HomeMy WebLinkAbout20250557.tiffResolution
Approve Contract Amendment #3 to Intergovernmental Agreement for Case
Management Agency (CMA) Services and Authorize Chair to Sign
Whereas, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
Whereas, the Board has been presented with Contract Amendment #3 to the
Intergovernmental Agreement for Case Management Agency (CMA) Services between
the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and the
Colorado Department of Health Care Policy and Financing, commencing April 1, 2025,
and ending June 30, 2025, with further terms and conditions being stated in said
amendment, and
Whereas, after review, the Board deems it advisable to approve said amendment, a copy
of which is attached hereto and incorporated herein by reference.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that Contract Amendment #3 to the Intergovernmental Agreement for Case
Management Agency (CMA) Services between the County of Weld, State of Colorado, by
and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, and the Colorado Department of Health Care Policy and
Financing, be, and hereby is, approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said amendment.
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 26th day of February, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppier: Aye
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
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2025-0557
HR0097
Con ad -1D `iIfl
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Case Management Agency Contract Amendment #3 for State Fiscal Year
(SFY) 2024-2025
DEPARTMENT: Human Services DATE: February 18, 2025
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: On January 17, 2024, the Department entered into an
Intergovernmental Agreement with Colorado Department of Health Care Policy and Financing
(HCPF) to serve as a Case Management Agency, know to the Board as Tyler# 2024-0121. The
Department's Home and Community Supports Division (HCSD) receives funding annually from HCPF
to provide long-term care information, initial intake, screening, referral, assessment of need,
determination of functional eligibility, care planning, case management, reassessment, and case
closure for older adults and individuals of all ages with disabilities in Weld County. These services
provide individuals the opportunity to remain in the community as an alternative to entering an
institutional setting such as a nursing home.
On June 12, 2024, the Board approved Amendment #1, known to the Board as Tyler# 2024-1535,
that extended the contract to June 30, 2025, modified Exhibit B, Exhibit C, and Exhibit E, and
adjusted rates.
On December 18, 2024, the Board approved Amendment #2, known to the Board as Tyler# 2024-
3344, that updated the General Contract Provisions and Exhibit B, Statement of Work.
HCPF has now issued Amendment #3 (C24 -188034A2), which updates the General Contract
Provisions and Exhibit B Statement of Work, to add the new Interim Support Level Assessment
(ISLA) requirements.
This Amendment has been reviewed and approved by legal (B. Howell).
What options exist for the Board?
• Approval of the Case Management Agency Contract Amendment #3 for SFY 2024-2025.
• Deny approval of the Case Management Agency Contract Amendment #3 for SFY 2024-2025.
Consequences: WCDHS will not have an updated contract and Exhibit B with HCPF.
Impacts: WCDHS will not have an updated contract and may not be able to continue to
provide services to older adults and individuals with disabilities in Weld County.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
• Total allocated = There is no cost associated with this Amendment.
2025-0557
Pass -Around Memorandum; February 18, 2025 - CMS ID 9117
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1 -ooh �1
Recommendation:
• Approval of the Case Management Agency Contract Amendment #3 and authorize the Chair to
sign electronically.
Support Recommendation
Place on BOCC Agenda
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
Schedule
Work Session Other/Comments:
Pass -Around Memorandum; February 18, 2025 - CMS ID 9117
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
STATE OF COLORADO CONTRACT MODIFICATION
CONTRACT AMENDMENT #3
State Agency
Department of Health Care Policy and Financing
Contractor
Weld County Department of Human Services
Original Contract Number
C24-188034
Amendment Contract Number
C24 -188034A3
Contract Performance Beginning Date
April 1, 2025
Current Contract Expiration Date
June 30, 2025
Current Contract Maximum Amount
Medicaid Programs
No Maximum for any SFY
State General Fund Programs
State Fiscal Year 2024-25 $21,693,981.00
Estimated Contractor Shared
$1,579, 756.82
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Each person signing this Amendment represents and warrants that he or she is duly authorized to
execute this Amendment and to bind the Party authorizing his or her signature.
CONTRACTOR
Weld County Department of Human Services
Perry L. Buck, Chair
"-Signed by:
P
6-- 2O8 EA00 BAC 0C 4B3...
By: Perry L. Buck, Chair
02/26/2025 I 11:28 PST
Date:
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care FFXPolicy and Financing
Kim Bimeste feoruExenetivie Director
9 y:
-0B6A84797EA8493...
02/26/2025 I 13:15 MST
Date:
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
Department of Health Care Policy and Financing
Jerrod Cotosman, Controller
CDocuSigned by:
2.4.04,1 edrdIviseaset.
76F69541272643A...
02/26/2025 I 13:17 MST
Amendment Effective Date:
In accordance with §24-30-202, C.R.S., this Amendment is not valid until signed and dated above by
the State Controller or an authorized delegate.
Amendment Contract Number: C24 -188034A3 Page 1 of 72
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1. PARTIES
This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover
Page for this Amendment (the "Contract") is entered into by and between the Contractor and the
State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date shown
on the Signature and Cover Page for this Amendment. The State shall not be bound by any
provision of this Amendment before that Amendment Effective Date, and shall have no
obligation to pay Contractor for any Work performed or expense incurred under this Amendment
either before or after of the Amendment term shown in &3.B of this Amendment.
A. Amendment Term
The Parties' respective performances under this Amendment and the changes to the Contract
contained herein shall commence on the Amendment Effective Date shown on the Signature and
Cover Page for this Amendment.
4. PURPOSE
This Amendment updates the General Contract Provisions and Exhibit B Statement of Work.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page is
hereby deleted and replaced with the Current Contract Expiration Date shown on the Signature
and Cover Page for this Amendment.
B. The Contract Maximum Amount table on the Contract's Signature and Cover Page is hereby
deleted and replaced with the Current Contract Maximum Amount table shown on the
Signature and Cover Page for this Amendment.
C. The Contract Provisions is hereby updated as follows.
D. Exhibit B is hereby deleted in its entirety and replaced with Exhibit B-3 as follows. All
references to Exhibit B shall now refer to Exhibit B-3.
E. Exhibit C is hereby deleted in its entirety and replaced with Exhibit C-3 as follows. All
references to Exhibit C shall now refer to Exhibit C-3.
F. Exhibit D is hereby deleted in its entirety and replaced with Exhibit D-3 as follows. All
references to Exhibit D shall now refer to Exhibit D-3.
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
Amendment Contract Number: C24 -188034A3 Page 1 of 2
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments or other modifications to the Contract, if any, remain in full force and effect except
as specifically modified in this Amendment. Except for the Special Provisions contained in the
Contract, in the event of any conflict, inconsistency, variance, or contradiction between the
provisions of this Amendment and any of the provisions of the Contract or any prior modification
to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and
control. The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment specifically
modifies those Special Provisions.
Amendment Contract Number: C24 -188034A3 Page 2 of 2
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
EXHIBIT B-3, STATEMENT OF WORK
1. CASE MANAGEMENT OBLIGATIONS
1.1. Contractor's Obligations
1.1.1.
Contractor shall provide case management activities outlined in this Contract for the
following Home and Community Based Services (HCBS) waivers, Community First Choice
(CFC), non-HCBS programs, and State General Fund programs:
1.1.1.1. CFC
1.1.1.2. Family Support Services Program (FSSP)
1.1.1.3. HCBS Children with a Life Limiting Illness Waiver (HCBS-CLLI)/HCBS Children with
Complex Health Needs (CwCHN)
1.1.1.4. HCBS Children's Extensive Supports Waiver (HCBS-CES)
1.1.1.5. HCBS Children's Habilitation Residential Program Waiver (HCBS-CHRP)
1.1.1.6. HCBS Children's Home and Community Based Services Waiver (CHCBS)
1.1.1.7. HCBS Community Mental Health Supports Waiver (HCBS-CMHS)
1.1.1.8. HCBS Complimentary and Integrative Health Waiver (HCBS-CIH)
1.1.1.9. HCBS Developmental Disabilities Waiver (HCBS-DD)
1.1.1.10. HCBS Persons who are Elderly, Blind and Disabled Waiver (HCBS-EBD)
1.1.1.11. HCBS Persons with Brain Injury Waiver (HCBS-BI)
1.1.1.12. HCBS Supported Living Services Waiver (HCBS-SLS)
1.1.1.13. Hospital Back -Up Program (HBU)
1.1.1.14. Intermediate Care Facilities -Intellectual and Developmental Disabilities (ICF-IDD)
1.1.1.15. Long Term Home Health (LTHH)
1.1.1.16. Nursing Facilities (NF)
1.1.1.17. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS)
1.1.1.18. Program for All -Inclusive Care for the Elderly (PACE)
1.1.1.19. State Supported Living Services Program (State SLS)
1.1.2. Contractor shall abide by and perform its duties and obligations in conformity with relevant
federal law, all pertinent federal regulations, State law, rules and regulations of the
Department of Health Care Policy and Financing which include, but are not limited to:
1.1.2.1. Colorado Revised Statutes, Title 25.5, Article 6, Sections 104 through and including 107.
1.1.2.2. Colorado Revised Statute, Title 25.5, Article 10 et seq.
1.1.2.3. Colorado Department of Health Care Policy and Financing written communications.
1.1.2.4. Colorado Department of Public Health and Environment at 6 C.C.R. 1011-1 et seq.
1.1.2.5. Colorado Department of Human Services 12 C.C.R. 2509-8 7.700 et seq.
Exhibit B-1, SOW Page 1 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.1.2.6.
