served within the funding allocated.
8.2.3. Target caseload is calculated by the Department using the unique number of members that
receive direct services during the contract period.
8.2.4. The Contractor shall enroll members into 0BRA-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 the Contractor's individual allocation to support the individual's needs.
8.2.5. The 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.. The Contractor shall not redirect unallocated funding from one State Funded Program
to another unless the minimum caseload requirement is being met or the Contractor has
obtained written approval from the Department to do so.
8.2.6. The Department may reduce the amount of funding allocated during the State Fiscal Year if
the Contractor does not meet minimum caseload requirements for State SLS or FSSP.
8.3. State General Fund Program Compensation
8.3.1. 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 the Contractor for the State SLS and 0BRA-SS activities at the rates
specified in Exhibit C, Rates. Direct services for State SLS and 0BRA-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 the Contractor for FSSP activities at the
rates specified in Exhibit C, Rates. Direct services for FSSP shall be reimbursed at one dollar
per unit.
8.3.2. The liability of the State, at any time, for such payment shall be limited to the unexpended
amount remaining of such funds and available to the Department.
8.3.3. 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
Exhibit B, SOW Page 39 of 46
contract using an Option Letter. When the Contractor's maximum allocation of State funding
has been paid to the Contractor, no additional funds shall be provided under this Contract.
8.3.4. Payment pursuant to this Contract is contingent upon the 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.
8.3.5. 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.
8.3.6. 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. The Contractor shall bill all FSSP direct
services at one dollar per unit.
8.4. Adjustments to Fund Disbursement Amounts
8.4.1. The Department reserves the right to make adjustments 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:
8.4.2. The Contractor does not achieve the Performance Standards identified for each program.
8.5. Case Management Agency Compensation
8.5.1. The compensation under this Contract shall consist of rates -based reimbursement intended to
cover the costs of all activities provided through this Contract.
8.5.2. The Contractor will receive payment as specified in Exhibit C, Rates.
8.5.2.1. 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.
8.6. Rural or Urban Designation
8.6.1. The Department shall determine the Contractor to be a Rural and Frontier or an Urban agency.
8.7. Detailed Invoicing and Payment Procedures
Exhibit B, SOW Page 40 of 46
8.7.1. Applications — HCBS-CES
8.7.1.1. The 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 the 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.
8.7.2. Appeal Packets and Hearing Attendance
8.7.2.1. The 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 11th day of the month for Appeal Packets
and Hearing Attendance from the previous month. The Contractor shall maintain all
supporting documentation and packets related to all Appeals.
8.7.3. Case Management Training
8.7.3.1. The Contractor shall submit the Case Management Training deliverable. The Contractor
will receive payment once the Department has reviewed and accepted the Deliverable. If
the original submission is rejected by the Department, the 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, the Contractor shall not receive payment for the Deliverable
until all trainings have been provided. The Contractor shall have 30 calendar days to
provide any outstanding trainings and resubmit the deliverable.
8.7.4. Community Advisory Committee Updates
8.7.4.1. The Contractor shall submit the Committee Updates Deliverables. The 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, the Contractor
shall not receive payment for the Deliverable.
8.7.5. Complaint Log and Trend Analysis
8.7.5.1. The Contractor shall submit a quarterly Complaint Log and Trend Analysis deliverable.
The Contractor will receive payment once the Department has reviewed and accepted the
Deliverable. If the original submission is rejected by the Department, the Contractor shall
not receive payment until a revised deliverable has been received and accepted by the
Department.
8.7.6. Continuous Quality Improvement Plan
8.7.6.1. The Contractor shall submit the Continuous Quality Improvement Plan deliverable and
updates. The Contractor shall receive payment once the Department has reviewed and
Exhibit B, SOW Page 41 of 46
accepted the Deliverable. If the original submission is rejected by the Department, the
Contractor shall not receive payment until a revised deliverable has been received and
accepted by the Department.
8.7.7. Critical Incident Quarterly Follow -Up Completion and Entry Performance Standard
8.7.7.1. The 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, the 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 the Contractor's performance at the close of each quarter to
determine if the Contractor will be awarded the performance -based payment. HCBS and
SGF CIRs will be calculated and paid separately.
8.7.8. Critical Incident Reports and Investigations: HCBS IDD Waivers
8.7.8.1. The 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 11th day of the month for HCBS-CES, HCBS-CHRP, HCBS-DD, and
HCBS-SLS enrollments from the previous month.
8.7.9. Critical Incident Reports: HCBS LTSS Waivers
8.7.9.1. The 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 11th day of the month for HCBS-BI, HCBS-CIH, HCBS-CLLI, HCBS-
CMHS, and HCBS-EBD.
8.7.10. Critical Incident Reporting and Investigation: State SLS, OBRA-SS, FSSP
8.7.10.1. The 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 11th day of the month for CIRS from the previous
month.
8.7.11. Developmental Disability and Delay Determinations
8.7.11.1. The 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 11th
day of the month for determinations from the previous month.
8.7.12. Direct Services: State SLS, OBRA-SS, FSSP
8.7.12.1. The Contractor shall submit the State General Fund program direct service expenditure
report 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.
8.7.13. Expedited Testing for DD Determinations for PASRR Level II Evaluations
Exhibit B, SOW Page 42 of 46
8.7.13.1.
8.7.14.
8.7.14.1.
8.7.15.
8.7.15.1.
8.7.16.
8.7.16.1.
8.7.17.
8.7.17.1.
8.7.18.
8.7.18.1.
The Contractor shall invoice the Department monthly for the costs of expediting testing
for DD Determinations necessary for the completion of a PASRR II evaluation by the
15th day of the month for the determinations completed in the previous month. The
Department will pay for the actual cost for each expedited DD Determination once the
invoice has been reviewed and accepted. All invoices shall be submitted on the format
prescribed by the Department.
Family Support Council Meetings
The 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. The Contractor shall maintain all supporting documentation related to an
FSC meeting and make it available to the Department upon request.
FSSP Annual Report
The Contractor shall submit an FSSP Report on an annual basis to the Department. The
Contractor shall receive payment for the Annual FSSP Report after it has been reviewed
and accepted by the Department.
FSSP Evaluation Report
The Contractor shall submit an FSSP Evaluation Report on an annual basis to the
Department. The 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 the 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.
Human Rights Committee: HCBS IDD Waivers
The Contractor shall create all HRC packets in accordance with Department requirements
and timeframes. The Contractor shall maintain all supporting documentation related to a
Human 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 11th day of the month for
HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous
month.
8.7.19. Human Rights Committee Packet Creation: State SLS, OBRA-SS, FSSP
8.7.19.1. The 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
:he 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 on the format prescribed by the Department.
8.7.20. Level of Care Screen: Initial and Reassessments
Exhibit B, SOW Page 43 of 46
8.7.20.1.
8.7.21.
8.7.21.1.
8.7.22.
8.7.22.1.
8.7.23.
8.7.23.1.
8.7.24.
8.7.24.1.
8.7.25.
8.7.25.1.
8.7.26.
8.7.26.1.
8.7.27.
Exhibit B, SOW
The 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 11th day of the month for Screens conducted in
the previous month.
Long -Range Plan
The Contractor shall submit a Long -Range Plan on an annual basis and present it to the
Department. The 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
The Contractor shall conduct and enter all monitoring contacts for State SLS and OBRA-
SS into the Department's prescribed system within the required timeframe. The
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 1 lth day of the month for contacts conducted
in the previous month.
Most in Need Assessment: FSSP
The Contractor shall conduct and enter all completed Needs Assessments into the
Department's prescribed system within the required timeframe. The 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 11th day of the
month for assessments conducted in the previous month.
Needs Assessment: Initial and Reassessment
The 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 11th day of the month for assessments conducted
in the previous month.
Ongoing Case Management: State SLS, OBRA-SS, FSSP
The 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. The 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 11th day of the month for activities conducted in the previous
month.
Operations Guide
The Contractor shall develop an Operations Guide that meets all requirements outlined
in this Contract for year one. The Contractor shall receive payment for the Operations
Guide once the deliverable has been reviewed and accepted by the Department.
Operations Guide Updates
Page 44 of 46
8.7.27.1.
8.7.28.
8.7.28.1.
8.7.29.
8.7.29.1.
The 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 the Contractor's processes and procedures. The 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 the 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. The 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
the 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.
Rural Travel Add -On for Rural and Frontier Counties
The 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 11th day of the month
for activities from the previous month.
SIS-A Assessments
The 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 11th day of the month for assessments from the
previous month. Re -assessment requests must be reviewed and accepted by the
Department prior to completion, entry, and payment.
8.7.30. Support Need Level Assessment - HCBS-CHRP
8.7.30.1. The Contractor shall maintain all supporting documentation related to the Support Need
Level Assessment and make it available to the Department upon request. The 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.
8.7.31. Training on the Colorado Single Assessment, and Person -Centered Support Plan Instruments
and Streamlined Eligibility
8.7.31.1. The 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.
8.7.32. Waiting List Management
8.7.32.1. The 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
Exhibit B, SOW Page 45 of 46
Department prescribed system on the 11th of the month for assessments from the previous
month. 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.
8.7.33. Year End Close Deadlines
8.7.33.1. 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 the
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.
8.8. Payment and Billing Errors
8.8.1. The Contractor shall review all payments made by the Department to ensure accuracy within
10 Business Days of receiving a payment summary.
8.8.2. The Contractor shall notify the Department of any errors in billing or payment within 10
Business Days of receiving a payment summary on the Department's prescribed template to
ensure over and under payments are adjusted.
8.8.2.1. DELIVERABLE: Payment Correction Form
8.8.2.2. DUE: Within 10 Business Days of receiving a payment summary from the Department.
8.9. Unexpended Funds
8.9.1. The Contractor shall remit any Subawards disbursed under this Contract that are not
expended by the close of the Period of Performance.
8.10. Closeout Payments
8.10.1. 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 days after the Department has
determined that Contractor has completed all of the requirements of the Closeout Period.
