HomeMy WebLinkAbout20252793.tiffMariah Higgins
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Good afternoon CTB,
Sara Adams
Tuesday, October 7, 2025 4:07 PM
CTB
HS -Contract Management; HS -CM Agreements
COMMUNICATION ITEM: HCS HCPF CMA Contract Option Letter #1 for C24-188034
Weld_24-188034OL1.docx.pdf
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Attached please find the Option Letter #1 for the HCPF CMA Contract, known to the Board as the
Following Tyler #'s:
Original Agreement (2024-0121)
Amendment #1(2024-1535)
Amendment #2 (2024-3344)
Amendment #3 (2025-0557)
Amendment #4 (2025-1396)
Amendment #5 (2025-1488)
Thank you,
Sara
COUNTY, CO
Sara Adams
Contract Administrative Coordinator
Department of Human Services
Desk: 970-400-6603
P.O. Box A, 315 N. 11th Ave., Greeley, CO 80632
011000
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Co MM u n ; co.t + cal S
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2025-2793
HR ooc 7
Docusign Envelope ID: 11F6CCB2-E306-4462-BC90-3DBCD5CD6B4F
State of Colorado Contract Modification
Option Letter #1
State Agency
Department of Health Care Policy and Financing
Contractor
Weld County Department of Human Services
Option Letter Number
Option Letter 1
Original Contract Number
C24-188034
Option Contract Number
C24-188034OL1
1. Options:
A. Option to modify Contract rates.
GAE
2026 - 2247
Contract Performance Beginning Date
March 1, 2024
Current Contract Expiration Date
June 30, 2026
Current Contract Maximum Amount
Medicaid Programs
No Maximum for any SFY
State General Fund Programs
State Fiscal Year 2025-26
Estimated Contractor Share
$21,812,013.00
$1,605,032.93
2. Required Provisions:
In accordance with Exhibit B, Statement of Work, in Section 9.3.5. of the Original
Contract referenced above, the State hereby exercises its option to modify the
Contract rates specified in Exhibit C - 4 Rates. 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.
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.
Page 1 of 5
Docusign Envelope ID: 11F6CCB2-E306-4462-BC90-3DBCD5CD6B4F
3. Option Effective Date
The effective date of this Option Letter is upon approval of the State Controller or
October 1, 2025, whichever is later.
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care Policy and Financing
Kim Bimestefer, Executive Director
DocuSignad by:
LLar
OBOA64797EA6493...
Date:
09/26/2025111:24 MDT
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
Department of Health Care Policy and Financing
Jerrod Cotosman, Controller, or authorized
delegate
5DocuSigned by:
ACIA, sue.
D9446FCCE33C45E...
09/29/20251 06:06 MDT
Option Effective Date:
In accordance with §24-30-202, C.R.S., this
Option is not valid until signed and dated above
by the State Controller or an authorized
delegate.
Page 2 of 5
Docusign Envelope ID: 11F6CCB2-E306-4462-BC90-3DBCD5CD6B4F
EXHIBIT C-5, RATES
Case Management Agency (CMA) Subaward Rates Table
Description
Rate
Frequency
Payment
Type
Funding Source
Operations Guide ,
$7,905.56
Annually - Year 1
of the Contract
Deliverable
Federal/State
Funded
Operations Guide Update
$1,424.14
Annually - Years 2+
of the Contract
Deliverable
Federal/State
Funded
Long -Range Plan
$3,543.31
Annually
Deliverable
Federal/State
Funded
Committee Updates
$1,071.73
Semi -Annually
Deliverable
Federal/State
Funded
Continuous Quality
Improvement Plan
$506.72
Annually
Deliverable
Federal/State
Funded
Complaint Trend Analysis
$3,857.04
Quarterly
Deliverable
Federal/State
Funded ,
Case Management Training
$648.75
Semi -Annually
Deliverable
Federal/State
Funded
Creation of Packet - Appeals
$531.60
Per Packet
Report
Federal/State
Funded
Attendance at Hearing -
Appeals
$490.97
Per Hearing
Report
Federal/State
Funded
IDD Critical Incident Reporting