1.1.2.6.1.
1.1.2.6.2.
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.
1.1.2.6.18.
1.1.2.6.19.
All State Medicaid regulations promulgated by the Department. These regulations
include, but are not limited to:
CHCBS 10 CCR 2505-10, Sections 8.7101.A et seq.
FSSP 10 CCR 2505-10, Sections 8.7558 et seq.
Long -Term Care 10 CCR 2505-10, Sections 8.400 through 8.409 et seq.
Colorado Case Management System - 10 CCR 2505-10, Section 8.7200 et seq.
HCBS-BI - 10 CCR 2505-10, Section 8.7101.E et seq.
HCBS-CES, 10 C.C.R. 2505-10 Section 8.7101.B et seq.
HCBS-CHRP, 10 C.C.R. 2505-10 Section 8.7101.C et seq.
HCBS-CIH 10 CCR 2505-10, Section 8.7101.H et seq.
HCBS-CLLI 10 CCR 2505-10, Section 8.7101.D et seq.
HCBS-CMHS 10 CCR 2505-10, Section 8.7101.F et seq.
HCBS-DD, 10 C.C.R. 2505-10 Sections 8.7101J et seq.
HCBS-EBD 10 CCR 2505-10, Sections 8.7101.G et seq.
HCBS-SLS, 10 C.C.R. 2505-10 Sections 8.7101.1 et seq.
PACE Section 25.5-5-412, Section 6a -b., C.R.S et seq.
Case Management, Family Support, Laboratory and X -Ray, 10 CCR 2505-10 Section
8.600 through 8.612.5
State SLS Program, 10 CCR 2505-10, Section 8.7557 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.
Wellness Education Benefit, 10 CCR 2505-10, Section 8.7556 et seq.
1 1.3. Contractor shall perform its obligations in conformity with the provisions of Title XIX of the
Social Security Act and other applicable federal and state laws and regulations.
1.1.4. Contractor shall ensure applicant, Member, and individual rights are protected in accordance
with Title XIX of the Social Security Act, other applicable federal and state laws, and
Department regulations.
1.1.5. Contractor shall comply with written Operational Memos, policies, procedures, and guidance
issued by the Department.
1.1.6. The general Business Functions of Contractor shall include, but is not limited to, all the
following:
1.1.6.1. Contractor shall maintain a physical, publicly accessible, and Americans with Disability
Act (ADA) compliant office within the Defined Service Area and appropriate staffing
pattern to serve the Defined Service Area.
1.1.6.1.1. Contractor shall ensure adequate staffing through virtual or in -person services
throughout the Defined Service Area in addition to a physical office space, providing
Exhibit B-1, SOW
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access to its office for staff, Members, families, services providers, and others to best
meet the needs of individuals based on individual preferences.
1.1.6.1.2. Contractor shall have the ability for case managers to travel, regional coverage, and
provide all required Work for the counties in which the agency operates.
1.1.6.1.3. Regular business office hours of operation shall follow a Monday through Friday
schedule except for federal, state, or local holidays and unplanned closures due to
inclement weather or other emergencies. Regular business office hours and holiday
closures must be provided to all Members upon enrollment and at least annually,
posted publicly at each office location, and posted on Contractor's website.
Contractor shall have a procedure for notifying Members and the public of unplanned
closures or changes to regular business hours due to inclement weather or other
emergencies, which includes emergency contact information
1.1.6.1.4. Contractor shall have internal procedures for accommodating individuals, Members,
and families who need assistance or consultation outside regular business office
hours. Non-standard business hours and method of contact information for crisis
situations must be posted on Contractor's website in an easily accessible location.
1.1.6.2. Contractor shall have an emergency on -call procedure to respond to crisis situations
outside of regular business hours. Procedures must clearly document how Contractor will
ensure timely response to emergency situations such as hospital discharges, risk of
homelessness, unexpected termination of residential services, etc. Contractor shall make
the procedure available on Contractor's website. Contractor shall notify individuals,
Members, families, providers, and community partners of the procedures and make it
readily available through a variety of methods. Contractor shall have an internal policy
and procedure to respond to all telephone calls, voicemails, and emails from Members
and families on average within two Business Days of receipt by Contractor.
1.1.6.3. Contractor shall overcome any geographic barriers within the Defined Service Area,
including distance from the agency office to provide timely assessment and case
management services to individuals, Members and families, as required by Contract,
Federal or State statutes and regulations. This may include staff who reside throughout
the Defined Service Area to best meet the needs of individuals and members.
1.1.6.4. Contractor shall protect Members' rights as they relate to the responsibilities of Case
Management Agencies as described in this Contract.
1.1.6.5. Contractor shall provide access to a telephone system and trained staff to ensure timely
response to messages and telephone calls received after hours.
1.1.6.6. Contractor shall provide access to telecommunication devices and/or interpreters for the
hearing and vocally impaired and foreign language interpreters as needed to fulfil all
Work. Contractor shall conduct an assessment of the communication needs of the
Members they serve and ensure their interpretation and telecommunication services
sufficiently meet the Member's need in a timely fashion.
1.1.6.7. 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.
1.1.6.8. Contractor shall support the Department's National Core Indicators (NCI) efforts.
Exhibit B-1, SOW Page 3 of 54
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
1.1.6.9. Contractor shall support the Department's Equity, Diversity, Inclusion, and Accessibility
(EDIA) efforts to include participation in a Department led EDIA assessment and survey.
Contractor shall have a written policy and procedure on the agency's commitment to
equity, diversity, inclusion, and accessibility that includes approaches to confronting
racism and building opportunity for inclusion that promotes equitable treatment of
historically underserved and marginalized communities. Contractor shall make the policy
and procedure available to the Department upon request.
1.1.6.10. Contractor shall enroll and act as a Medicaid Targeted Case Management (TCM) provider
for all HCBS waivers to include, but not limited to, providing ongoing case management
and monitoring activities for the Defined Service Area.
1.1.6.11. 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.
1.1.6.11.1. Contractor shall obtain and maintain approval for the CFCMW throughout the
Contract Period to meet program requirements for a Case Management Agency.
1.1.6.11.2. The Department reserves the right to revoke Contractor's CFCMW at any time.
1.1.6.11.3. Contractor shall submit an annual report to the Department that includes, but is not
limited to, the following information:
1.1.6.11.3.1. Written processes in place to ensure remediation of conflict and separation of
entities.
1.1.6.11.3.2. Documentation of Member choice and informed consent of the conflict of the
agency being selected.
1.1.6.11.3.3. A summary of the individuals participating in direct services and case
management at the agency with the CFCMW.
1.1.6.11.3.4. Policies and procedures outlining how Contractor will validate that there are no
other willing and qualified providers in their Defined Service Area with capacity
to provide services for all eligible members in the service area.
1.1.6.11.3.5. How Contractor is supporting the recruitment of providers in their area to
remediate conflict.
1.1.6.11.4. If Contractor is denied a CFCMW for any reason, or one is revoked, Contractor must
have documented written plans for transitioning individuals and Members. Contractor
shall continue to provide services until a transition maybe successfully implemented.
1.1.6.11.5. 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.
1.1.6.11.6. DUE: June 15th of each year or prior to contract renewal for CMAs with an approved
rural exception
1.2. Collaboration with other Care Coordination Entities and Case Management Agencies
1.2.1. Contractor shall comply with written communication from the Department, provided by the
Department, between Contractor and community partners and service providers that outline
how Contractor will work together with these partners to coordinate care and better serve
Exhibit B-1, SOW Page 4 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.2.1.1.
1.2.1.1.1.
1.2.1.1.1.1.
1.2.1.1.1.2.
individuals and Members. Contractor shall establish written memorandum of understanding
with local care coordination entities that outline roles and responsibilities, avoidance of
duplication of effort, and communication expectations. Contractor is responsible for
streamlining the Member experience to ensure full range of Medicaid services are being
offered and accessed based on the Member's needs. As applicable, a memorandum of
understanding shall address partnerships with:
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
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.
Contractor shall ensure collaboration with RAEs occurs for all shared Members
that need care coordination services for physical and behavioral health services.
Contractor shall identify which community agencies are responsible for
facilitation, follow-up, and solution focused on next steps for each Member
collaboration.
Contractor shall collaborate with the appropriate RAE when a Member needs
assistance in accessing or coordinating the Member's physical, behavioral, or
mental health needs. This shall include but is not limited to Members who have
complex medical or behavioral support needs, change of conditions or
involvement with Child Welfare or Adult Protection.
1.2.1.1.1.3. Coordinating with the RAE for shared Members who admit to a hospital, to
include, but not limited to, communicating reasons for admission, Member's
hospital status, and plans for discharge.
1.2.1.1.1.4. Collaborating with the RAE for shared Members discharging from the hospital to
ensure all support needs are reflected in the Support Plan and the Member is
connected to the necessary services to support a successful discharge.
1.2.1.1.1.5. Enter into a data sharing arrangement for the sharing of all necessary information
for the RAE to assist Members in accessing and coordinating physical and
behavioral health needs.