Exhibit B, SOW Page 46 of 46
EXHIBIT C, RATES
Case Management Agency (CMA) Rates Table
Description
Rate
Frequency
Payment
Type
Funding
Source
Operations Guide
$ 7,750.55
Annually — Year 1
of the Contract
Deliverable
Federal/State
Funded
Operations Guide Update
$ 1,396.22
Annually — Years
2+ of the Contract
Deliverable
Federal/State
Funded
Long Range Han
$ 3,473.83
Annually
Deliverable
Federal/State
Funded
Committee Updates
$ 1,050.72
Semi -Annually
Deliverable
Federal/State
Funded
Continuous Quality
Improvement Plan
$ 496.78
Annually
Deliverable
Federal/State
Funded
Complaint Trend
Analysis
$ 3,781.41
Quarterly
Deliverable
Federal/State
Funded
Case Management
Training
$ 636.03
Semi -Annually
Deliverable
Federal/State
Funded
Creation of Packet -
Appeals
$ 521.18
Per Packet
Report
Federal/State
Funded
Attendance at Hearing -
Appeals
$ 481.34
Per Hearing
Report
Federal/State
Funded
Critical Incident
Reporting will
Investigation 1I--ICBS —
CES, HCBS —CHRP,
HCBS — DD, HCBS —
SLS)
$ 6.18
Monthly, Per
Member Enrolled
Report
Federal/State
Funded
Critical Incident
Reporting (HCBS — BI,
HCBS - CMHS, HCBS -
EBD, HCBS - SCI,
HCBS - CLL1)
$ 1.58
Monthly, Per
Member Enrolled
Report
Federal/State
Funded
Critical Incident Follow-
Up Performance Standard
$ 3,389.28
Quarterly
Deliverable
Federal/State
Funded
Human Rights
Committee (IBS —
CES, HCBS —CHRP,
HCBS — DD, HCBS —
SLS)
$ 5.83
Monthly, Per
Member Enrolled
Report
Federal/State
Funded
Waiting List
Management
$ 93.55
Per Contact
Report
State Funded
Initial Level of Care
Assessment (100.2)
$ 278.06
Per Assessment
Report
Federal/State
Funded
CSR Level of Care
Assessment (100.2)
$ 209.83
Per Assessment
Report
Federal/State
Funded
Exhibit C, Rates
Page 1 of 3
Initial Level of Care
Screen
$ 206.15
Per Screen
Report
Federal/State
Funded
Annual Reassessment —
Level of Care Screen
$ 191.79
Per Screen
Report
Federal/State
Funded
Initial Needs Assessment
— Required Questions
Only
$ 260.28
Per Assessment
Report
Federal/State
Funded
Annual Reassessment
Needs Assessment —
Required Questions Only
$ 244.31
Per Assessment
Report
Federal/State
Funded
Initial Needs Assessment
— Voluntary Questions
Included
$ 325.36
Per Assessment
Report
Federal/State
Funded
Annual Reassessment
Needs Assessment —
Voluntary Questions
Included
$ 310.93
Per Assessment
Report
Federal/State
Funded
SIS Assessment
$ 350.09
Per Assessment
Report
Federal/State
Funded
HCBS-CHRP ICAP
Assessment
$ 162.02
Per Assessment
Invoice
Federal/State
Funded
Initial HCBS-CES
Application
$ 185.50
Per Application
Report
Federal/State
Funded
CSR HCBS-CES
Application
$ 139.96
Per Application
Report
Federal/State
Funded
Medicaid Eligible IDD
Determination
$ 449.81
Per Determination
Report
Federal/State
Funded
Medicaid Eligible Delay
Determination
$ 267.61
Per Determination
Report
Federal/State
Funded
SGF IDD Determination
$ 449.81
Per Determination
Report
State Funded
SGF Delay
Determination
$ 267.61
Per Determination
Report
State Funded
Expedited DD
Determination Testing for
PASRR Level II
Evaluations
$ 471.67
Actual Costs up to
Rate, Per
Evaluation
Invoice
Federal/State
Funded
Rural Travel Add -On
$ 36.73
Per Required in
Person Contact for
Rural and Frontier
Agencies
Report
Federal/State
Funded
Completed Training on
the Colorado Single
Assessment and Person -
Calculated
Allocation
Upon Training
Completion
Deliverable
Federal/State
Funded
Exhibit C, Rates
Page 2 of 3
Centered Support Plan
Instruments
State SLS, OBRA-SS,
and FSSP Critical
Incident Reporting &
Investigation: MANE
$
342.33
Per Incident
Report
State Funded
State SLS, OBRA-SS,
and FSSP Critical
Incident Reporting &
Investigation: Non -
MANE
$
45.79
Per Incident
Report
State Funded
State SLS, OBRA-SS,
and FSSP Hunan Rights
Committee
$
123.26
Per Member
Reviewed
Invoice
State Funded
State SLS and OBRA-SS
Complaints Mend
Analysis
$
216.36
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS,
and FSSP CIR Follow -Up
Performance Standard
$
50.79
Quarterly
Deliverable
State Funded
State SLS, OIBRA-SS,
and FSSP Ongoing Case
Management
$
89.87
Monthly, Per
Activity
Report
State Funded
State SLS and OBRA-SS
Monitoring
$
102.65
Per Contact
Report
State Funded
State SLS andOBRA-SS
Monitoring - Virtual
$
85.74
Per Contact
Report
State Funded
State SLS Expenditure
Report
$
613.49
Monthly
Invoice
State Funded
OBRA-SS Expenditure
Report
$
362.31
Monthly
Invoice
State Funded
FSSP Needs Assessment
$
32.60
Per Assessment
Report
State Funded
FSSP Expenditure Report
$
545.66
Monthly
Invoice
State Funded
Family Support Council
Meetings
$
410.09
Per Meeting
Invoice
State Funded
FSSP Annual Report
$
609.60
Annually
Deliverable
State Funded
FSSP Program
Evaluation
$
518.81
Annually
Deliverable
State Funded
Exhibit C, Rates Page 3 of 3
EXHIBIT D, TERMINOLOGY
1. TERMINOLOGY
1.1. In addition to the terms defined in §3 of this Contract, the following list of terms shall be
construed and interpreted as follows:
1.1.1. Adverse Action — A denial, reduction, termination, or suspension from a long-term service
and support program or service.
1.1.2. Affiliated Entity — An organization that directly or indirectly controls another entity, has
substantially similar ownership of another entity, and/or owns a substantial share of another
entity.
1.1.3. Appeal — The process a case manager participates in when a Client or Member appeals an
adverse action made by the case manager.
1.1.4. Behavioral Health Authorities (BHA) — The behavioral health administration established in
Part 200 of Article 50 of Title 27, C.R.S.
1.1.5. Business Day — Any day in which the State is open and conducting business, but shall not
include Saturday, Sunday, or any day which the State observes one of the holidays listed in
C.R.S. §24-11-101(1).
1.1.6. Business Interruption — Any event that disrupts the Contractor's ability to complete the Work
for a period of time, and may include, but is not limited to a Disaster, power outage, strike,
loss of necessary personnel or computer virus.
1.1.7. Care and Case Management System (CCM) — The Department's case management
Information Technology (IT) platform.
1.1.8. Case Management — The assessment of a Member eligible to receive or receiving long-term
services and supports, the development and implementation of a Support Plan for such
Member, referral and related activities, the coordination and monitoring of long-term service
and supports delivery, the evaluation of service effectiveness, and the periodic reassessment
of such Member's needs.
1.1.9. Case Management Agency (CMA) — A public or private not -for-profit or for-profit
organization contracted with the state of Colorado to provide case management services and
activities pursuant to C.R.S. 25.5-6-1702.
1.1.10. Case Manager — A person who provides case management services and activities pursuant to
Article 6 and Article 10 of C.R.S. Title 25.5 for members receiving long-term services and
supports.
1.1.11. Child Health Plan Plus — Colorado's public low—cost health insurance for certain children
and pregnant women. It is for people who earn too much to qualify for Health First Colorado,
but not enough to pay for private health insurance.
1.1.12. Client — Any individual applying for or seeking information for LTSS.
1.1.13. Closeout Period — The period beginning on the earlier of 90 days prior to the end of the last
Extension Term or notice by the Department of its decision to not exercise its option for an
Extension Term, and ending on the day that the Department has accepted the final deliverable
for the Closeout Period, as determined in the Department —approved and updated Closeout
Plan, and has determined that the closeout is complete.
Exhibit D, Terminology Page I of 9
1.1.14. Colorado Revised Statutes (C.R.S.) — The legal code of Colorado; the legal codified general
and permanent statutes of the Colorado General Assembly.
1.1.15. Community Centered Board (CCB) — A private for-profit or not -for profit organization that
is an administrator of locally generated funding pursuant to CRS 25.5-10-206(6) and acts as
a resource for persons with an intellectual and developmental disability or a child with a
developmental delay.
1.1.16. Complaints — Any complaint received by the Contractor as it relates to the services provided
through this Contract to include, but not limited to: general business functions,
administration, State General Fund program functions, and case management functions.
Excludes any complaints regarding activities outside the scope of this Contract.
1.1.17. Consumer -Directed Attendant Support Services (CDASS) — The service delivery option for
services that assist an individual in accomplishing activities of daily living when included as
a waiver benefit that may include health maintenance, personal care and homemaker
activities.
1.1.18. Contract — The agreement, including all attached Exhibits, all documents incorporated by
reference, all referenced statutes, rules and cited authorities, and any future modifications
themto, that is entered into as a result of this solicitation.
1.1.19. Contract Funds — The funds that have been appropriated, designated, encumbered, or
otherwise made available for payment by the State under the Contract resulting from this
Solicitation.
1.1.20. Contractor — The individual or entity selected as a result of this solicitation to complete the
Work contained in the Contract.
1.1.21. Contractor Pre —Existing Material — Material, code, methodology, concepts, process, systems,
technique, trade or service marks, copyrights, or other intellectual property developed,
licensed or otherwise acquired by Contractor prior to the Effective Date of this Contract and
independent of any services rendered under any other contract with the State.
1.1.22. Corrective Action Plan — A written plan, which includes the specific actions the agency shall
take to correct non-compliance with regulations and contractual obligations, which stipulates
the date by which each action shall be completed.
1.1.23. Critical Incident — An actual or alleged event that creates the risk of serious harm to the health
or welfare of an individual receiving services; and it may endanger or negatively impact the
mental and/or physical well-being of an individual.
1.1.24. Critical Incident Report (CIR) Mistreatment, Abuse, Neglect or Exploitation (MANE) — A
Critical Incident Report entered into the Department prescribed system with a category of
Mistreatment, Abuse, Neglect, or Exploitation.
1.1.25. Critical Incident Report (CIR) Non -MANE — A Critical Incident Report entered into the
Department prescribed system with a category of criminal activity, damage to consumer's
property/theft, death, injury/illness, medication management issues, missing persons, other
high -risk issues, and unsafe housing/displacement.
1.1.26. Date — State Confidential Information and other State information resources transferred to
the Contractor for the purpose of completing a task or project assigned in the Statement of
Work.
Exhibit D, Terminology Page 2 of 9
1.1.27. Deliverable — Any tangible or intangible object produced by Contractor as a result of the
work that is intended to be delivered to the Department, regardless of whether the object is
specifically described or called out as a "Deliverable" or not.
1.1.28. Department — The Colorado Department of Health Care Policy and Financing, a department
of the government of the State of Colorado.
1.1.29. Designated Service Area — The geographical area determined by the State Department to be
served by a Case Management Agency per C.R.S. 25.5-6-1702.
1.1.30. Disaster — An event that makes it impossible for Contractor to perform the Work out of its
regular facility or facilities, and may include, but is not limited to, natural disasters, fire or
terrorist attacks.
1.1.31. Effective Date — The date on which the Contract resulting from this solicitation is approved
and signed by the Colorado State Controller or designee, as shown on the Signature and Cover
Page for the Contract.
1.1.32. Eligibility Determination — The eligibility of an individual for a Long -Term Services and
Supports (LTSS) program is determined by meeting all the requirements of the program, to
include Level of Care Determination and financial eligibility.
1.1.33. Fraud — An intentional deception or misrepresentation made by a person with the knowledge
that the deception could result in some unauthorized benefit to that person or some other
person and includes any act that constitutes fraud under any federal or state law.
1.1.34. Goods — Any movable material to be acquired, produced, or delivered by Contractor which
shall include any movable material acquired, produced, or delivered by Contractor in
connection with the Services.
1.1.35. Health First Colorado — Colorado's Medicaid program.
1.1.36. Health Insurance Portability and Accountability Act (HIPAA) — The Health Insurance
Portability and Accountability Act of 1996, as amended.
1.1.37. Home and Community Based Services (HCBS) Waivers — Services and supports authorized
through a 1915(c) waiver of the Social Security Act and provided in community settings to a
client who requires an institutional level of care that would otherwise be provided in a
Hospital, Nursing Facility, or Intermediate Care Facility for Individuals with Intellectual
Disabilities (ICF-IID). This includes: Home and Community Based Services Waiver for
Persons with Brain Injury (HCBS-BI), Home and Community Based Services Children's
Extensive Services Waiver (HCBS-CES), Home and Community Based Services Children's
Residential Habilitation Program Waiver (HCBS-CHRP), Home and Community Based
Services Waiver for Children with a Life Limiting Illness (HCBS-CLLI), Home and
Community Based Services Community Mental Health Supports Waiver (HCBS-CMHS),
Home and Community Based Services Waiver for Persons with Developmental Disabilities
(HCBS-DD), Home and Community Based Services Waiver for Persons who are Elderly,
Blind and Disabled (HCBS-EBD), Home and Community Based Services Supported Living
Services Waiver (HCBS-SLS), and Home and Community Based Services Waiver for
Persons with Spinal Cord Injury (HCBS-CIH).