(HCBS - CES, HCBS - CHRP,
HCBS - DD, HCBS - SLS)
$6.30
Monthly, Per
Member Enrolled
Report
Federal/State
Funded
LTSS Critical Incident
Reporting (HCBS - BI, HCBS -
CHCBS, CMHS, HCBS - EBD,
HCBS - SCI, HCBS - CLLI)
$1.61
Monthly, Per
Member Enrolled
Report
Federal/State
Funded
HCBS Critical Incident Follow-
Up Performance Standard
$3,457.07
Quarterly
Deliverable
Federal/State
Funded
Human Rights Committee
(HCBS - CES, HCBS - CHRP,
HCBS - DD, HCBS - SLS)
$5.95
Monthly, Per
Member Enrolled
Report
Federal/State
Funded
Initial Level of Care
Assessment (100.2)
$283.62
Per Assessment
Report
Federal/State
Funded
CSR Level of Care Assessment
(100.2)
$214.03
Per Assessment
Report
Federal/State
Funded
Rapid Reintegration Barrier
Questions
$48.54
Per Assessment
Invoice or
Report
Federal/State
Funded
Rapid Reintegration
Assessment and Support
$107.73
Per Assessment
Invoice or
Report
Federal/State
Funded
Post Rapid Reintegration
Survey Questions
$22.84
Per Survey
Invoice or
Report
Federal/State
Funded
Interim Support Level
Assessment
$294.17
Per Assessment
Report
Federal/State
Funded
Initial At -Risk Diversion - In
Person
$104.70
Monthly
Invoice or
Report
Federal/State
Funded
Page 3 of 5
Docusign Envelope ID: 11F6CCB2-E306-4462-BC90-3DBCD5CD6B4F
Initial At -Risk Diversion -
Virtual
$87.45
Monthly
Invoice or
Report
Federal/State
Funded
HCBS-CHRP Support Level
Needs Assessment
$165.26
Per Assessment
Invoice
Federal/State
Funded
Initial HCBS-CES Application
$189.21
Per Application
Report
Federal/State
Funded
CSR HCBS-CES Application
$142.76
Per Application
Report
Federal/State
Funded
Medicaid Eligible IDD
Determination
$458.81
Per Determination
Report
Federal/State
Funded
Medicaid Eligible Delay
Determination
$272.96
Per Determination
Report
Federal/State
Funded
IDD Determination Testing
$481.10
Actual Costs up to
Rate for Testing
Invoice
Federal/State
Funded
Rural Travel Add -On
$37.46
Per Required in
Person Contact for
Rural and Frontier
Agencies
Report
Federal/State
Funded
Case Management Agency (CMA) State Only Rates Table
Waiting List Management
$95.42
Per Contact
Report
State Funded
Non -Medicaid Eligible IDD
Determination
$458.81
Per Determination
Report
State Funded
Non -Medicaid Eligible Delay
Determination
$272.96
Per Determination
Report
State Funded
Non -Medicaid Eligible IDD
Determination Testing
$481.10
Actual Costs up to
Rate for Testing
Invoice
State Funded
State SLS, OBRA-SS, and FSSP
Critical Incident Reporting Et
Investigation: MANE
$349.18
Per Incident
Report
State Funded
State SLS, OBRA-SS, and FSSP
Critical Incident Reporting &
Investigation: Non -MANE
$46.71
Per Incident
Report
State Funded
State SLS, OBRA-SS, and FSSP
Human Rights Committee
$125.73
Per Member
Reviewed
Invoice
State Funded
State SLS and OBRA-SS
Complaints Trend Analysis
$220.69
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS, and FSSP
CIR Follow -Up Performance
Standard
$51.81
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS, and FSSP
Ongoing Case Management
$91.67
Monthly, Per
Activity
Report
State Funded
State SLS and OBRA-SS
Monitoring - In Person
$104.70
Per Contact
Report
State Funded
State SLS and OBRA-SS
Monitoring - Virtual
$87.45
Per Contact
Report
State Funded
Page 4 of 5
Docusign Envelope ID: 11F6CCB2-E306-4462-BC90-3DBCD5CD6B4F
State SLS Expenditure Report
$625.76
Monthly
Invoice
State Funded
OBRA-SS Expenditure Report
$369.56
Monthly
Invoice
State Funded
FSSP Needs Assessment
$33.25
Per Assessment
Report
State Funded
FSSP Expenditure Report
$556.57
Monthly
Invoice
State Funded
Family Support Council
Meetings
$418.29
Per Meeting
Invoice
State Funded
FSSP Annual Report Ft
Evaluation
$1,150.98
Annually
Deliverable
State Funded
Page 5 of 5
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