1.2.1.1.1.6. Contractor shall create a complex and creative solutions process with the RAE(s)
and designated staff to address needs spanning multiple Medicaid systems for all
shared Members. This shall include, but not be limited to, a regularly scheduled
joint coordination meeting at a cadence that best meets the Member's needs to
ensure holistic case management and care coordination. This process shall be
made available upon request,
1.2.1.1.1.7. Contractor shall honor Member's preferences for case management and care
coordination, when applicable, while ensuring collaboration with the RAE occurs.
Exhibit B-1, SOW Page 5 of 54
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1.2.2. Contractor shall work with the Department to identify a Key Performance Indicator (KPI) to
measure the effectiveness of coordination between Contractor and RAE. Medicaid Eligibility
Sites
1.2.2.1 County department of human/social services (counties) and Medical Assistance (MA)
Sites are designated sites allowed by statute or certified by the Department of Health Care
Policy and Financing (Department) to process the State -authorized Medical Assistance
application for the programs that are administered by the Department and determine
eligibility for said programs. The role of county departments, specified in CRS 25.5-1-
118, is specific to the responsibility for the local administration of Medical Assistance.
Additionally, the Department is authorized to establish MA sites by statute (CRS 25.5-4-
205 et seq). Counties and MA Sites use the Colorado Benefits Management System
(CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Health First
Colorado (Colorado's Medicaid Program) programs.
1.2.2.2. Contractor shall ensure collaboration with all county and Medical Assistance sites
pertaining to application, renewal, case changes, or re -application status for members in
Contractor's designated service area.
1.2.2.3. Contractor shall collaborate with the appropriate counties and/or Medical Assistance sites
to ensure proper follow-up and communication to support members in obtaining and
maintaining their benefits.
1.2.3. Community Centered Boards
1.2.3.1. Community Centered Boards (CCB) are the agencies responsible for leveraging local and
regional resources to meet unmet needs for individuals with Intellectual and
Developmental Disabilities (IDD) and their families.
1.2.3.2. Contractor shall collaborate with CCBs, this may include, but is not limited to:
1.2.3.2.1. Receiving referrals or sharing information necessary for the CCB and/or CMA to
assist individuals and Members in accessing LTSS programs targeted for individuals
with intellectual and developmental disabilities or children with disabilities.
1.2.3.2.2. Coordinating care for non -waiver services for members with intellectual and
developmental disabilities where applicable or appropriate.
1.3. Qualification and Training Requirements
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
8.7203.A to 8.7204 et seq.
1.3.2. Contractor shall ensure all case managers meet the qualification requirements established in
10 C.C.R. 2505-10, Section 8.7203.A et seq.
1.3.3. 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. 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
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management duties. All other case management staff must receive retraining as required by
the Department, a Department -approved vendor, or 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. 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. Community First Choice
1.3.6.4. Determination of Developmental Disability or Delay
1.3.6.5. Disability and Cultural Competency
1.3.6.6. Equity, Diversity, Inclusion and Accessibility (EDIA)
1.3.6.7. Intake and Referral
1.3.6.8. Level of Care Screen and Needs Assessment (Colorado Single Assessment) or
Department Prescribed Tools
1.3.6.9. Long -Term Home Health (LTHH)
1.3.6.10. Long -Term Services and Supports Eligibility
1.3.6.11. Mandatory Reporting
1.3.6.12. Notices and Appeals
1.3.6.13. Nursing Facility Admissions
1.3.6.14. Rapid Reintegration
1.3.6.15. Participant Directed Training
1.3.6.16. Person -Centered Support Planning and Person -Centered Support Plan
1.3.6.17. Pre -Admission Screening and Resident Review (PASRR)
1.3.6.18. State General Fund Program Ongoing Case Management
1.3.6.19. State General Fund Program Requirements and Services
1.3.6.20. System Documentation
1.3.6.21. Waiver Requirements and Services
1.3.7. DELIVERABLE: Case Management Training
1.3.8. DUE: Semi -Annually, trainings held between July 1St and December 3lst are due January
15th, and trainings held between January 1st through June 1st are due June 15th
1.3.9. Contractor shall maintain supporting documentation demonstrating case managers attended
the required trainings and make the information available to the Department upon request.
Supporting documentation must include the name and description of the training, the date the
training was held, case managers in attendance, and trainer sign -off showing the case
manager completed the training.
Exhibit B -I, SOW Page 7 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.3.10. There will be no exemptions to the above list of required trainings as all case managers shall
have a basic knowledge of all case management activities regardless of ongoing duties.
1.3.11. Case Managers shall meet competency requirements determined by the Department to
perform case management tasks including the correct application of the Colorado Single
Assessment and Person -Centered Support Plan. Case Managers must pass assigned training
competency requirements to independently perform Case Management activities.
1.3.12. Contractor shall participate in Department and vendor trainings, which will be tracked by the
Department. Participation can be at the time of the presented training or, if applicable,
following the training using the materials available from the Department's website or LMS.
1.3.13. For Case Managers who have a documented minimum of one-year immediate prior work
experience at a different Colorado CMA, Contractor may assign independent case
management activities once Contractor has verified that the Case Manager's training
requirements were previously met.
1.3.14. Contractor may elect to perform additional training not outlined in the Contract, but
applicable to the Scope of Work, which may include mental health first aid, crisis
intervention, and trauma informed care. Contractor may utilize the Department's Case
Management Training Template to identify trainings attended that are not required by the
Department.
1.3.15. Case Management staff are required to retake training to address and remediate performance
concerns as directed by the Department.
1.3.16. Contractor shall provide the date all case management staff, including new and existing staff,
were hired and the dates of received training in the areas identified in Section 1.2.3, using the
reporting template provided by the Department for review, approval, and payment.
1.3.17. Case Managers shall receive oversight reviews of their performance including their
competency with completing the Level of Care Screen. Contractor shall shadow case
management staff completing the Level of Care Screen on an annual basis and prior to the
end of each Contract Fiscal year to establish case manager's competency administering the
Level of Care Screen. Documentation on case manager performance will be maintained by
Contractor and provided to the Department upon request. Supervisors, lead workers, or a case
manager with at least three years of case management experience may perform the
shadowing.
1.4. Care and Case Management (CCM) System Training
1.4.1. Contractor shall participate in all trainings required by the Department for the Care and Case
Management (CCM) Information Technology system and the new Colorado Single
Assessment and Person -Centered Support Plan.
1.4.1.1. Staff employed by Contractor shall participate in training on the Colorado Single
Assessment and Person -Centered Support Plan instruments prior to performing the LOC
Screen, Needs Assessment, or Person -Centered Support Plan.
1.4.1.2. Contractor shall receive a one-time payment for the training and oversight of Contractor
staff in performing the Colorado Single Assessment and Person -Centered Support Plan.
Payment will be calculated based on the average number of staff as specified by the
Department.
Exhibit B-1, SOW Page 8 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.4.1.3. DELIVERABLE: Colorado Single Assessment and Person -Centered Support Plan
Training
1.4.1.4. DUE: As Provided by the Department
1.5. Community First Choice
1.5.1. Contractor shall participate in all trainings required by the Department for the implementation
of Community First Choice.
1.5.1.1. Staff employed by Contractor shall participate in training provided by the Department
and associated vendors on Community First Choice.
1.5.1.2. DELIVERABLE: Completed Case Management Training on the Community First
Choice Implementation.
1.5.1.3. DUE: As Assigned by the Department
1.6. Complaints
1.6.1. Contractor shall develop and maintain a formal complaints procedure, notify Members
annually of the procedures, and make the procedure publicly available to include posting the
procedure to Contractor's website. Procedures must include requirements for member
notification in accordance with 10 CCR 2505-10 9.519.20 and 10 CCR 2505-10 8.7201.D.
1.6.2. Contractor shall receive, document, and track any complaint received by Contractor as it
relates to the services provided through this Contract to include, but not limited to, general
business functions, administration, State General Funded Programs, and case management
functions outlined in this Contract. Complaints received outside of the scope of this Contract
shall not be included. Documentation shall consist of a complaint log that includes the date
of complaint, name of the complainant, the nature of the complaint and the date and
description of the resolution.
1.6.3. Contractor shall submit all complaints to the Community Advisory Committee for review,
feedback, and input on resolving complaints.
1.6.4. Contractor shall analyze complaints for trends quarterly and shall submit all complaint -
oriented trends observed since the Effective Date of this Contract and the remedial actions
taken to address them to the Department.
1.6.5. Trend analysis shall include an examination of information including, but not limited to:
1.6.5.1. A comparison of complaint types and number of complaints over a period of time.
1.6.5.2. Number of type of complaint against Contractor, time, location, individual involved, staff
involved, and/or any additional relevant information.
1.6.5.3. An examination of potential reasons for the increase or decrease in complaints by total
number, subcontractor, individual, or staff.
1.6.5.4. An examination of preventative measures that can be implemented to reduce the number
or frequency of future complaints.
1.6.5.5. Implementation of a plan of action or any future actions to take place.
1.6.5.6. An analysis of whether the plan of action and changes made were effective or if additional
changes need to occur.
Exhibit B-1, SOW Page 9 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.6.5.7. As part of the complaint process Contractor shall include, but is not limited to, all of the
following:
1.6.5.7.1. Document complaints received.
1.6.5.7.2. Address substantiated complaints.
1.6.5.7.3. Respond to complaints received and document actions taken to resolve and/or
mitigate complaints.