1.1.38. Hospital Back -Up - A LTSS program for Members who have complex wound care and/or
are ventilator -dependent or medically complex.
Exhibit D, Terminology Page 3 of 9
1.1.39. Incident — Any accidental or deliberate event that results in or constitutes an imminent threat
of the unauthorized access or disclosure of State Confidential Information or of the
unauthorized modification, disruption, or destruction of any State Records.
1.1.40. In -Home Services and Supports (IHSS) — Means services that are provided in the home and
in the community by an Attendant under the direction of the client or client's Authorized
Representative, including Health Maintenance Activities and support for activities of daily
living or instrumental activities of daily living, Personal Care services and Homemaker
services.
1.1.41. Intermediate Care Facility (ICF) - A residential facility that is certified by the Centers for
Medicare and Medicaid (CMS) to provide habilitative, therapeutic and specialized support
services to persons with intellectual and developmental disabilities.
1.1.42. Intake, Screening and Referral — The initial contact between the individual and the Contractor
and shall include but is not limited to a preliminary screening in the following areas: a Client's
need for long term services and supports; a Client's need for referral to other programs or
services; a Client's eligibility for financial and program assistance; and the need for a Level
of Care Screen and Needs Assessment of the Client seeking services.
1.1.43. Key Personnel — The position or positions that are specifically designated as such in the
Contract.
1.1.44. Leaning Management System (LMS) - An online software application for the
administration, delivery and tracking of case management training programs and materials.
1.1.45. Level of Care — The level of assistance needed by an individual seeking services or a member
to perform activities of daily living, to include mobility; bathing; dressing; eating; toileting;
transferring; and need for supervision as determined by the Level of Care Screen.
1.1.46. Level of Care Determination — The eligibility determination of an individual for a Long -Term
Services and Supports (LTSS) program by a Case Management Agency as determined by the
requirements of the program, using the Department prescribed instrument.
1.1.47. Long Term Care notice of action — The form required to be sent to Clients by the Contractor
witkin eleven (11) business days regarding their appeal rights in accordance with 10 CCR
2506-10 8.507 et seq.
1.1.48. Long Term Services and Supports (LTSS) — The services and supports used by Members of
all ages with functional limitations and chronic illnesses who need assistance to perform
routine daily activities such as bathing, dressing, preparing meals, and administering
medications.
1.1.49. Long Term Services and Supports (LTSS) Programs - Any of the following publicly funded
programs: FSSP, HCBS-BI, HCBS-CES, HCBS-CHRP, HCBS-CLLI, HCBS-CMHS,
HCBS-DD, HCBS-EBD, HCBS-CIH, HCBS-SLS, HBU, LTHH, Medicaid Nursing
Facilities, OBRA-SS, PACE, State SLS.
1.1.50. Long Term Services and Supports Level of Care Eligibility Determination Screen (LOC
Screen) — An evaluation conducted by the case manager with the individual seeking services
and others chosen by the individual to participate (such as family members, friends, and/or
caregivers), to determine an applicant or member's eligibility for long-term services and
supports based on their need for institutional level of care as determined by utilizing the
Department's prescribed instrument, with supporting diagnostic information from the
Exhibit D, Terminoloey Page 4 of 9
Individual's medical providers, for the purpose of determining the Individual's level of
functioning for admission or continued stay in Long -Term Services and Supports (LTSS)
programs.
1.1.51. Medical Assistance (MA) Site - 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.
1.1.52. Member — Any individual enrolled in the Colorado Medicaid program, State General Fund
program, Colorado's CHP+ program or the Colorado Indigent Care Program, as determined
by the Department.
1.1.53. National Core Indicators -Aging and Disabilities (NCI -AD) — Standard measures used across
participating states to assess the quality of life and outcomes of seniors and adults with
physical disabilities —including traumatic or acquired brain injury —who are accessing
publicly -funded services through the Older Americans Act (OAA), Program of All -Inclusive
Care for the Elderly (PACE), Medicaid, and/or state -funded programs. The project is
coordinated by Advancing States and Human Services Research Institute (HSRI). NCI -AD
data are gathered through yearly in -person Adult Consumer Surveys administered by state
Aging, Disability, and Medicaid Agencies (or an Agency -contracted vendor) to a sample of
at least 400 individuals in each participating state. NCI -AD data measures the performance
of states' long term services and supports (LTSS) systems and service recipient outcomes,
helping states prioritize quality improvement initiatives, engage in thoughtful decision
making, and conduct futures planning with valid and reliable LTSS data.
1.1.54. Needs Assessment - A comprehensive evaluation conducted by the case manager, using the
Department prescribed instrument, with the individual seeking services or member and
appropriate collaterals as requested and/or necessary (such as family members, advocates,
friends and/or caregivers), and including supporting information from the individual's
providers to determine the individual's service needs, goals, available resources, and
potential funding resources.
1.1.55. Nursing Facility - A facility provider that meets the state nursing facility licensing standards
established pursuant to C.R.S. §25-1.5-103 and is maintained primarily for the care and
treatment of inpatients under the direction of a physician.
1.1.56. Offeror — Any individual or entity that submits a proposal, or intends to submit a proposal,
in response to this solicitation.
1.1.57. Operational Start Date — When the Department authorizes the Contractor to begin fulfilling
its obligations under the Contract.
1.1.58. Organized Health Care Delivery System - A Case Management Agency that contracts with
other qualified providers to furnish services authorized in the HCBS-BI, HCBS-CLLI,
HCBS-CES, HCBS-CIH, HCBS-CHRP, HCBS-CMHS, HCBS-DD, HCBS-EBD, and
HCBS-SLS waivers. CMAs are responsible for purchasing specific goods and services for
members, authorized on the Person -Centered Support Plan, as set forth by the Department's
prescribed guidelines for OHCDS.
1.1.59. Other Personnel — Individuals and Subcontractors, in addition to Key Personnel, assigned to
positions to complete tasks associated with the Work.
Exhibit D, Terminology Page 5 of 9
1.1.60. Pandemic — Refers to an epidemic that has spread over several countries or continents, usually
affecting a large number of people.
1.1.61. Period of Performance — Means the total estimated time interval between the start of an initial
Federal award and the planned end date, which may include one or more funded portions, or
budget periods. Identification of the period of performance in the Federal award per §
200-211(b)(5) does not commit the awarding agency to fund the award beyond the currently
approved budget period.
1.1.62. Person -Centered Approach — Respecting and valuing individuals' and Members' preferences,
strengths, and contributions.
1.1.63. Person -Centered Support Plan - A document, using the State -prescribed instrument, that
ideitifies approved services, regardless of funding source, necessary to assist a member to
remain safely in the community and develop in accordance with the Department rules. The
plat includes the funding source, frequency, amount and provider of each service and is
developed with the member and people chosen by the member to identify goals, needed
services, individual choices and preferences, and appropriate service providers based on the
member's Assessment and knowledge of the individual and community resources and
informs the member of their rights and responsibilities.
1.1.64. Person -Centered Support Planning — The process of working with the Member receiving
services and people chosen by the Member to identify goals, needed services, individual
choices and preferences, and appropriate service providers based on the Member seeking or
receiving services, assessment and knowledge of the Member and of community resources.
Support planning informs the Member receiving services of his or her rights and
responsibilities.
1.1.65. Personally Identifiable Information — Personally identifiable information including, without
limitation, any information maintained by the State about an individual that can be used to
distinguish or trace an individual's identity, such as name, social security number, date and
plane of birth, mother's maiden name, or biometric records; and any other information that is
linked or linkable to an individual, such as medical, educational, financial, and employment
information. PII includes, but is not limited to, all information defined as personally
identifiable information in §24-72-501 C.R.S.
1.1.66. Pre Admission Screening and Resident Review (PASRR) — The review that occurs for all
Clicrits seeking admission to a Medicaid nursing facility to screen the Client for evidence of
serious mental illness and/or intellectual and developmental disabilities or related conditions.
The review determines whether the Client needs the level of services that a nursing facility
provides and whether Clients who need nursing facility services also need specialized
serices.
1.1.67. Professional Medical Information Page (PMIP) — The medical information document signed
by a licensed medical professional used as a component of the Level of Care Screening and
Assessment to determine the Client's or Member's need for a LTSS program.
1.1.68. Program — A publicly funded program including, but not limited to: Home and Community
Based Services Waivers, Medicaid Nursing Facility, Hospital Back -Up, Program for All -
Inclusive Care for the Elderly (PACE), Long Term Home Health (LTHH), and State General
Funded (SGF) Programs.
Exhibit D, Terminolov Page 6 O9
1.1.69. Protected Health Information — Any protected health information, including, without
limitation 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. PHI
includes, but is not limited to, any information defined as Individually Identifiable Health
Information by the federal Health Insurance Portability and Accountability Act.
1.1.70. Provider — Any health care professional or entity that has been accepted as a provider in the
Colorado Medicaid program, Colorado's CHP+ program or the Colorado Indigent Care
Program, as determined by the Department.
1.1.71. Quality Improvement Strategy (QIS) — The Department's process to measure and improve
its performance in meeting the HCBS waiver assurances annually as set forth in 42 CFR
441.301 and 441.302.
1.1.72. Quarter — Four (4) distinct time periods during the State Fiscal Year. Quarter one (1) begins
on July 1 and ends September 30. Quarter two (2) begins on October 1 and ends December
31. Quarter three (3) begins on January 1 and ends March 31. Quarter four (4) begins on April
1 and ends June 30.
1.1.73. Regional Accountable Entity (RAE) — A single regional entity responsible for duties
previously performed by Regional Care Collaborate Organizations and Behavioral Health
Organizations (BHO).
1.1.74. Resource Development — The study, establishment and implementation of additional
resources or services that extend the capabilities of community based LTSS systems to better
serve LTSS Clients and Members and those likely to need community based LTSS in the
future.
1.1.75. Rural and Frontier — Defined Service Areas that are eligible for rural travel add-on
reimbursement for required in -person activities reimbursed through this Contract.
1.1.76. Services — The services and activities to be performed by the Contractor as set forth in this
Contract and shall include any services and activities to be rendered by the Contractor in
connection with the Goods. Services identified through this Contract specifically exclude any
Home and Community Based Services, State Plan Benefit Services, and other Medicaid
services reimbursed through a Medicaid Provider Agreement.
1.1.77. Start —Up Period — The period starting on the Effective Date and ending on the Operational
Start Date.
1.1.78. State — The State of Colorado, acting by and through any State agency.
1.1.79. State Fiscal Rules — The fiscal rules promulgated by the Colorado State Controller pursuant
to C.R.S. §24-30-202(13)(a).
1.1.80. State Fiscal Year — The 12 -month period beginning on July 1 of each calendar year and
ending on June 30 of the following calendar year. If a single calendar year follows the term,
then it means the State Fiscal Year ending in that calendar year.
1.1.81. State Intellectual Disability Authority (SIDA) — The person authorized by the Department to
review PASRR Level II Evaluations and approve or deny a nursing facility admission for
Exhibit D, Terminology Page 7 of 9
individuals with intellectual and developmental disabilities. SIDA issues the Letter of
Determination to the nursing facility.
1.1.82. State General Fund Programs — Case management, services, and supports authorized by the
General Assembly and provided in the family home, a community setting, or Nursing Facility
using 100% General Fund dollars. Including, the Family Support Services Program (FSSP),
State Supported Living Services Program (State SLS), and Omnibus Reconciliation Act of
1987 Specialized Services Program (OBRA-SS).
1.1.83. Stale Records — Any and all State data, information, and records, regardless of physical form,
including, but not limited to, information subject to disclosure under CORA.
1.1.84. Subcontractor — Third parties, if any, engaged by Contractor to aid in performance of the
Work.
1.1.85. Support Need Level Assessment - The standardized assessment tool to identify and measure
the practical support requirements for HCBS-CHRP waiver participants.
1.1.86. Surcharge - Any additional amount added by the Contractor, over and above the rate charged
by the subcontractor to the Contractor, which would be shown on an individual's service plan
or cxi encounter data service rates submitted to the Department.
1.1.87. Target Criteria — Department defined criteria based on Member needs to access services
under a HCBS waiver.
1.1.88. Targeted Case Management (TCM) — Required case management activities for Members
enrolled in a HCBS waivers as defined in 10 CCR 2505-10 8.761.14 et seq. that are
reimbursed as a State Plan benefit and through a Medicaid Provider Agreement. TCM
activities are excluded from the Work within this Contract.
1.1.89. Waiting List - A list of otherwise eligible individuals established to manage selection of
individuals' entrance into the waiver or State General Fund programs until approved capacity
and funding become available.
1.1.90. Work — The delivery of the Goods and performance of the Services described in the Contract.
1.1.91. Work Product — The tangible and intangible results of the Work, whether finished or
unfinished, including drafts. Work Product includes, but is not limited to, documents, text,
software (including source code), research, reports, proposals, specifications, plans, notes,
studies, data, images, photographs, negatives, pictures, drawings, designs, models, surveys,
maps, materials, ideas, concepts, know—how, and any other results of the Work. "Work
Product" does not include any material that was developed prior to the Effective Date that is
used, without modification, in the performance of the Work.
2. ACRONYMS AND ABBREVIATIONS
2.1. The following list is provided to assist the reader in understanding certain acronyms and
abbreviations used in this Contract:
2.1.1. CFI — Code of Federal Regulations
2.1.2. CHP+ —Child Health Plan Plus
2.1.3. CORA —Colorado Open Records Act, C.R.S. §24-72-200.1, et. seq.
2.1.4. C.R.S. — Colorado Revised Statutes
2.1.5. CPI — Consumer Price Index
Exhibit D, Terminology Page 8 of 9
2.1.6. CPI -U - CPI for all urban consumers
2.1.7. HIPAA — Health Insurance Portability and Accountability Act of 1996, as amended.
2.1.8. MFCU — the Colorado Medicaid Fraud Control Unit in the Colorado Department of Law
2.1.9. PCI — Payment Card Information
2.1.10. PHI — Protected Health Information
2.1.11. PII — Personally Identifiable Information
2.1.12. SFY — State Fiscal Year
2.1.13. U.S.C. — United States Code
2.1.14. VARA — Visual Rights Act of 1990
Exhibit D, Terminology Page 9 of 9
EXHIBIT E, CONTRACTOR'S ADMINISTRATIVE REQUIREMENTS
1. CONTRACTOR'S GENERAL REQUIREMENTS
1.1.
1.2.
1.2.1.
1.3.
The Department will contract with only one organization, the 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.
The Contractor shall serve as the Case Management Agency for the following counties:
We'd County
Contractor may be privy to internal policy discussions, contractual issues, price negotiations,
confidential medical information, Department financial information, advance knowledge of
legislaton and other Confidential Information. In addition to all other confidentiality
requirements of the Contract, the 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. The 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
discretbn, 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. The 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 the
Contractor's responsibilities under this Contract.
1.6. The Contractor shall maintain complete and detailed records of all meetings, system development
life cyde documents, presentations, project artifacts, and any other interactions or Deliverables
related _o the Work described in the Contract. The Contractor shall make such records available
to the Eepartment 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,
-eview, and acceptable cycle, the 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.
1.7.1.1.3.2. Spelling.
1.7.1.1.3.3. Grammar.
1.7.1.1.3.4. Completion.
Exhibit E, Contractor: Administrative Requirements Page 1 of 21
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.
1.7.6. If any Deliverable contains ongoing responsibilities or requirements for the 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.
Exhibit E, Contractor's Administrative Requirements Page 2 of 21
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. StatedDeliverables 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
inteaided 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. The 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 the
Contractor uses a compatible program, then the Contractor shall ensure that all documents or
film delivered to the Department are completely transferrable and reviewable, without error,
on te Department's systems.
1.9.2. The Department will use a transmittal process to provide the Contractor with official direction
within the scope of the Contract. The 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 the Contractor regarding performance under the Contract.
1.9.2.3. A due date or timeline by which the 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 the 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 the 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 the Contractor through a transmittal.
1.9.3. The Department may deliver a completed transmittal to the 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 tie Contractor receives conflicting transmittals, the 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 the Contractor receives direction from the Department outside of the
transmittal process, it shall contact the Department's primary designee, or backup designees
Exhibit E, Contractor, Administrative Requirements Page 3 of 21
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 the Contractor, and the Department may provide day-to-day communication
to the Contractor without using a transmittal.
1.9.7. The Contractor shall retain all transmittals for reference and shall provide copies of any
received transmittals upon request by the Department.
1.9.8. The Contractor shall provide written notification to the Department in instances where the
Contractor has not been successful in meeting any requirement or timeframe identified in this
Contract. This notification must be provided to the Department within 3 Business Days of
the breach on a template provided by the Department.
1 10. Individual and Member Engagement
1 10.1. Person- and Family -Centered Approach
1 10.2. The 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. The 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. The Contractor shall provide and facilitate the delivery of services in a culturally competent
manner to all individuals and Members, including those with limited English proficiency and
diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual
orientation or gender identity.
1.11.2. The 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. The 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. The Contractor shall make oral interpretation available in all languages.
1.12.3. The Contractor shall assure the competence of language assistance provided by interpreters
and bilingual staff.
Exhibit E, Contractor's Administrative Requirements Page 4 of 21
1.12.4. The Contractor shall not use family and friends to provide interpretation services except by
request of the individual or Member.
1.12.5. The Contractor shall provide interpreter services for all interactions with individuals and
Members when there is no Contractor staff person available who speaks a language
uncerstood by an individual or Member.
1.12.6. The 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
across 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. The 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. The 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. The 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. The 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. The Contractor shall write all materials in easy to understand language.
1.14. Individual and Member Communications
1.14.1. The Contractor shall maintain consistent communication, both proactive and responsive, with
individuals and Members.
1.14.2. The Contractor shall assist any individual or Member who contacts the Contractor, including
individuals and Members not in the 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. The 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. The 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. The Contractor shall post and distribute rights to individuals, including but not limited to:
1.15.3.1. Individuals/Members.
Exhibit E, Contractor, Administrative Requirements Page 5 of 21
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. The 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 the Contractor.
1.16.1.2. A description of all steps, timelines, milestones, and Deliverables necessary for the
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 the 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.
1.16.1.5.1. DELIVERABLE: Start -Up Plan
1.16.1.5.2. DUE: 20 Calendar Days Prior to the Contract Start Date
1.17. Start -Up Period
1.17.1. With input from the Department, the 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.
1.17.1.1.4.
1.17.1.2.
1.17.1.2.1.
1.17.1.2.2.
1.17.1.2.3.
1.17.1.2.4.
1.17.1.3.
1.17.1.3.1.
1.17.1.3.2.
Department Project Team Members.
Any other relevant and needed persons or organizations.
Develop Kickoff Meeting materials and an agenda that contains, at a minimum, the
following:
Initial timelines for starting the Work and creating initial Deliverables.
Establishment of Communication channels to describe how the Work is to be
completed.
Transmission methods and specific Deliverable templates or requirements.
Any other item required to initiate and ensure Work is started and completed on time.
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
Exhibit E, Contractor's Administrative Requirements Page 6 of 21
1.17.1.4.
1.17.1.5.
1.17.1.5.1.
1.17.1.5.2.
Create a Policy and Procedures Manual that contains the policies and procedures for all
systems and functions necessary for the 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 the Contractor to begin work on the Operational Start Date.
The 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. Operaions Guide
1.18.1. Contractor shall not engage in any Work under the Contract, other than the Work described
in this Sections 1.10 and 11.18 prior to the Operational Start Date. The Department shall not
be liable to the Contractor for, and Contractor shall not receive, any payment for any period
prior to the Operational Start Date under this Contract.
1.18.2. The 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. The 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. The 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 the Contractor's processes and procedures and update the
Guide as appropriate to account for any changes. The 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
charges.
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. The 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 the Contractor will communicate to Members any changes to
Exhibit E, Contractor% Administrative Requirements Page 7 of 21
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 the 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 the Contractor will address communication deficiencies or
crisis situations, including how the Contractor will increase staff, contact hours or
other steps the 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 the Contractor's organization, including
cell phone numbers and email addresses:
1.18.6.1.5.1. 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.
1.18.6.1.5.2. An individual who is responsible for any website or marketing related to the
Work.
1.18.6.1.5.3. 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. The Contractor shall create a Business Continuity Plan that the 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 the 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 the 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 the Contractor will address training personnel, preparing equipment, and backup
systems.
1.18.7.1.6. How the Contractor will address budget and finance mechanisms to ensure financing
of essential services.
1.18.7.1.7. How the Contractor will ensure necessary supplies and equipment are available to
maintain essential services.
Exhibit E, Contractor's Administrative Requirements Page 8 of 21
1.18.7.1.8. How the 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 the 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 the Contractor will ensure or enhance communication and information
technology infrastructure to support tele-commuting.
1.18.7.1.11. How the 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 the Contractor will make
all information available at its back-up facilities.
1.18.7.1.13. How the 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 the Contractor will minimize the effects on Members of any Business
Interruption to include how the Contractor will notify members of closures and
cancellations.
1.18.7.1.15. How the Contractor will communicate with the Department during the Business
Interruption and points of contact within the Contractor's organization the
Department can contact in the event of a Business Interruption.
1.18.7.1.16. How the 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 the Contractor can continue
operations after a Disaster.
1.18.7.1.18. The time period it will take to transition all activities from the Contractor's regular
facilities to the back-up facilities after a Disaster.
1.18.7.1.19. How the 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 the 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 the Contractor will implement steps to return to normal after a Business
Interruption.
1.18.8. Closeout Plan
1.18.8.1.
The 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 the Contractor to the Department or to another contractor
selected by the Department to be the 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
Exhibit E, Contractor's Administrative Requirements Page 9 of 21
1.18.8.1.2.
1.18.8.1.3.
1.18.8.1.4.
1.18.8.1.5.
1.18.8.2.
1.18.8.2.1.
1.18.8.3.
1.18.8.4.
1.18.8.5.
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.
The Contractor shall ensure all policy, procedures, training, and appeals information
are transferred to the Department.
The Contractor shall deliver the Closeout Plan to the Department for review and approval.
The Contractor shall provide weekly updates to the Department throughout the creation
of and the performances within the Operations Guide, that show the Contractor's status
toward meeting the milestones described herein.
The Contractor shall be ready to perform all Work by the Operational Start Date.
1.19. Closeout Period
1.19.1. During the Closeout Period, the Contractor shall complete all of the following:
1.19.1.1. 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.
1.19.1.2. 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.
1.19.1.3. 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.
1.19.1.4. Notify any Subcontractors of the termination of the Contract, as directed by the
Department.
1.19.1.5. Notify all Members that the 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
1.19.1.5.1.
1.19.1.5.2.
1.19.1.6.