1.6.5.7.4. Conduct a quarterly trend analysis of all complaints received for the full period of the
Contract.
1.6.5.8. Contractor shall maintain all supporting documentation related to the collection and
follow-up to complaints and make it available to the Department upon request.
1.6.5.9. If Contractor received no complaints during the quarter, Contractor may submit the
Complaint Trends Analysis to the Department identifying no complaints were reported
during the quarter.
1.6.5.10. If Contractor received less than five complaints during the quarter and cannot establish a
complaint trend, Contractor may submit the Complaint Trends Analysis to the
Department with the complaint log that includes the date of complaint, name of the
complainant, the nature of the complaint and the date and description of the resolution.
1.6.5.11. Contractor shall submit the Complaint Trends Analysis to the Department for review and
approval.
1.6.5.11.1. DELIVERABLE: Complaint Trend Analysis
1.6.5.11.2. DUE: Quarterly, by October 15th, January 15th, April 15th and June 15th of each year.
1.7. Continuous Quality Improvement Plan
1.7.1. Contractor shall create and implement a Continuous Quality Improvement Plan for the
contract period. The Continuous Quality Improvement Plan shall include, but not be limited
to a description of the following:
1.7.1.1. How Contractor oversees the work performed by Case Managers as outlined in the
contract to ensure all tasks are being performed according to the requirements.
1.7.1.2. How Contractor reviews work to determine whether the work is being completed in a
correct and high -quality manner.
1.7.1.3. How Contractor identifies and addresses Case Management performance issues.
1.7.1.4. How Contractor notifies the Department of identified performance issues.
1.7.1.5. How Contractor will address at a minimum the following areas: operations, quality
controls, staffing, training, and community engagement. Required tasks will be outlined
in Department template that will be provided to Contractor yearly.
1.7.1.6. Contractor shall participate in the Department hosted Quality Community of Practice.
1.7.2. Contractor shall submit the Continuous Quality Improvement Plan to the Department for
review, approval, and payment. The Department will establish a regularly scheduled cadence
with Contractor to review and discuss the CQI Plan, data, and agency specific quality
dashboard. Contractor shall review the plan and metrics with the Department annually.
Exhibit B-1, SOW Page 10 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.7.2.1. DELIVERABLE: Continuous Quality Improvement Plan
1.7.2.2. DUE: Within 90 Business Days after the Effective Date
1.7.3. Contractor shall review its Continuous Quality Improvement Plan on an annual basis and
update the plan as appropriate to account for any changes. Contractor shall submit the
Continuous Quality Improvement Plan Update or document that the plan was reviewed, and
changes were not required.
1.7.3.1. DELIVERABLE: Continuous Quality Improvement Plan Update
1.7.3.2. DUE: Annually, by October 1st
1.8. Appeals
1.8.1. Contractor shall represent the Department and defend any adverse action in accordance with
10 CCR 2505-10 8.7202.R et seq., and 10 CCR 2505-10 Section 8.057 et. seq. in all HCBS,
CFC, LTHH, PACE, Hospital Back -Up Facilities, and Nursing Facility appeals initiated
during this Contract. This section does not apply to State General Fund Programs. Contractor
shall coordinate with the Department for any adverse actions necessitating Department
attendance at a hearing.
1.8.1.1. Contractor shall identify and disclose to the Department immediately, and no later than
45 Calendar Days prior to a scheduled appeal hearing, any conflict of interest that would
interfere with Contractor's ability to represent the Department in any appeal.
1.8.2. Contractor shall represent its actions at Administrative Law Judge hearings when the
individual or Member appeals a denial or adverse action affecting individual's or Member's
program eligibility or receipt of services.
1.8.3. Contractor shall process appeals in accordance with schedules published by the State of
Colorado Office of Administrative Courts and rules promulgated by the Department.
1.8.4. Contractor shall develop an Appeals Packet which contains all relevant documentation to
support Contractor's denial or adverse action.
1.8.5. Contractor shall develop an Appeals Packet no later than 20 Business Days prior to the date
of a scheduled hearing.
1.8.6. Contractor shall submit exceptions when applicable and include all relevant information.
1.8.7. Contractor shall cooperate with the Office of the State Attorney General for any case in which
it is involved.
1.8.8. Contractor shall document all appeals where Contractor attends any hearing in an
Administrative Law Court.
1.8.9. Contractor shall make the Appeal Packets available to the Department upon request.
1.9. Critical Incidents
1.9.1. Critical Incident Reporting
1.9.1.1. Contractor shall be responsible for entering Critical Incident Reports (CIR) in the
Department prescribed system as soon as possible, but no later than 24 hours (one
business day) following notification.
1.9.1.2. Contractor shall ensure all suspected incidents of abuse, neglect, and exploitation are
immediately reported consistent with current statute; Section 19-3-301 through 19-3-318
Exhibit B-1, SOW Page 11 of 54
Docusign Envelope ID: 69A10C9A-A155-4052-956A-6CE0473D383F
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).
1.9.1.3. Contractor shall document all CIR follow-up information in accordance with Department
direction in the Department prescribed system and maintain detailed documentation.
1.9.2. Critical Incident Follow -Up Completion and Entry
1.9.2.1. Contractor shall ensure all CIRs follow-up is completed and entered into the
Department's prescribed system within the timelines established by the Department
and/or the Department's Quality Improvement Organization.
1.9.2.2. 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:
1.9.2.2.1. High Priority Follow Up- CIRs which require immediate attention and must be
addressed to ensure the immediate health and safety of a waiver participant must be
remediated within and responded to in the Department prescribed system within 24-
48 hours.
1.9.2.2.2. 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.
1.9.2.2.3. Low Priority Follow Up — CIRs that have been remediated by CMAs, have addressed
immediate and long-term needs, have implemented services or supports to ensure
health and safety, and those that have protocols in place to prevent a recurrence of a
similar CIR but may require an edit to the CIR or additional information entered into
the Department prescribed system. The follow-up for CIRs in this category must be
completed and entered within five Business Days.
1.9.2.3. PERFORMANCE STANDARD: 90% of all CIRs assigned follow-up are completed
and entered into the Department's prescribed system within the timelines established by
the Department and/or the Department's Quality Improvement Organization each quarter.
1.10. Critical Incident Report Administrative Review
1.10.1. Contractor shall conduct a Critical Incident Report Administrative Review upon direction
from the Department.
1.11. Critical Incident Report administrative reviews shall be initiated by the Department and will
require the Contractor to upload documentation to the Department's prescribed system as
assigned. Contractor may be required to document that the reported incident of alleged
Mistreatment, Abuse, Neglect, or Exploitation (MANE) was reported to law enforcement, per
mandated reporting laws, and to adult/child protection services to be screened for additional
investigation by the Colorado Department of Human Services as appropriate. The Department
may also request that the Contractor file a report with the Colorado Department of Public Health
and Environment as necessary. Critical Incident Report administrative review may also require
documentation of whether additional services might be needed as a result of the incident or
gathering of additional documentation at the request of the Department.
1.12. Human Rights Committee (HRC)
Exhibit B-1, SOW Page 12 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.12.1. Contractor shall establish an HRC. The HRC is composed, to the extent possible, of two
professional persons trained in the application of behavior development techniques and three
representatives of persons receiving services, their parents, legal guardians, or authorized
representatives. An employee or board member of a service agency within the Contractor's
designated service area shall not serve as a member of the HRC.
1.12.2. Contractor shall establish and facilitate a Human Rights Committee (HRC) pursuant to 10
C.C.R. 2505-10 Section 8.7202.Q et seq. Contractor shall maintain qualifications for each
member of the HRC and make it available to the Department upon request.
1.12.3. Contractor shall submit a list of HRC members annually.
1.12.3.1. DELIVERABLE: HRC Member List
1.12.3.2. DUE: Annually, by August 15th
1.12.4. Contractor shall notify the Department of any changes to the HRC members within 10
Business Days of the date of change.
1.12.4.1. DELIVERABLE: HRC Member Updates
1.12.4.2. DUE: Within 10 Business Days of the date of change to the HRC members
1.12.5. Contractor shall establish at least one HRC as a third -party mechanism to safeguard the rights
of persons enrolled in HCBS-CES, HCBS-CHRP, HCBS-SLS, HCBS-DD, State SLS,
OBRA-SS, and FSSP. The HRC is an advisory and review body to the administration of
Contractor.
1.12.6. Contractor shall develop policies and procedures which include, but are not limited to, HRC
responsibilities for the committee's organization, use of Department required universal
documents, the review process, mitigation of potential conflicts of interest, and provisions
for recording dissenting opinions of committee members in the committee's
recommendations. CMAs must also develop and adopt an HRC policy and procedure for the
emergency review of Rights Modifications.
1.12.7. Contractor shall orient members regarding the duties and responsibilities of the Human
Rights Committee and make this information available to the Department upon request.
1.12.8. Contractor shall provide the HRC with the necessary staff support to facilitate its functions.
1.12.9. Contractor shall keep proper documentation and record of all HRC recommendations and
ensure that all documentation is a part of the members record in the Department's prescribed
system.
1.12.10. Contractor shall maintain HRC meeting minutes, attendance logs, and supporting
documentation related to an HRC meeting and make it available to the Department within 10
Business Days upon request.
1.12.11. Contractor shall notify the Department in writing of any changes to the HRC membership
within 10 Business Days.
1.12.12. Contractor shall document all reviews within the Department's prescribed system within 10
Business Days of the date of the HRC review.
2. PRE -ENROLLMENT ACTIVITIES
2.1. LTSS LOC Referral, Intake, and Screening
Exhibit B-1, SOW Page 13 of54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
2.1.1. Contractor shall perform all long-term services and supports Level of Care referral, intake,
and screening functions/activities for enrollment into the following waivers and programs:
2.1.1.1. HCBS-CHCBS
2.1.1.2. Community First Choice (CFC)
2.1.1.3. Consumer -Directed Attendant Support Services (CDASS)
2.1.1.4. Family Support Services Program (FSSP)
2.1.1.5. HCBS-BI
2.1.1.6. HCBS-CESHCBS-CHRP
2.1.1.7. HCBS-CIH
2.1.1.8. HCBS-CLLUHCBS-CwCHN
2.1.1.9. HCBS-CMHS
2.1.1.10. HCBS-DD
2.1.1.11. HCBS-EBD
2.1.1.12. HCBS-SLS
2.1.1.13. Hospital Back -Up
2.1.1.14. In Home Supports and Services (IHSS)
2.1.1.15. Intermediate Care Facilities for Individuals with Intellectual and Developmental
Disabilities (ICF/IID)
2.1.1.16. Nursing Facilities
2.1.1.17. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS)
2.1.1.18. PACE
2.1.1.19. State Supported Living Services Program (State SLS)
2.2. Contractor shall perform all Long Term Supports and Services Level of Care (LTSS LOC)
referral, intake, and screening functions/activities in accordance with §25.5-6-104, C.R.S. and 10
CCR 2505-10, Sections 8.7202.B., 8.7202.E, and 8.401 et seq., shall include, but not limited to,
the following:
2.2.1.1. Timelines shall be applied based on the location of the applicant at the time the Contractor
receives the LTSS Level of Care (LOC) referral or another intake referral:
2.2.1.1.1. Hospital
2.2.1.1.2. Skilled Nursing Facility, or
2.2.1.1.3. Community
2.2.1.1.3.1. Programs such as Hospital Back-up and PACE are subject to timelines based on
the location of the applicant at the time the Contractor receives the LTSS LOC
referral or another referral for LOC Assessment.
2.2.1.2. CMAs shall not require a LTSS LOC Referral form to intake a referral requesting a LOC
Assessment.
Exhibit B-1, SOW Page 14 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
2.2.1.3. Conduct and document the Colorado Intake Screen Tool (CIST), LOC Assessment, and
Rapid Reintegration within required timelines set forth by the Department.
2.2.1.3.1. Conduct and document the CIST in the Department's prescribed system within 2
business days of receiving the LTSS LOC referral or any other intake referral
requesting a LOC Assessment.
2.2.1.3.2. Timeline to conduct and document the CIST does not extend the LOC Assessment
timelines set forth by the Department.
2.2.1.3.3. Ensure documentation includes the individual's need for LTSS and/or the individual's
request fora LOC Screen even if the CIST indicates the individual may not be eligible
for LTSS.
2.2.1.3.4. LTSS LOC referral form is uploaded to the Department's prescribed system.
2.2.1.3.4.1. Any other referral requesting a LOC Assessment is uploaded in the Department's
prescribed system.
2.2.1.3.5. Document all efforts to contact an applicant to conduct the CIST, LOC Assessment,
and any referrals made to non-LTSS services in the Department's prescribed system.
2.2.1.4. Have a written policy and procedure for expediting the LTSS LOC referral or another
referral for LOC Assessment in the event that an applicant is in an emergency situation.
2.2.1.5. Conduct and document a LOC Assessment without delay if an applicant has requested a
Delay Determination or Developmental Disability Determination required for HCBS-
DD, HCBS-SLS, HCBS-CES, HCBS-CHRP waivers, and CFC.
2.2.1.6. For an individual who is not being discharged from a hospital or a nursing facility, the
CIST, and LOC Assessment shall be conducted and documented in the Department's
prescribed system within 10 business after receiving confirmation that the Medicaid
application has been received by the county department of social services.
2.2.1.6.1. CMAs shall attempt to verify that a LTC Medicaid Application has been submitted
after receiving a LTSS LOC referral but should not delay a LOC Assessment if the
interview conducted to complete the CIST indicates that an applicant has not
submitted a LTC Medicaid Application.
2.2.1.6.2. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
2.2.1.7. Individuals shall be notified at the time of the decision of their application for publicly
funded LTSS that they have the right to appeal the actions of Contractor according to 10
CCR 2505-10 section 8.057 and 8.7202.R et seq. The notification shall include the right
to request a fair hearing before an Administrative Law Judge.
2.2.1.7.1. PERFORMANCE STANDARD: 100% of LTSS LOC Referrals and all intake
referrals submitted to the Contractor are entered or uploaded into the Department
prescribed system within two Business Days of the LTSS LOC Referral or intake
referral receipt date.
2.3. Developmental Disability and Delay Determinations
Exhibit B-1, SOW Page 15 of54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
2.3.1. Contractor shall determine whether an applicant meets the definition of an Individual with a
Developmental Disability or Delay as defined under 10 CCR 2505-10, section 8.8.7100.A.,
in accordance with 10 C.C.R. 2505-10 section 8.607.2 et seq.
2.3.2. Contractor may expedite psychological or adaptive behavior testing for Developmental
Disability Determinations when there are delays due to issues identifying a provider or
scheduling testing with a provider in order complete the PASRR Level II assessments for
individuals residing in skilled nursing facilities. Requests for testing funding must be
submitted on the template prescribed by the Department.
2.3.3. Contractor may request funding for testing necessary to complete Delay or Developmental
Determination to move forward with intake and referral activities. This includes cases where
an applicant cannot access testing due to financial burden and other funding is not available
if they have submitted a long-term care Medicaid application and the financial eligibility has
not been determined. Requests for funding must be submitted to the Department for approval
prior to funding being approved.
2.3.3.1. DELIVERABLE: Prior Approval for Testing Funding and Invoice
2.3.3.2. DUE: Monthly, by the 15th
2.3.3.3. Contractor shall maintain all supporting documentation related to the testing for DD
Determination and make it available to the Department upon request.
2.3.4. Contractor shall complete the individual's determination record and assessment record in the
Department prescribed system with all applicable dates and information within 10 Business
Days after a determination is complete.
2.3.5. Contractor shall maintain the individual's determination, documents, and upload them to the
Department's prescribed system.
2.3.6. Contractor shall ensure that all determinations are complete, in accordance with Department
regulations, and the individual has been determined to have a disability or delay prior to
enrollment into HCBS-DD, HCBS-SLS, HCBS-CHRP, HCBS-CES, CFC, State SLS, FSSP,
and OBRA-SS.
2.3.7. Individuals shall be notified at the time of the decision of the determination that they have
the right to appeal actions of Contractor to 10 CCR 2505-10 sections 8.057 et seq., 8.7202.R
et seq. The notification shall include the right to request a fair hearing before an
Administrative Law Judge.
2.4. Waiting List Management
2.4.1. Contractor shall maintain a program specific waiting list within the Department's prescribed
system for all eligible individuals for whom funding is not available. Waiting lists may be
applicable for HCBS-DD, State SLS, OBRA-SS and FSSP dependent on available funding.
Contractor shall not maintain a waiting list for any of the other programs included within this
Contract.
2.4.2. Contractor shall determine HCBS-DD waiting list eligibility by conducting an assessment
that clearly defines detailed and member specific information that specifies how the
individual meets the HCBS-DD waiver requirement for needing access to services and
supports twenty-four (24) hours a day pursuant to 10 CCR 2505-10 8.7202.G et seq. and
8.7101.J et seq.
Exhibit B-1, SOW Page 16 of 54
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
2.4.2.1. Contractor's description of daily living needs of an individual who requires access to
twenty-four (24) hour a day services and support in the LOC waiting list assessment
should indicate services and support needs that are only available in the HCBS-DD
waiver to determine why access to services and supports twenty-four hours a day are
necessary for the individual.
2.4.3. The name of a person eligible for the program shall be placed on the waiting list by Contractor
making the eligibility determination.
2.4.4. When an eligible person is placed on the waiting list for Waiver services, a written notice of
action including information regarding individual rights and appeals shall be sent to the
person or the person's legal guardian in accordance with the provisions of 10 C.C.R. 2505-
10 8.7202J et seq.
2.4.5. When funding has been made available for an individual Contractor will remove the person
from the "As Soon as Available" (ASAA) waiting list within 10 Business Days.
2.4.6. The placement date used to establish a person's order on an HCBS waiver waiting list shall
be:
2.4.6.1. The date on which the person was initially determined to have a developmental disability
by Contractor; or
2.4.6.2. The 14th birth date if a child is determined to have a developmental disability by
Contractor prior to the age of 14.
2.4.7. When an individual is eligible for a program and funding is not available, Contractor shall:
2.4.7.1. Verify demographic information.
2.4.7.2. Compile and correct data.
2.4.8. Contractor shall complete data entry of Waiting List record into the Department prescribed
system within 10 Business Days of any addition or change to the Waiting List.