DUE: 90 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
Exhibit E, Contractor's Administrative Requirements Page 10 of 21
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 the Contractor of this
determination for that requirement.
1.19.1.7. 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 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 the 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 the 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 the Contractor to be a barrier to ensuring a comprehensive
ease management system and suggested modifications to overcome the barriers.
1.20.1.6. A summary of how the 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 the 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. How the 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.
1.20.1.10. How State General Fund programs and supports will be used to support individuals,
members, and families within the Defined Service Area.
1.20.1.11. How the voices of historically underserved and marginalized communities will be
incorporated into decision -making within the Defined Service Area.
1.20.1.12. 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, Contractor's Administrative Requirements Page 11 of 21
1.20.3. DUE: Annually, by August 15th
1.21. Community Advisory Committee
1.21.1. Within 30 days of the Contract execution date, the 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.
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 district's county commissioners,
1.21.2.2. area agencies on aging,
1.21.2.3. medical professionals,
1.21.2.4. physical or intellectual disability professionals,
1.21.2.5. ombudsmen,
1.21.2.6. human service agencies,
1.21.2.7. county government officials,
1.21.2.8. mental/behavioral health professionals,
1.21.2.9. or HCBS Professionals with experience working with members with Intellectual and
Developmental Disabilities.
1.21.2.10. Membership must include regional representation from one or more LTSS members or
family members of individuals receiving LTSS:
1.21.2.10.1. Members with I/DD and/or
1.21.2.10.2. Members with disabilities
1.21.2.10.3. Self -advocates and members shall be given priority of selection over family members
1.21.3.
1.21.3.1.
1.21.3.2.
1.21.4.
1.21.4.1.
1.21.4.2.
1.21.5.
1.21.6.
The Contractor shall submit the Community Advisory Committee member list annually on
the template prescribed by the Department.
DELIVERABLE: Community Advisory Committee Member List
DUE: Annually, by August 15th
The Contractor shall notify the Department of any changes to Community Advisory
Committee membership within 10 Business Days of the date of change.
DELIVERABLE: Community Advisory Committee Membership Updates
DUE: Within 10 Business Days of the date of change to the membership list.
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.
The CMA 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.
Exhibit E, Contractor's Administrative Requirements Page 12 of 21
1.21.7. The Community Advisory Committee is an advisory body to the CMA that provides
recommendations and is not a decision -making body. As such the Community Advisory
Committee shall:
1.21.7.1. Provide public input and guidance to the CMA in the review of service delivery policies
and procedures, marketing strategies, resource development, overall CMA operations,
service quality, individual member satisfaction and other related programmatic
opportunities to address barriers at a local or regional level.
1.21.7.2. Support the CMA with developing strategies for resolving complaints at the local or
regional level.
1.21.7.3. Maintain and post public notices of meetings, meeting minutes, and documented follow
up on the Contractor's website.
1.21.7.4. Report to the CMA governing body or board of directors quarterly on all case
management complaints trends and follow up completed by the CMA.
1.21.7.5. Provide reports to the Department and its committees upon request.
1.21.7.6. The Community Advisory Committee may be combined in purpose or name with other
CMA committees in the CMA defined service area so long as it meets the above purpose,
criteria and reports.
1.21.7.7. The Community Advisory Committee must use the operational templates prescribed by
:he Department as minimum standards.
1.21.7.7.1. DELIVERABLE: Committee Updates
1.21.7.7.2. DUE: Bi-Annually, for meetings held between July 1st 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 the Contractor in
relmion to the Work performed under the Contract.
1.22.2. The Department may work with the 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. The 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. The Contractor shall provide this information regardless of whether
the Department decides to work with the 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 tie public or may publicly post the results of any performance reviews or evaluations.
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
stag regulations or this Contract.
Exhibit E, Contractor: Administrative Requirements Page 13 of 21
1.23. Corrective Action Plan
1.23.1. When the Department determines that the Contractor is not in compliance with any term of
this Contract, the 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.
1.23.1.2. Contractor's employee(s) responsible for implementing the actions.
1.23.1.3. The implementation time frames and a date for completion.
1.23.2. The 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. The 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. The Contractor shall explain
the rationale for the delay and the Department may grant an extension, in writing, of the
deadline for the Contractor's compliance.
1.23.4. Upon receipt of the 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 the Contractor's Corrective Action Plan the 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 the 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. The Contractor shall ensure all
supporting documentation is submitted within the timeframes established in the Corrective
Action Plan.
1.23.9. Upon receipt of the Contractor's supporting documentation, the Department will accept,
request modifications, or reject the documentation. Modifications and rejections shall be
accompanied by a written explanation.
1.23.10. In the event of a rejection of the Contractor's supporting documentation to the Corrective
Action Plan, the Contractor shall correct and resubmit the supporting documentation to the
Department for review.
Exhibit E, Contractor's Administrative Requirements Page 14 of 21
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 tie 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
repocure 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
Cobrado 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 lie event that the Contractor requires access to any Department computer system to
complete the Work, the Contractor shall have and maintain all hardware, software, and
interfaces necessary to access the system without requiring any modification to the
Department's system. The Contractor shall follow all Department policies, processes, and
procedures necessary to gain access to the Department's systems.
1.25.2. The 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 the 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. Upcm identification or suspicion of possible Provider Fraud, the Contractor shall complete
the 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.
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.
Exhibit E, Contractor's Administrative Requirements Page 15 of 21
1.26.2.1.5.
1.26.2.1.6.
Any claims data associated with its report (in a mutually agreed upon format, if
possible).
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 the 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, the Contractor shall complete
the 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.
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 the Contractor Suspected
Fraud Written Notice Form as requested by the Department.
Exhibit E, Contractor's Administrative Requirements Page 16 of 21
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 of 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.
2.1.4. Contractor shall provide the Department with a final list of individuals assigned to the
Coriract 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
Exhibit E, Contractor's Administrative Requirements Page 17 of 21
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 of 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. The 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. The Contractor shall meet or exceed best practice standards as
set forth by the Department for HCBS waiver caseloads. The Contractor shall not exceed
the best practice caseload size standards without written approval from the Department.
2.1.7.2. The Contractor's Case Manager(s) shall meet all of the qualifications listed in 10 C.C.R.
2505-10, Section 8.519.5 et seq.
2.1.7.3. The 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 the Contractor
upon request within the Department's LMS.
2.2. Background Checks
2.2.1. The 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 employment, the 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 the 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 the 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.
Exhibit E, Contractor's Administrative Requirements Page 18 of 21
2.3.2. Contractor's Key Personnel and Other Personnel shall be available for all regularly scheduled
meetings between Contractor and the Department, unless the Department has granted prior
written approval otherwise.
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, the 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. The Contractor shall respond to all telephone calls, voicemails, and emails from the
Department within two Business Days of receipt by the 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.
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. Cortractor 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
De 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. The Contractor shall notify the Department of any changes to Subcontractors within 10
Business Days of the change.
2.4.3.4. The Contractor shall obtain prior consent and written approval for any use of
Subcontractor(s).
3. INFORMATION TECHNOLOGY RELATED REQUIREMENTS
Exhibit E, Contractor, Administrative Requirements Page 19 of 21
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 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 a designated representative of the State's Office of
Information Security ("OIS").
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 current background checks in a form reasonably acceptable to the
State on all of its respective employees and agents performing services or having access to
State Records provided under this Contract, including any Subcontractors or the employees
of Subcontractors. A background check performed within 30 days prior to the date such
employee or agent begins performance or obtains access to State Records shall be deemed to
be current.
3.1.5.1. Security and Compliance Representative for the State indicating that background checks
have been performed. Such notice will inform the State of any action taken in response
to such background checks, including any decisions not to take action in response to
negative information revealed by a background check.
3.1.5.2. If Contractor will have access to Federal Tax Information under the Contract, Contractor
shall agree to the State's requirements regarding Safeguarding Requirements for Federal
Exhibit E, Contractor's Administrative Requirements Page 20 of 21
Tax Information and shall comply with the background check requirements defined in
IRS Publication 1075 and §24-50-1002, C.R.S.
3.2. Data Handling
3.2.1. The State, in its sole discretion, may securely deliver State Records directly to the facility
where such data is used to perform the Work. Contractor may not maintain or forward these
State Records to or from any other facility or location, except for the authorized and approved
purposes of backup and disaster recovery purposes, without the prior written consent of the
State. 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 OIS.
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 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 certify
to the State that it has done so. If legislation imposed upon Contractor prevents it from
retuning 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
Stale 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, Contractor's Administrative Requirements Page 21 of 21
EXHIBIT F, SAMPLE OPTION LETTER
OPTION LETTER
State Agency
Department of Health Care Policy and Financing
Option Letter Number
Insert the Option Number (e.g. "1" for the first option)
Contractor
Original Contract Number
Insert Contractor's Full Legal Name, including
Insert CMS number or Other Contract Number of the Original Contract
"Inc.", "LLC", etc...
Current Contract Maximum Amount
Option Contract Number
Initial Term
Insert CMS number or Other Contract Number of this Option
State Fiscal Year 20. $0.00
Extension Terms
Contract Performance Beginning Date
State Fiscal Year 20. $0.00
The later of the Effective Date or Month Day, Year
State Fiscal Year 20. $0.00
State Fiscal Year 20xx $0.00
Current Contract Expiration Date
State Fiscal Year 20xx $0.00
Month Day, Year
Total for All State Fiscal Years $0.00
1.
Options
A. Option to extend for an Extension Term.
B. Option to change the quantity of Goods under the Contract.
C. Option to change the quantity of Services under the Contract.
D. Option to modify the Contract rates.
E. Option to initiate next phase of the Contract.
2. Required Provisions
A. For use with Option 1(A): In accordance with Section(s) Number of the Original Contract referenced
above, the State hereby exercises its option for an additional term, beginning Insert start date and ending
on the current contract expiration date shown above, at the rates stated in the Original Contract, as
amended.
B. For use with Options 1(B and C): In accordance with Section(s) Number of the Original Contract
referenced above, the State hereby exercises its option to Increase/Decrease the quantity of the
Goods/Services or both at the rates stated in the Original Contract, as amended.
C. For use with Option 1(D): In accordance with Section(s) Number of the Original Contract referenced
above, the State hereby exercises its option to modify the Contract rates specified in Exhibit/Section
Number/Letter. The Contract rates attached to this Option Letter replace the rates in the Original Contract
as of the Option Effective Date of this Option Letter.
D. For use with Option 1(E): In accordance with Section(s) Number of the Original Contract referenced
above, the State hereby exercises its option to initiate Phase indicate which Phase: 2, 3, 4, etc, which shall
begin on Insert start date and end on Insert ending date at the cost/price specified in Section Number.
E. For use with all Options that modify the Contract Maximum Amount: 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 above.
3. Option Effective Date
a. The Effective Date of this Option Letter is upon approval of the State Controller or the Effective Date
of this Option Letter, whichever is later.
Exhibit F, Sample Option Letter Page 1 of 2
STATE OF COLORADO
John W. Hickenlooper, Governor
Department cf Health Care Policy and Financing
Kim Bmestefer, Executive Director
By: Kim Bimestefer, Executive Director
Date:
In accordance with C.R.S. §24-30-202, this Option is not valid
until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Greg Tanner, Controller; Department of Health Care Policy
and Financing
Option Effective Date:
Exhibit F, Sample Option Letter Page 2 of 2
EXHIBIT G, FEDERAL PROVISIONS
1. APPLICABILITY OF PROVISIONS.
1.1. The Contract to which these Federal Provisions are attached has been funded, in whole or
in part, with an Award of Federal funds. In the event of a conflict between the provisions
of these Federal Provisions, the Special Provisions, the body of the Contract, or any
attachments or exhibits incorporated into and made a part of the Contract, the provisions
of these Federal Provisions shall control.