2.4.9. Contractor shall conduct and document, in the Department's prescribed system, an annual
follow-up with individuals 18 and older for all HCBS waivers with a Waiting List timeline
of ASAA, Safety Net (SN), or "see date" to update changes in demographic information and
ensure the individual is appropriately identified on waiting lists for the program and services
the individual is eligible to receive.
2.4.9.1. PERFORMANCE STANDARD: 100% of HCBS individuals 18 and older with an
ASAA, SN, or "see date" timeline on the Waiting List are contacted annually and
documented within the Department's prescribed system within 10 Business Days.
2.5. Program Enrollment from the Waiting List
2.5.1. HCBS-DD Enrollment from the Waiting List
2.5.1.1. When an enrollment becomes available from the HCBS-DD Waiting List, the Department
will notify Contractor of the individual who will be offered an enrollment by the order of
selection date.
2.5.1.2. Contractor shall notify the individual of the enrollment offer within 5 Business Days.
Contractor shall make three attempts to contact the individual within a 30 -calendar day
period. Contractor shall document in the Departments prescribed system all attempts to
contact the individual for the enrollment offer. If the individual does not respond to the
Exhibit B -1, SOW Page 17 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
offer of enrollment, Contractor shall change the individuals waiting list timeline to
"Safety Net".
2.5.1.3. Individuals shall be notified at the time of the enrollment offer that they have the right to
appeal the actions of Contractor to 10 CCR 2505-10 sections 8.7202.R et seq. and 8.057
et seq. The notification shall include the right to request a fair hearing before an
Administrative Law Judge.
2.5.2. HCBS-DD Waiting List Enrollment Capacity Building
2.5.2.1. As appropriated and earmarked by the General Assembly, Contractor may receive
capacity building funding to support the enrollment of members into the HCBS-DD
waiver from the waiting list.
2.5.2.2. Contractor shall receive written notification of any capacity building funding for
individuals enrolling into the HCBS-DD waiver from the waiting list.
2.5.2.3. If funding is allocated, Contractor shall report how the capacity building funding was
used to support the enrollment of the authorized Member(s) into the HCBS-DD waiver
on a template developed by the Department. Funding must be used to support Member
enrollment in the following categories:
2.5.23.1. Staffing costs
2.5.2.3.1.1. Recruiting and hiring
2.5.2.3.1.2. Professional development
2.5.2.3.1.3. Equipment and supplies
2.5.2.3.1.4. Information technology
2.5.2.3.2. Program costs
2.5.2.3.2.1. Advertising
2.5.23.2.2. Equipment and supplies
2.5.2.4. DELIVERABLE: Capacity Building Funding Expenses
2.5.2.5. DUE: Quarterly, if funding is allocated, by October 31st, January 31st, April 30th, and
June 15th or the Fiscal Year end close date determined by the Department
2.5.3. FSSP Enrollment from the Waiting List
2.5.3.1. In cooperation with the local Family Support Council, Contractor shall develop
procedures for determining how and which individuals on the Waiting List will be
enrolled into FSSP. These procedures must comply with Department regulations on
waiting list and prioritization of funding.
2.5.3.2. Contractor shall select individuals from the waiting list to enroll into FSSP in accordance
with 10 CCR 2505-10 8.7561et seq.
2.5.4. State SLS Enrollment from the Waiting List
2.5.4.1. Contractor shall develop procedures for determining how and which individuals on the
waiting list will be enrolled into the State SLS program in accordance with 10 C.C.R.
2505-10 Section 8.7.7557. 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.
Exhibit B -I, SOW Page 18 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
2.5.5. OBRA-SS Enrollment from the Waiting List
2.5.5.1. Contractor shall determine when funding is not available within Contractor's existing
State General Fund program allocation and notify the Department that additional funding
is being requested to enroll the individual into OBRA-SS within 10 Business Days of
funding needs being identified.
2.5.5.2. Contractor shall place the individual on the waiting list until funding becomes available
or Contractor may partially fund services when limited funding is available within
existing allocations.
2.5.5.3. Contractor shall develop procedures for determining how and when individuals will be
placed on the waiting list and make the procedures available to the Department upon
request.
2.5.6. Waiting List Records Maintenance
2.5.6.1. Contractor shall remove individuals from the Waiting List after an enrollment is
authorized to the individual and the individual or guardian accepts or refuses the
authorization for enrollment within 10 Business Days after the individual or guardian's
response or the last communication attempt.
2.5.6.2. If an individual or guardian declines an enrollment, Contractor shall enter the reason for
declining an enrollment into the Department prescribed system Waiting List record within
10 Business Days of the enrollment being declined.
2.5.6.3. Contractor shall provide information and referrals to individuals, families and/or
guardians at the time of the annual follow-up.
2.5.6.4. Contractor shall continue to refer individuals on the Waiting List to other community
resources that may be available and inform individuals of their choice of providers,
waivers, and services.
2.5.6.5. Contractor shall provide assistance completing Medicaid financial applications or other
public assistance program applications at the time assistance is requested by the
individual, family, or guardian.
2.5.6.6. Individuals shall be notified at the time of the enrollment authorization that they have the
right to appeal actions of Contractor as described in 10 CCR 2505-10 section 8.057 et
seq., 8.7202.R et seq. The notification shall include the right to request a fair hearing
before an Administrative Law Judge.
2.6. Compilation and Correction of Waiting List Data
2.6.1. Contractor shall correct 100% of Waiting List data errors discovered by the Department
within 10 Business Days of notification from the Department of an error.
2.6.1.1. PERFORMANCE STANDARD: 100% of Waiting List data corrected within 10
Business Days of notification.
2.7. Authorization and Reporting of HCBS-DD Enrollments
2.7.1. Contractor shall obtain prior authorization from the Department for all enrollments into the
HCBS-DD waiver.
Exhibit B-1, SOW Page 19 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
2.7.2. In accordance with 10 CCR 2505 Section 8.7101J, Contractor shall inform the Department
of all vacancies in the HCBS-DD waiver. Vacancies shall be submitted to the Department
monthly on the date and template prescribed by the Department.
2.7.3. Individuals shall be notified at the time of the enrollment authorization that they have the
right to appeal the actions of Contractor to 10 CCR 2505-10 section 8.7202.R and 8.057 et
seq. The notification shall include the right to request a fair hearing before an Administrative
Law Judge.
2.7.3.1. DELIVERABLE: HCBS-DD Vacancy Reporting
2.7.3.2. DUE: Monthly, by the 15th on the template prescribed by the Department
2.7.4. Contractor shall report all enrollment dates or changes to enrollment status for the HCBS-
DD waiver to the Department monthly on the date and template prescribed by the
Department.
2.7.4.1. DELIVERABLE: HCBS-DD Enrollment Date and Enrollment Change Reporting
2.7.4.2. DUE: Monthly, by the 15th on the template prescribed by the Department
3. SCREENING AND ASSESSMENT
3.1. Contractor shall perform the Level of Care (LOC) (100.2) Assessment as indicated in Section
3.2 or the LOC Screen and Needs Assessment as indicated in Section 3.3 for each Member as
directed by the Department.
3.2. Contractor shall not perform both a LOC Assessment (100.2) and a LOC Screen and Needs
Assessment for the same Member unless directed to do so by the Department.
3.3. Level of Care Assessment (100.2)
3.3.1. Contractor shall provide staff that meet the case manager qualifications set forth in state
statutes and regulations to perform all LOC Assessments.
3.3.2. Contractor shall utilize and conduct the Department prescribed tools for the Initial LOC
Assessment for all new applicants to the HCBS waivers, CFC, PACE, Nursing Facilities,
Hospital Back -Up, and ICF-IDD. Initial Level of Care Assessment include the following
Assessment Event types: Initial Review, HCBS-DD Waitlist, Deinstitutionalization (DI), and
Reverse Deinstitutionalization. Continued Stay Review LOC Assessment include the
following Assessment Event types: Continued Stay Review and Unscheduled Review.
3.3.3. An Unscheduled Review Assessment Event Type shall be utilized when a LOC Assessment
is completed due to a significant change in the Member functioning and support needs
including documented medical conditions, post hospitalization, or significant change in
activities of daily living.
3.3.3.1. Contractor shall schedule an in -person Initial LOC Assessment in accordance with 10
CCR 2505-10 8.7202.E. and shall adhere to the following processes and timelines based
on type:
3.3.3.1.1. Hospital to HCBS or CFC
3.3.3.1.1.1. Contractor conducts and documents the LOC Assessment within 2 Business Days
of receiving a LTSS LOC referral for LOC Assessment.
3.3.3.1.1.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the Contractor.
Exhibit B-1, SOW Page 20 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
3.3.3.1.1.3.
3.3.3.1.1.4.
3.3.3.1.2.
3.3.3.1.2.1.
3.3.3.1.2.2.
3.3.3.1.2.3.
3.3.3.1.2.4.
3.3.3.1.2.5.
3.3.3.1.2.6.
3.3.3.1.3.
3.3.3.1.3.1.
3.3.3.1.3.2.
3.3 .3.1.3.3.
3.3.3.1.4.
3.3.3.1.4.1.
3.3.3.1.4.2.
3.3.3.1.4.3.
3.3.3.1.5.
3.3.3.1.5.1.
3.3.3.1.5.2.
Exhibit B-1, SOW
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 2 Business Days.
Hospital to Skilled Nursing Facility
Contractor conducts and documents the LOC Assessment Screen and PASRR
Level I Screen within 2 Business Days of receiving a LTSS LOC referral or
another referral for LOC Assessment.
Contractor completes and documents the Nursing Facility Length of Stay form to
indicate the length of stay necessary to meet the applicant's needs.
LOC Eligibility Determination date may be the date of LTSS LOC referral form
is received by the Contractor.
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 Business Days of the LTSS LOC Referral or another
referral requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 2 Business Days.
Hospital timelines apply to any applicant in a hospital wanting to enroll in PACE
and, HBU.
Skilled Nursing Facility to HCBS or CFC
Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date or another referral requesting a LOC Assessment.
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 5 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment
Referral to LOC Eligibility Determination not to exceed 5 Business Days.
Skilled Nursing Facility Payer Source Change
Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date or another referral requesting a LOC Assessment.
Contractor generates a LOC Eligibility Determinations in the Department's
prescribed system within 5 Business Days of the LTSS LOC Referral or another
referral requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 5 Business Days.
HCBS or CFC to Skilled Nursing Facility
Contractor completes the LOC Assessment and PASRR Level I Screen within 10
Business Days of the LTSS LOC referral date or another referral requesting a
LOC Assessment.
Contractor completes the nursing facility length of stay form to indicate the length
of stay necessary to meet the applicant's needs.
Page 21 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
3.3.3.1.5.3.
3.3.3.1.5.4.
3.3.3.1.5.5.
3.3.3.1.6.
3.3.3.1.6.1.
LOC Eligibility Determination start date will be the date of referral on the LTSS
LOC referral form or another referral requesting a LOC Assessment.
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 10 Business Days.
HCBS or CFC Referral
Contractor completes the LOC Assessment within 10 Business Days of the LTSS
LOC referral date or another referral requesting a LOC Assessment.
3.3.3.1.6.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the Contractor.
3.3.3.1.6.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
3.3.3.1.6.4. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.3.3.1.6.5. Contractor shall attempt to verify that a LTC Medicaid Application has been
submitted after receiving a LTSS LOC referral but should not delay a LOC
Assessment if the interview conducted to complete the CIST indicates that an
applicant has not submitted a LTC Medicaid Application.
3.3.3.1.6.5.1. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
3.3.3.2. Contractor shall consider a LOC Assessment to be complete when the following has been
done: an in -person assessment is completed, the PMIP has been obtained and verified to
be accurate by the Case Manager to determine target criteria, and the assessment has been
entered in the Department's prescribed system.
3.3.3.3. A LOC Certification notice shall be provided to referring agencies such as PACE
organizations, Nursing Facilities, or Hospitals upon obtaining written consent provided
by the applicant that meets HIPAA standards.
3.3.3.3.1. PERFORMANCE STANDARD: Contractor shall ensure a Professional Medical
Information Page (PMIP) is signed by a medical professional and dated no earlier
than six months from the certification start date and of an Initial LOC Assessment.
3.3.3.4. Contractor shall conduct all Level of Care Assessments in accordance with regulations.
3.3.3.5. Contractor shall conduct an in -person Continued Stay Review Assessment annually, at
least one but no more than three months before the current LOC certification end date for
Members who are continually enrolled for in HCBS, CFC, PACE, Nursing Facilities,
Hospital Back -Up, and ICF-IDD. Contractor shall enter the review into the Department's
prescribed system within 10 Business Days of conducting the assessment.
3.3.3.5.1. PERFORMANCE STANDARD: Contractor shall ensure a Professional Medical
Information Page (PMIP) is signed within 90 Calendar Days of the certification start
date and before the certification end date for a Continued Stay Review (CSR) for all
applicants and individuals currently receiving services through the Hospital Back -Up
Exhibit B-1, SOW Page 22 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
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).
3.3.3.6. Contractor shall enter and complete the Continued Stay Reviews within 10 Business Days
after conducting the assessment.
3.3.4. Failure by Contractor to complete the annual Level of Care Assessment shall cause a break
in payment authorization for waiver services for the individual or Member.
3.3.4.1. Contractor shall ensure that this break in payment authorization shall not affect the
continued delivery of waiver services to the individual or Member. Service costs incurred
during a break in payment authorization are non -allowable costs.
3.3.4.2. Contractor shall bear the sole fmancial responsibility for all costs incurred during this
break in payment authorization and shall be responsible for reimbursing providers for any
loss in funding as a result of the break in payment authorization.
3.3.4.3. Contractor shall notify all providers of the discontinuation of services no later than 11
Calendar Days prior to the certification end date that services shall not be authorized past
the certification end date.
3.4. Level of Care Screen and Needs Assessment
3.4.1. Contractor shall perform all Initial and Annual Reassessment Level of Care Screens and
Needs Assessments for the operation of a CMA in accordance with §25.5-6-104, C.R.S., 10
CCR 2505-10, Section 8.401, and 10 CCR 2505-10, Sections 8.7202.E et seq. and 8.7202.F
et seq.
3.4.1.1. The Initial and Reassessment Level of Care Screen shall include and ensure, but not
limited to, the following:
3.4.1.1.1. A verification of Long -Term Care (LTC) Medicaid Financial eligibility or LTC
Medicaid application submission.
3.4.1.1.2. 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.
3.4.1.1.3. Needs Assessments shall be conducted in person or virtually based on the Member's
preference.
3.4.1.1.4. Contractor shall verify that a Member meets institutional level of care by receiving a
PMIP signed by a medical professional and dated no earlier than six months from the
certification start date and no later than 90 Calendar Days from the evaluation date of
an Initial Level of Care Screen; and within 90 Calendar Days of the certification start
date and before the certification end date for a Reassessment for all individuals and
Members currently receiving services through Hospital Back -Up Unit (HBU),
Nursing Facility (NF), Intermediate Care Facility for Individuals with Intellectual and
Developmental Disabilities (ICF-IDD), and Program for All -Inclusive Care for the
Elderly (PACE).
3.4.1.1.5. A review of all supportive information related to the Level of Care for the Member to
include, but not limited to, documentation and interviews.
3.4.1.1.6. Communicating Level of Care Eligibility status to the appropriate eligibility site.
Exhibit B-1, SOW Page 23 of 54
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
3.4.1.1.7. Representing the Department in all appeals relevant to a LTSS program eligibility.
3.4.1.1.8. A review of HCBS waiver Target Criteria for applicant or Member participation.
3.4.1.1.9. Determine individual or Member Level of Care Eligibility for enrollment in an HCBS
Waiver, CFC, PACE, 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.
3.4.1.1.10. Providing notice of action to Members of all appealable actions related to their
eligibility in a LTSS program.
3.4.1.1.11. 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 8.7202.E and
8.7202.F et seq.
3.4.2. Level of Care Screen
3.4.2.1. The LOC Screen shall include the following event types:
3.4.2.1.1. Initial
3.4.2.1.2. Reassessment
3.4.2.1.3. Off -Cycle Review
3.4.2.1.4. Waiting List
3.4.2.2. Contractor shall conduct an Initial LOC Screen prior to enrolling in the following
programs:
3.4.2.2.1. HCBS Waivers
3.4.2.2.2. CFC
3.4.2.2.3. PACE
3.4.2.2.4. Nursing Facilities
3.4.2.2.5. Hospital Back -Up
3.4.2.2.6. ICF-IDD
3.4.2.3. Contractor shall conduct an Initial LOC Screen in accordance with 10 CCR 2505-10
8.7202.E.:
3.4.2.3.1. Hospital to HCBS or CFC
3.4.2.3.1.1. Contractor conducts and documents the LOC Assessment within 2 business days
of receiving a LTSS LOC referral or another referral requesting a LOC
Assessment.
3.4.2.3.1.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the CMA.
3.4.2.3.1.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 business days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
3.4.2.3.1.4. Referral to LOC Eligibility Determination not to exceed 2 Business Days.
Exhibit B-1, SOW Page 24 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4O52-956A-6CE0473D383F
3.4.2.3.2.
3.4.2.3.2.1.
3.4.2.3.2.2.
3.4.2.3.2.3.
3.4.2.3.2.4.
3.4.2.3.2.5.
3.4.2.3.2.6.
3.4.2.3.3.
3.4.2.3.3.1.
3.4.2.3.3.2.
3.4.2.3.3.3.
3.4.2.3.4.
3.4.2.3.4.1.
3.4.2.3.4.2.
3.4.2.3.4.3.
3.4.2.3.5.
3.4.2.3.5.1.
3.4.2.3.5.2.
3.4.2.3.5.3.
3.4.2.3.5.4.
Exhibit B-1, SOW
Hospital to Skilled Nursing Facility
Contractor conducts and documents the LOC Assessment and PASRR Level 1
Screen within 2 business days of receiving a LTSS LOC referral another referral
requesting a LOC Assessment.
Contractor completes and documents the Nursing Facility Length of Stay form to
indicate the length of stay necessary to meet the applicant's needs.
LOC Eligibility Determination date maybe the date of LTSS LOC referral form
is received by the Contractor.
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 2 Business Days of the LTSS LOC Referral or another
referral requesting a LOC assessment.
Referral to LOC Eligibility Determination not to exceed 2 Business Days.