2. FFATA AND UNIFORM GUIDANCE REQUIREMENTS
2.1 Definitions.
2.1.1. For the purposes of these Federal Provisions, the following terms shall have the
meanings ascribed to them below.
2.1.1.1. "Award" means an award of Federal financial assistance, and the Contract setting
forth the terms and conditions of that financial assistance, that a non -Federal Entity
receives or administers.
2.1.1.1.1. Awards may be in the form of:
2.1.1.1.1.1. Grants;
2.1.1.1.1.2. Contracts;
2.1.1.1.1.3. Cooperative Contracts, which do not include cooperative research and
development Contracts (CRDA) pursuant to the Federal Technology
Transfer Act of 1986, as amended (15 U.S.C. 3710);
2.1.1.1.1.4. Loans;
2.1.1.1.1.5. Loan Guarantees;
2.1.1.1.1.6. Subsidies;
2.1.1.1.1.7. Insurance;
2.1.1.1.1.8. Food commodities;
2.1.1.1.1.9. Direct appropriations;
2.1.1.1.1.10. Assessed and voluntary contributions; and
2.1.1.1.1.11. Other financial assistance transactions that authorize the expenditure of
Federal funds by non -Federal Entities.
2.1.1.1.1.12. Any other items specified by OMB in policy memoranda available at the
OMB website or other source posted by the OMB.
2.1.1.1.2. Award does not include:
2.1.1.1.2.1. Technical assistance, which provides services in lieu of money;
2.1.1.1.2.2. A transfer of title to Federally -owned property provided in lieu of money;
even if the award is called a grant;
2.1.1.1.2.3. Any award classified for security purposes; or
Exhibit G, Federal Provisions Page 1 of 13
2.1.1.1.2.4. Any award funded in whole or in part with Recovery funds, as defined in
section 1512 of the American Recovery and Reinvestment Act (ARRA) of
2009 (Public Law 111-5).
2.1.1.2. "Contract" means the Contract to which these Federal Provisions are attached and
includes all Award types in §2.1.1.1.1 of this Exhibit.
2.1.1.3. "Contractor" means the party or parties to a Contract funded, in whole or in part,
with Federal financial assistance, other than the Prime Recipient, and includes
grantees, subgrantees, Subrecipients, and borrowers. For purposes of Transparency
Act reporting, Contractor does not include Vendors.
2.1.1.4. "Entity" means all of the following as defined at 2 CFR part 25, subpart C;
2.1.1.4.1. A governmental organization, which is a State, local government, or Indian
Tribe;
2.1.1.4.2. A foreign public entity;
2.1.1.4.3. A domestic or foreign non-profit organization;
2.1.1.4.4. A domestic or foreign for-profit organization; and
2.1.1.4.5. A Federal agency, but only a Subrecipient under an Award or Subaward to a
non -Federal entity.
2.1.1.5. "Executive" means an officer, managing partner or any other employee in a
management position.
2.1.1.6. "Federal Award Identification Number (FAIN)" means an Award number assigned
by a Federal agency to a Prime Recipient.
2.1.1.7. "Federal Awarding Agency" means a Federal agency providing a Federal Award
to a Recipient as described in 2 CFR §200.37
2.1.1.8. "FFATA" means the Federal Funding Accountability and Transparency Act of
2006 (Public Law 109-282), as amended by §6202 of Public Law 110-252.
FFATA, as amended, also is referred to as the "Transparency Act."
2.1.1.9. "Federal Provisions" means these Federal Provisions subject to the Transparency
Act and Uniform Guidance, as may be revised pursuant to ongoing guidance from
the relevant Federal or State of Colorado agency or institutions of higher education.
2.1.1.10. "OMB" means the Executive Office of the President, Office of Management and
Budget.
2.1.1.11. "Prime Recipient" means a Colorado State agency or institution of higher education
that receives an Award.
2.1.1.12. "Subaward" means an award by a Recipient to a Subrecipient funded in whole or
in part by a Federal Award. The terms and conditions of the Federal Award flow
down to the Award unless the terms and conditions of the Federal Award
specifically indicate otherwise in accordance with 2 CFR §200.38. The term does
not include payments to a contractor or payments to an individual that is a
beneficiary of a Federal program.
Exhibit G, Federal -Provisions Page 2 of 13
2.1.1.13.
2.1.1.14.
2.1.1.15.
2.1.1.16.
2.1.1.16.1.
2.1.1.16.2.
2.1.1.16.3.
2.1.1.16.4.
2.1.1.16.5.
2.1.1.16.6.
2.1.1.17.
2.1.1.18.
"Subrecipient" means a non -Federal Entity (or a Federal agency under an Award
or Subaward to a non -Federal Entity) receiving Federal funds through a Prime
Recipient to support the performance of the Federal project or program for which
the Federal funds were awarded. A Subrecipient is subject to the terms and
conditions of the Federal Award to the Prime Recipient, including program
compliance requirements. The term "Subrecipient" includes and may be referred to
as Subgrantee. The term does not include an individual who is a beneficiary of a
federal program.
"Subrecipient Unique Entity Identifier" means the subrecipient organization's 12 -
digit Unique Entity Identifier (UEI) number that appears in the subrecipient's
System for Award Management (SAM) profile, if applicable.
"System for Award Management (SAM)" means the Federal repository into which
an Entity must enter the information required under the Transparency Act, which
may be found at http://www.sam.gov.
"Total Compensation" means the cash and noncash dollar value earned by an
Executive during the Prime Recipient's or Subrecipient's preceding fiscal year and
includes the following:
Salary and bonus;
Awards of stock, stock options, and stock appreciation rights, using the dollar
amount recognized for financial statement reporting purposes with respect to
the fiscal year in accordance with the Statement of Financial Accounting
Standards No. 123 (Revised 2005) (FAS 123R), Shared Based Payments;
Earnings for services under non -equity incentive plans, not including group life,
health, hospitalization or medical reimbursement plans that do not discriminate
in favor of Executives and are available generally to all salaried employees;
Change in present value of defined benefit and actuarial pension plans;
Above -market earnings on deferred compensation which is not tax -qualified;
Other compensation, if the aggregate value of all such other compensation (e.g.
severance, termination payments, value of life insurance paid on behalf of the
employee, perquisites or property) for the Executive exceeds $10,000.
"Transparency Act" means the Federal Funding Accountability and Transparency
Act of 2006 (Public Law 109-282), as amended by §6202 of Public Law 110-252.
The Transparency Act also is referred to as FFATA.
"Uniform Guidance" means the Office of Management and Budget Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards, which supersedes requirements from OMB Circulars A-21, A-87, A-110,
and A-122, OMB Circulars A-89, A-102, and A-133, and the guidance in Circular
A-50 on Single Audit Act follow-up. The terms and conditions of the Uniform
Guidance flow down to Awards to Subrecipients unless the Uniform Guidance or
the terms and conditions of the Federal Award specifically indicate otherwise.
Exhibit G, Federal Provisions Page 3 of 13
2.1.1.19.
"Vendor" means a dealer, distributor, merchant or other seller providing property
or services required for a project or program funded by an Award. A Vendor is not
a Prime Recipient or a Subrecipient and is not subject to the terms and conditions
of the Federal award. Program compliance requirements do not pass through to a
Vendor.
2.2. Compliance.
2.2.1. Contractor shall comply with all applicable provisions of the Transparency Act, all
applicable provisions of the Uniform Guidance, and the regulations issued pursuant
thereto, including but not limited to these Federal Provisions. Any revisions to such
provisions or regulations shall automatically become a part of these Federal Provisions,
without the necessity of either party executing any further instrument. The State of
Colorado may provide written notification to Contractor of such revisions, but such
notice shall not be a condition precedent to the effectiveness of such revisions.
2.3. System for Award Management (SAM) and Unique Entity Identifier (UEI) Number
Requirements.
2.3.1. SAM. Contractor shall maintain the currency of its information in SAM until the
Contractor submits the final financial report required under the Award or receives final
payment, whichever is later. Contractor shall review and update SAM information at
least annually after the initial registration, and more frequently if required by changes
is its information.
2.3.2. UEI. Contractor shall provide its UEI number to its Prime Recipient, and shall update
Contractor's information in SAM at least annually after the initial registration, and
more frequently if required by changes in Contractor's information.
2.4. Total Compensation.
2.4.1. Contractor shall include Total Compensation in SAM for each of its five most highly
compensated Executives for the preceding fiscal year if:
2.4.1.1. The total Federal funding authorized to date under the Award is $25,000 or more;
and
2.4.1.2. In the preceding fiscal year, Contractor received:
2.4.1.2.1. 80% or more of its annual gross revenues from Federal procurement contracts
and subcontracts and/or Federal financial assistance Awards or Subawards
subject to the Transparency Act; and
2.4.1.2.2. $25,000,000 or more in annual gross revenues from Federal procurement
contracts and subcontracts and/or Federal financial assistance Awards or
Subawards subject to the Transparency Act; and
2.4.1.3. The public does not have access to information about the compensation of such
Executives through periodic reports filed under section 13(a) or 15(d) of the
Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d) or § 6104 of the
Internal Revenue Code of 1986.
2.5. Reporting.
Exhibit G, Federal Provisions Page 4 of 13
2.5.1. Contractor shall report data elements to SAM and to the Prime Recipient as required in
this Exhibit if Contractor is a Subrecipient for the Award pursuant to the Transparency
Act. No direct payment shall be made to Contractor for providing any reports required
under these Federal Provisions and the cost of producing such reports shall be included
in the Contract price. The reporting requirements in this Exhibit are based on guidance
from the US Office of Management and Budget (OMB), and as such are subject to
change at any time by OMB. Any such changes shall be automatically incorporated
into this Contract and shall become part of Contractor's obligations under this Contract.
2.6. Effective Date and Dollar Threshold for Reporting.
2.6.1. Reporting requirements in §2.7 below apply to new Awards as of October 1, 2010, if
the initial award is $25,000 or more. If the initial Award is below $25,000 but
subsequent Award modifications result in a total Award of $25,000 or more, the Award
is subject to the reporting requirements as of the date the Award exceeds $25,000. If
the initial Award is $25,000 or more, but funding is subsequently de -obligated such
that the total award amount falls below $25,000, the Award shall continue to be subject
to the reporting requirements.
2.6.2. The procurement standards in §2.8 below are applicable to new Awards made by Prime
Recipient as of December 26, 2015. The standards set forth in §2.10 below are
applicable to audits of fiscal years beginning on or after December 26, 2014.
2.7. Subrecipient Reporting Requirements.
2.7.1. If Contractor is a Subrecipient, Contractor shall report as set forth below.
2.7.1.1. To SAM. A Subrecipient shall register in SAM and report the following data
elements in SAM for each Federal Award Identification Number no later than the
end of the month following the month in which the Subaward was made:
2.7.1.1.1. Subrecipient UEI Number;
2.7.1.1.2. Subrecipient UEI Number + 4 if more than one electronic funds transfer (EFT)
account;
2.7.1.1.3. Subrecipient's address, including: Street Address, City, State, Country, Zip +
4, and Congressional District;
2.7.1.1.4. Subrecipient's top 5 most highly compensated Executives if the criteria in §4
above are met; and
2.7.1.1.5. Subrecipient's Total Compensation of top 5 most highly compensated
Executives if criteria in §4 above met.
2.7.1.2. To Prime Recipient. A Subrecipient shall report to its Prime Recipient, upon the
effective date of the Contract, the following data elements:
2.7.1.2.1. Subrecipient's UEI Number as registered in SAM.
2.7.1.2.2. Primary Place of Performance Information, including: Street Address, City,
State, Country, Zip code + 4, and Congressional District.
2.8. Procurement Standards.
Exhibit G, Federal Provisions Page 5 of 13
2.8.1. Procurement Procedures. A Subrecipient shall use its own documented procurement
procedures which reflect applicable State, local, and Tribal laws and regulations,
provided that the procurements conform to applicable Federal law and the standards
identified in the Uniform Guidance, including without limitation, §§200.318 through
200.326 thereof.
2.8.2. Procurement of Recovered Materials. If a Subrecipient is a State Agency or an agency
of a political subdivision of the State, its contractors must comply with section 6002 of
the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery
Act. The requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that
contain the highest percentage of recovered materials practicable, consistent with
maintaining a satisfactory level of competition, where the purchase price of the item
exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year
exceeded $10,000; procuring solid waste management services in a manner that
maximizes energy and resource recovery; and establishing an affirmative procurement
program for procurement of recovered materials identified in the EPA guidelines.
2.9. Access to Records
2.9.1. A Subrecipient shall permit Recipient and auditors to have access to Subrecipient's
records and financial statements as necessary for Recipient to meet the requirements of
§200.331 (Requirements for pass -through entities), §§200.300 (Statutory and national
policy requirements) through 200.309 (Period of performance), and Subpart F -Audit
Requirements of the Uniform Guidance. 2 CFR §200.331(a)(5).
2.10. Single Audit Requirements
2.10.1. If a Subrecipient expends $750,000 or more in Federal Awards during the
Subrecipient's fiscal year, the Subrecipient shall procure or arrange for a single or
program -specific audit conducted for that year in accordance with the provisions of
Subpart F -Audit Requirements of the Uniform Guidance, issued pursuant to the Single
Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR §200.501.
2.10.1.1. Election. A Subrecipient shall have a single audit conducted in accordance with
Uniform Guidance §200.514 (Scope of audit), except when it elects to have a
program -specific audit conducted in accordance with §200.507 (Program -specific
audits). The Subrecipient may elect to have a program -specific audit if
Subrecipient expends Federal Awards under only one Federal program (excluding
research and development) and the Federal program's statutes, regulations, or the
terms and conditions of the Federal award do not require a financial statement audit
of Prime Recipient. A program -specific audit may not be elected for research and
development unless all of the Federal Awards expended were received from
Recipient and Recipient approves in advance a program -specific audit.
2.10.1.2. Exemption. If a Subrecipient expends less than $750,000 in Federal Awards
during its fiscal year, the Subrecipient shall be exempt from Federal audit
requirements for that year, except as noted in 2 CFR §200.503 (Relation to other
audit requirements), but records shall be available for review or audit by appropriate
Exhibit G, Federal Provisions Page 6 of 13
officials of the Federal agency, the State, and the Government Accountability
Office.
2.10.1.3. Subrecipient Compliance Responsibility. A Subrecipient shall procure or
otherwise arrange for the audit required by Part F of the Uniform Guidance and
ensure it is properly performed and submitted when due in accordance with the
Uniform Guidance. Subrecipient shall prepare appropriate financial statements,
including the schedule of expenditures of Federal awards in accordance with
Uniform Guidance §200.510 (Financial statements) and provide the auditor with
access to personnel, accounts, books, records, supporting documentation, and other
information as needed for the auditor to perform the audit required by Uniform
Guidance Part F -Audit Requirements.
2.11. Contract Provisions for Subrecipient Contracts
2.11.1. If Contractor is a Subrecipient, then it shall comply with and shall include all of the
following applicable provisions in all subcontracts entered into by it pursuant to this
Contract.
2.11.1.1.
2.11.1.1.1.
2.11.1.1.1.1.
Equal Employment Opportunity. Except as otherwise provided under 41 CFR
Part 60, all contracts that meet the definition of "federally assisted construction
contract" in 41 CFR Part 60-1.3 shall include the equal opportunity clause provided
under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal
Employment Opportunity" (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp.,
p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246
Relating to Equal Employment Opportunity," and implementing regulations at 41
CFR part 60, "Office of Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor.
During the performance of this contract, the contractor agrees as follows:
Contractor will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, or national origin. The
contractor will take affirmative action to ensure that applicants are
employed, and that employees are treated during employment, without
regard to their race, color, religion, sex, or national origin. Such action shall
include, but not be limited to the following: Employment, upgrading,
demotion, or transfer, recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship. The contractor agrees to post in
conspicuous places, available to employees and applicants for employment,
notices to be provided by the contracting officer setting forth the provisions
of this nondiscrimination clause.
2.11.1.1.1.2. Contractor will, in all solicitations or advertisements for employees placed
by or on behalf of the contractor, state that all qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex, or national origin.
2.11.1.1.1.3. Contractor will send to each labor union or representative of workers with
which he has a collective bargaining Contract or other contract or
Exhibit G, Federal Provisions Page 7 of 13
2.11.1.1.1.4.
2.11.1.1.1.5.
2.11.1.1.1.6.
2.11.1.1.1.7.
2.11.1.2.
understanding, a notice to be provided by the agency contracting officer,
advising the labor union or workers' representative of the contractor's
commitments under section 202 of Executive Order 11246 of September
24, 1965, and shall post copies of the notice in conspicuous places available
to employees and applicants for employment.
Contractor will comply with all provisions of Executive Order 11246 of
September 24, 1965, and of the rules, regulations, and relevant orders of the
Secretary of Labor.
Contractor will furnish all information and reports required by Executive
Order 11246 of September 24, 1965, and by the rules, regulations, and
orders of the Secretary of Labor, or pursuant thereto, and will permit access
to his books, records, and accounts by the contracting agency and the
Secretary of Labor for purposes of investigation to ascertain compliance
with such rules, regulations, and orders.
In the event of Contractor's non-compliance with the nondiscrimination
clauses of this contract or with any of such rules, regulations, or orders, this
contract may be canceled, terminated or suspended in whole or in part and
the contractor may be declared ineligible for further Government contracts
in accordance with procedures authorized in Executive Order 11246 of
September 24, 1965, and such other sanctions maybe imposed and remedies
invoked as provided in Executive Order 11246 of September 24, 1965, or
by rule, regulation, or order of the Secretary of Labor, or as otherwise
provided by law.
Contractor will include the provisions of paragraphs (1) through (7) in every
subcontract or purchase order unless exempted by rules, regulations, or
orders of the Secretary of Labor issued pursuant to section 204 of Executive
Order 11246 of September 24, 1965, so that such provisions will be binding
upon each subcontractor or vendor. The contractor will take such action
with respect to any subcontract or purchase order as may be directed by the
Secretary of Labor as a means of enforcing such provisions including
sanctions for noncompliance: Provided, however, that in the event
Contractor becomes involved in, or is threatened with, litigation with a
subcontractor or vendor as a result of such direction, the contractor may
request the United States to enter into such litigation to protect the interests
of the United States."
Davis -Bacon Act. Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When
required by Federal program legislation, all prime construction contracts in excess
of $2,000 awarded by non -Federal entities must include a provision for compliance
with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented
by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions
Applicable to Contracts Covering Federally Financed and Assisted Construction").
In accordance with the statute, contractors must be required to pay wages to
laborers and mechanics at a rate not less than the prevailing wages specified in a
wage determination made by the Secretary of Labor. In addition, contractors must
Exhibit G, Federa[Provisions Page 8 of 13
2.11.1.3.
2.11.1.4.
2.11.1.5.
2.11.1.6.
be required to pay wages not less than once a week. The non -Federal entity must
place a copy of the current prevailing wage determination issued by the Department
of Labor in each solicitation. The decision to award a contract or subcontract must
be conditioned upon the acceptance of the wage determination. The non -Federal
entity must report all suspected or reported violations to the Federal awarding
agency. The contracts must also include a provision for compliance with the
Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department
of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public
Building or Public Work Financed in Whole or in Part by Loans or Grants from the
United States"). The Act provides that each contractor or Subrecipient must be
prohibited from inducing, by any means, any person employed in the construction,
completion, or repair of public work, to give up any part of the compensation to
which he or she is otherwise entitled. The non -Federal entity must report all
suspected or reported violations to the Federal awarding agency.
Rights to Inventions Made Under a Contract or Contract. If the Federal Award
meets the definition of "funding Contract" under 37 CFR §401.2 (a) and
Subrecipient wishes to enter into a contract with a small business firm or nonprofit
organization regarding the substitution of parties, assignment or performance of
experimental, developmental, or research work under that "funding Contract,"
Subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to
Inventions Made by Nonprofit Organizations and Small Business Firms Under
Government Grants, Contracts and Cooperative Contracts," and any implementing
regulations issued by the awarding agency.
Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution
Control Act (33 U.S.C. 1251-1387), as amended. Contracts and subgrants of
amounts in excess of $150,000 must contain a provision that requires the non -
Federal award to agree to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the
Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387).
Violations must be reported to the Federal awarding agency and the Regional
Office of the Environmental Protection Agency (EPA).
Debarment and Suspension (Executive Orders 12549 and 12689). A contract
award (see 2 CFR 180.220) must not be made to parties listed on the government
wide exclusions in the System for Award Management (SAM), in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR
part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment
and Suspension." SAM Exclusions contains the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligible
under statutory or regulatory authority other than Executive Order 12549.
Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). Contractors that apply or
bid for an award exceeding $100,000 must file the required certification. Each tier
certifies to the tier above that it will not and has not used Federal appropriated funds
to pay any person or organization for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, officer or employee of
Congress, or an employee of a member of Congress in connection with obtaining
Exhibit G, Federal Provisions Page 9 of 13
any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each
tier must also disclose any lobbying with non -Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from
tier to tier up to the non -Federal award.
2.12. Certifications.
2.12.1. Unless prohibited by Federal statutes or regulations, Recipient may require
Subrecipient to submit certifications and representations required by Federal statutes
or regulations on an annual basis. 2 CFR §200.208. Submission may be required more
frequently if Subrecipient fails to meet a requirement of the Federal award.
Subrecipient shall certify in writing to the State at the end of the Award that the project
or activity was completed or the level of effort was expended. 2 CFR §200.201(3). If
the required level of activity or effort was not carried out, the amount of the Award
must be adjusted.
2.13. Exemptions.
2.13.1. These Federal Provisions do not apply to an individual who receives an Award as a
natural person, unrelated to any business or non-profit organization the individual may
cwn or operate in their name.
2.13.2. A Contractor with gross income from all sources of less than $300,000 in the previous
tax year is exempt from the requirements to report Subawards and the Total
Compensation of its most highly compensated Executives.
2.13.3. There are no Transparency Act reporting requirements for Vendors.
2.14. Event of Default.
2.14.1. Failure to comply with these Federal Provisions shall constitute an event of default
under the Contract and the State of Colorado may terminate the Contract upon 30 days
prior written notice if the default remains uncured five calendar days following the
termination of the 30 day notice period. This remedy will be in addition to any other
remedy available to the State of Colorado under the Contract, at law or in equity.
3. NONDISCRIMINATION UNDER FEDERAL AND STATE AUTHORITY
3.1. In addition to the statutes described in section 2.11 above, the Contractor shall also at all
times during the term of this Contract strictly adhere to, and comply with, all applicable
Federal and State laws, and their implementing regulations, as they currently exist and may
hereafter be amended, which are incorporated herein by this reference as terms and
conditions of this Contract. The Contractor shall also require compliance with these statutes
and regulations in subcontracts and subgrants permitted under this Contract. Applicable
Federal and State law and regulations include:
Exhibit G, FederaEProvisions Page 10 of 13
Age Discrimination Act of 1975, as amended
42 U.S.C. 6101, et seq.,
45 CFR 90, 45 CFR 91
Age Discrimination in Employment Act of 1967
29 U.S.C. 621-634
Americans with Disabilities Act of 1990 (ADA)
42 U.S.C. 12101, et seq.,
28 CFR Part 35
Equal Pay Act of 1963
29 U.S.C. 206(d)
Federal Water Pollution Control Act, as
amended
33 U.S.C. 1251, et seq.
Immigration Reform and Control Act of 1986
8 U.S.C. 1324b
Section 504 of the Rehabilitation Act of 1973, as
amended
29 U.S.C. 794, 45 CFR
84, 45 CFR 85
Section 508 of the Rehabilitation Act of 1973
29 USC 794, 36 CFR
1194
Title VI of the Civil Rights Act of 1964, as
amended
42 U.S.C. 2000d, 45 CFR
80
Title VII of the Civil Rights Act of 1964
42 U.S.C. 2000e, 29 CFR
1606.2
Title IX of the Education Amendments of 1972,
as amended
20 U.S.C. 1681
Civil Rights Division
Section 24-34-301, CRS,
et seq.
3.2. The Contractor also shall comply with any and all laws and regulations prohibiting
discrimination in the specific program(s) which is/are the subject of this Contract. In
consideration of and for the purpose of obtaining any and all federal and/or state financial
assistance, the Contractor makes the following assurances, upon which the State relies.
3.2.1. The Contractor shall not discriminate against any person on the basis of race, color,
ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity
and expression, religion, creed, political beliefs, or disability, including Acquired
Immune Deficiency Syndrome (AIDS) or AIDS -related conditions, in performance of
Work under this Contract
3.2.2. At all times during the performance of this Contract, no qualified individual with a
disability shall, by reason of such disability, be excluded from participation in, or
denied benefits of the service, programs, or activities performed by the Contractor, or
be subjected to any discrimination by the Contractor.
3.2.3. All websites and web content must meet Web Content Accessibility Guidelines
(WCAG) 2.1 Level AA standards, as issued by the World Wide Web Consortium.
3.3. Procurement Provisions
Exhibit G, Federal Provisions Page 11 of 13
3.3.1. The Contractor shall take all necessary affirmative steps, as required by 45 C.F.R.
92.36(e), Colorado Executive Order and Procurement Rules, to assure that small and
minority businesses and women's business enterprises are used, when possible, as
sources of supplies, equipment, construction, and services purchased under this
Contract.
4. FEDERAL FINANCIAL PARTICIPATION RELATED INTELLECTUAL
PROPERTY OWNERSHIP
4.1 In addition to the intellectual property ownership rights specified in the Contract, the
following subsections enumerate the intellectual property ownership requirements the
Contractor shall meet during the term of the Contract in relation to federal financial
participation under 42 CFR §433.112 and 45 CFR §95.617.
4.1.1. The Contractor shall notify the State before designing, developing, creating or
installing any new data, new software or modification of a software using Contract
Funds. The Contractor shall not proceed with such designing, development, creation or
installation of data or software without express written approval from the State.
4.1.2. If the Contractor uses Contract Funds to develop necessary materials, including, but
not limited to, programs, products, procedures, data and software to fulfill its
obligations under the Contract, the Contractor shall document all Contract Funds used
in the development of the Work Product, including, but not limited to the materials,
programs, procedures, and any data, software or software modifications.
4.1.2.1. The terms of this Contract will encompass sole payment for any and all Work
Product and intellectual property produced by the Contractor for the State. The
Contractor shall not receive any additional payments for licenses, subscriptions, or
to remove a restriction on any intellectual property Work Product related to or
developed under the terms of this Contract.
4.1.3. The Contractor shall provide the State comprehensive and exclusive access to and
disclose all details of the Work Product produced using Contract Funds.
4.1.4. The Contractor shall hereby assign to the State, without further consideration, all right,
iiterest, title, ownership and ownership rights in all work product and deliverables
prepared and developed by the Contractor for the State, either alone or jointly, under
this Contract, including, but not limited to, data, software and software modifications
designed, developed, created or installed using Contract Funds, as allowable in the
United States under 17 U.S.C.S. §201 and §204 and in any foreign jurisdictions.
4.1.4.1. Such assigned rights include, but are not limited to, all rights granted under 17
U.S.C.S §106, the right to use, sell, license or otherwise transfer or exploit the Work
Product and the right to make such changes to the Work Product as determined by
the State.
4.1.4.2. This assignment shall also encompass any and all rights under 17 U.S.C.S §106A,
also referred to as the Visual Artists Rights Act of 1990 (VARA), and any and all
moral rights to the Work Product.
Exhibit G, Federal Provisions Page 12 of 13
4.1.4.3. The Contractor shall require its employees and agents to, promptly sign and deliver
any documents and take any action the State reasonably requests to establish and
perfect the rights assigned to the State or its designees under these provisions.
4.1.4.4. The Contractor shall execute the assignment referenced herein immediately upon
the creation of the Work Product pursuant to the terms of this Contract.
4.1.5. The State claims sole ownership and all ownership rights in all copyrightable software
designed, developed, created or installed under this contract, including, but not limited
to:
4.1.5.1. Data and software, or modifications thereof created, designed or developed using
Contract Funds.
4.1.5.2. Associated documentation and procedures designed and developed to produce any
systems, programs, reports and documentation.
4.1.5.3. All other Work Products or documents created, designed, purchased, or developed
by the Contractor and funded using Contract Funds.
4.1.6. All ownership and ownership rights pertaining to Work Product created in the
performance of this Contract will vest with the State, regardless of whether the Work
Product was developed by the Contractor or any Subcontractor.
4.1.7. The Contractor shall fully assist in and allow without dispute, both during the term of
this Contract and after its expiration, registration by the State of any and all copyrights
and other intellectual property protections and registrations in data, software, software
modifications or any other Work Product created, designed or developed using
Contract Funds.
4.1.8. The State reserves a royalty -free, non-exclusive and irrevocable license to produce,
publish or otherwise use such software, modifications, documentation and procedures
created using Contract Funds on behalf of the State, the Federal Department of Health
and Human Services (HHS) and its contractors. Such data and software includes, but
is not limited to, the following:
4.1.8.1. All computer software and programs, which have been designed or developed for
the State, or acquired by the Contractor on behalf of the State, which are used in
performance of the Contract.
4.1.8.2. All internal system software and programs developed by the Contractor or
subcontractor, including all source codes, which result from the performance of the
Contract; excluding commercial software packages purchased under the
Contractor's own license.
4.1.8.3. All necessary data files.
4.1.8.4. User and operation manuals and other documentation.
4.1.8.5. System and program documentation in the form specified by the State.
4.1.8.6. Training materials developed for State staff, agents or designated representatives in
the operation and maintenance of this software.
Exhibit G, Federal Provisions Page 13 of 13
EXHIBIT H, PII CERTIFICATION
STATE OF COLORADO
THIRD PARTY ENTITY / ORGANIZATION CERTIFICATION FOR ACCESS TO PII
THROUGH A DATABASE OR AUTOMATED NETWORK
Pursuant to § 24-74-105, C.R.S., I, , on behalf of
(legal name of entity / organization) (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.
Signature:
Printed Narie:
Title:
Date:
Exhibit H — PII Certification Page 1 of 1
EXHIBIT I, SUPPLEMENTAL PROVISIONS FOR FEDERAL AWARDS
For the purposes of this Exhibit only, Contractor is also identified as "Subrecipient." This
Contract has been funded, in whole or part, with an award of Federal Funds. In the event of a
conflict between the provisions of these Supplemental Provisions for Federal Awards, the
Special Provisions, the Contract or any attachments or exhibits incorporated into and made a part
of the Contract, the Supplemental Provisions for Federal Awards shall control. In the event of a
conflict between the Supplemental Provisions for Federal Award and the FFATA Supplemental
Provisions (if any), the FFATA Supplemental Provisions shall control.
1) Federal Award Identification
i. Subrecipient: Weld County Department of Human Services;
ii. Subrecipient Unique Entity Identifier (UEI) Number: MKKXT9U9MTV5;
iii. The Federal Award Identification Number (FAIN): 1805CO5ADM;
iv. The Federal Award date is: 3/1/2024;
v. The subaward period of performance start date is 3/1/2024 and the end date is
6/30/2031, or the date in which your contract ends or whichever date comes
sooner.
vi. Federal Funds:
Contract or
Fiscal Year
Amount of Federal Funds
obligated by this Contract
Total amount of Federal
Funds obligated to the
Subrecipient
Total amount of the
Federal Award
Fiscal Year
2023-24
TBD
TBD
TBD
vii. Federal Award project description: To secure case management and
administrative activities for applicants and individuals enrolled in the Home and
Community Based Services Medicaid Waivers, Hospital Back -Up Program,
Intermediate Care Facilities for Intellectual and Developmental Disabilities, Long
Term Home Health, Nursing Facilities, and the Program for All -Inclusive Care
for the Elderly. The Contractor was selected by the State in accordance with
C.R.S. §25.5-1-101, et seq., C.R.S. and C.R.S. §25.5-6-1703, et seq.
viii. The name of the Federal awarding agency is the United States Centers for
Medicare & Medicaid Services (CMS); the name of the pass -through entity is the
Colorado Department of Health Care Policy & Financing (HCPF); and the contact
information for the awarding official is Amanda Allen, Financial Compliance and
Monitoring Section Manager, Office of Community Living, 1570 Grant Street,
Denver, CO 80203, Amanda.Allen@state.co.us, 303-866-5668.
ix. The Catalog of Federal Domestic Assistance (CFDA) number is 93.778, the name
is Medical Assistance Program, and the dollar amount is TBD.
x. This award is not for research & development.
Exhibit I, Supplemental Provisions for Federal Awards Page 1 of 1
EXHIBIT J, SUBRECIPIENT OF FEDERAL AWARD STATUS
By submitting a proposal and responding to HCPF Solicitation #RFP UHAA 2023000170,
Offeror's Response #1. f, each Offeror was required to attest that the Offeror understands and
agrees to their obligations as a subrecipient of federal award.
As this Contract is awarded off #RFP UHAA 2023000170, Contractor agrees to the following:
1) Contractor understands their obligations as a subrecipient of federal award and has read
and understands their obligations under 2 CFR Part 200.
2) Contractor understands and agrees that funds provided via the Contract must be spent on
allowable activities in alignment with 2 CFR Part 200, state regulation, and this Contract.
3) Contractor understands and agrees that any unspent funds must be returned to the
Department following the end of the Period of Performance, as identified by the
Department.
Exhibit J — Subrecipient of Federal Award Status Page I of I
Contract For
Entity Information
Entity Name* Entity ID*
DEPARTMENT OF HEALTH CARE @00023890
POLICIES & FINANCIAL
Contract Name"
INTERGOVERNMENTAL AGREEMENT
Contract Status
CTB REVIEW
Q New Entity?
Contract ID
7733
Contract Lead
SADAMS
Contract Lead Email
sadams@weld.gov;cobbx
xlk@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description *
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
PA ROUTING THROUGH NORMAL PROCESS. ETA TO CTB 1/9/2024.
Contract Type *
AGREEMENT
Amount*
$0.00
Renewable *
NO
Automatic Renewal
Grant
IGA
Department
HUMAN SERVICES
Department Email
CM-
HumanServices@weldgov.
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Requested BOCC Agenda
Date *
01/17/2024
Due Date
01/13/2024
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
04/30/2024
Committed Delivery Date
Renewal Date
Expiration Date*
06/30/2024
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CHRIS D'OVIDIO BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
01/11/2024 01/11/2024 01/12/2024
Final Approval
BOCC Approved Tyler Ref #
AG 011724
BOCC Signed Date Originator
SADAMS
BOCC Agenda Date
01/17/2024
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