Hospital timelines apply to any applicant in a hospital wanting to enroll in PACE
and HBU.
Skilled Nursing Facility to HCBS or CFC
Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date or another referral requesting a LOC Assessment.
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 5 Business Days of the LTSS LOC or another referral
requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 5 Business Days.
Skilled Nursing Facility payer source change
Contractor conducts and documents the LOC Assessment within 5 Business Days
of the LTSS LOC referral date another referral requesting a LOC Assessment.
Contractor generates a LOC Eligibility Determinations in the Department's
prescribed system within 5 Business Days of the LTSS LOC Referral or another
referral requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 5 Business Days.
HCBS or CFC to Skilled Nursing Facility
Contractor completes the LOC Assessment and PASRR Level 1 Screen within 10
Business Days of the LTSS LOC referral date or another referral requesting a
LOC Assessment. Contractor completes the nursing facility length of stay form
to indicate the length of stay necessary to meet the applicant's needs.
LOC Eligibility Determination start date will be the date of referral on the LTSS
LOC referral form another referral requesting a LOC Assessment.
Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 business days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
Referral to LOC Eligibility Determination not to exceed 10 Business Days.
Page 25 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
3.4.2.4.
3.4.2.4.1.
3.4.2.4.2.
3.4.2.4.3.
3.4.2.4.4.
3.4.2.3.6. HCBS or CFC Referral
3.4.2.3.6.1. Contractor completes the LOC Assessment within 10 Business Days of the LTSS
LOC referral dateanother referral requesting a LOC Assessment.
3.4.2.3.6.2. LOC Eligibility Determination start date for Assisted Care Facility may be the
date of referral on the LTSS LOC referral form received by the Contractor.
3.4.2.3.6.3. Contractor generates a LOC Eligibility Determination in the Department's
prescribed system within 10 Business Days of the LTSS LOC referral or another
referral requesting a LOC Assessment.
3.4.2.3.6.4. Referral to LOC Eligibility Determination not to exceed 10 Business Days.
3.4.2.3.7. CMAs shall attempt to verify that a LTC Medicaid Application has been submitted
after receiving a LTSS LOC referral but should not delay a LOC Assessment if the
interview conducted to complete the CIST indicates that an applicant has not
submitted a LTC Medicaid Application.
3.4.2.3.8. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid
application verification.
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.
A review of all community living information and options as an alternative to nursing
facility/institutionalized care.
3.4.3. Annual Level of Care Screen Reassessment
3.4.3.1. Contractor shall conduct an Annual Reassessment Level of Care Screen no earlier than
90 Calendar Days prior to and no later than 30 Calendar Days prior to the current Level
of Care Screen certification end date.
3.4.3.2. 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.
3.4.3.2.1. In the event Contractor fails to conduct the Annual Reassessment Level of Care
Screen for a Member enrolled in a HCBS waiver or CFC, Contractor shall be
responsible for reimbursing any providers for services rendered during the gap in
eligibility.
3.4.3.2.2. Contractor shall follow 10 C.C.R. 2505-10, Section 8.7202.M et seq. when
transferring a Member from one county to another county or from one Defined
Service Area to another Defined Service Area.
3.4.3.2.3. Contractor shall take action regarding Member Medicaid eligibility within one
Business Day of receipt from the eligibility site.
Exhibit B-1, SOW Page 26 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
3.4.3.2.4.
3.4.4.
3.4.4.1.
3.4.5.
3.4.5.1.
3.4.5.1.1.
3.4.5.1.2.
3.4.5.2.
In the event Contractor fails to discontinue waiver services for a Member found
ineligible for a HCBS waiver or CFC, Contractor shall be responsible for reimbursing
any providers for services rendered.
PERFORMANCE STANDARD: 100% of Initial Level of Care Screen and Annual Level
of Care Screen assessments are conducted within required timelines at 10 CCR 2505-10,
Sections 8.7202.E et seq. and 8.7202.F 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 8.7202.E et seq.
Members shall be notified at the time of the eligibility decision that they have the right to
appeal the actions of Contractor to 10 CCR 2505-10 Section 8.057 et seq. and 8.7202.R
The notification shall include the right to request a fair hearing before an Administrative
Law Judge.
Needs Assessment
Contractor shall conduct an Initial and Annual Needs Assessment for the following
programs:
HCBS Waivers
Community First Choice
Contractor shall conduct a Needs Assessment (Initial) prior to enrollment into a HCBS
waiver, annually (Reassessment), and as needed (off -cycle) by the Member due to a
material change of situation or condition that may reasonably result in a change in the
support needs of the Member. Members who are financially eligible, who choose to enroll
in HCBS waiver services, and who meet the required Level of Care for LTSS and waiver
Target Criteria for one of more HCBS waivers must have a Needs Assessment conducted.
3.4.5.2.1. Contractor shall conduct a Needs Assessment with Members to determine the level
of support needed and identify personal preferences and goals.
3.4.5.2.2. Contractor shall explain to the Member the option to respond to required questions
only or the choice to answer additional voluntary questions in the Needs Assessment.
3.4.5.3. Contractor shall conduct and document a Needs Assessment for Members in accordance
with the following timelines:
3.4.5.3.1. Within 15 Business Days after determination of Level of Care and Financial
eligibility for HCBS Waivers.
3.4.5.3.2. 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.
3.4.5.3.3. The Needs Assessment shall be conducted at time, modality, and location convenient
for the Member and should include people of the Member's identified preference.
3.5. At -Risk Diversion
3.5.1. Contractor shall:
Exhibit B-1, SOW Page 27 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
3.5.1.1. Outreach the identified At -Risk Diversion individuals in conjunction with timelines
determined by the Department to ensure basic health and safety needs in the community
are being met to avoid nursing facility placement.
3.5.1.2. Initial Outreach shall include any Member's first occurrence on the at -risk determination
list as indicated by the Department.
3.5.1.2.1. At -Risk Diversion activities shall include, but are not limited to:
3.5.1.2.2. Assessing the effectiveness of current support and services to determine if there is a
need for additional resources, supports, and/or services.
3.5.1.2.3. Support in assessing if the individual has become eligible for any other resources
including community resources and other Medicaid resources.
3.5.1.2.4. Documenting all At -Risk Diversion activities in detail in the Department's prescribed
system within 10 Business Days of the activity.
3.5.1.2.5. Maintaining all supporting documentation and make it available to the Department
upon request.
3.5.1.2.5.1. DELIVERABLE: At -Risk Diversion Invoice
3.5.12.5.2. DUE: Monthly, by the 15th
3.6. Rapid Reintegration
3.6.1. Contractor shall initiate the Rapid Reintegration if applicable, during the LOC Assessment
for Nursing Facility.
3.6.1.1. Contractor shall provide Members information about community -based services using
the Member preference guide available on the Department's prescribed system and
website.
3.6.1.2. Contractor shall complete the Rapid Reintegration within the Department's prescribed
system if the Member expresses a desire to return to the community.
3.6.1.3. Contractor shall ensure the Rapid Reintegration includes the Rapid Reintegration barrier
questions and either the Rapid Reintegration Plan or Rapid Referral as determined by the
Department's prescribed system.
3.6.1.4. Contractor shall ensure that any referrals deemed necessary during the Rapid
Reintegration process are completed within 2 Business Days of the LOC Assessment.
3.6.1.5. Contractor shall complete the post Rapid Reintegration satisfaction survey at the next
scheduled contact with the Member or within 90 Calendar Days of the transition,
whichever is earlier. The Rapid Reintegration survey shall be completed with any
Member transitioning from a Nursing Facility to the community that received a Rapid
Reintegration Plan or Rapid Referral.
3.6.1.6. DELIVERABLE: Rapid Reintegration Diversion Invoice
3.6.1.7. DUE: Monthly, by the 15th
3.7. Supports Intensity Scale -A Assessment
3.7.1. Contractor shall conduct a Supports Intensity Scale -A (SIS) assessment for all HCBS-DD
and HCBS-SLS enrollments and reassessments when criteria set forth at 10 C.C.R. 2505-10
Section 8.612 et seq. are met. Contractor shall not be reimbursed for an SIS assessment prior
Exhibit B-1, SOW Page 28 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
to the individual being determined eligible for a waiver through the Level of Care Screen and
confirmation of financial eligibility. Contractor shall not be reimbursed for SIS reassessments
without prior authorization from the Department to conduct the SIS reassessment.
3.7.2. Contractor shall conduct all initial SIS Assessments within 60 Calendar Days from the date
of the Initial Level of Care Screen. Contractor shall conduct all SIS reassessments within 60
calendar days from the date of approval from the Department.
3.7.3. Contractor shall enter the SIS Assessment into SIS-A Online within 65 Calendar Days of
completing the Level of Care Screen.
3.7.4. Contractor shall complete the SIS-A assessment and enter it into SIS-A Online prior to the
Prior Authorization Review (PAR) Date.
3.8. Interim Support Level Assessment Pilot
3.8.1. Contractor shall establish one point of contact for Interim Support Level Assessment (ISLA)
related processes and communications.
3.8.2. Contractor shall conduct an ISLA for all initial HCBS-DD and HCBS-SLS enrollments when
the criteria set forth at 10 C.C.R. 2505-10 Section 8.7202.AA et seq. are met, and the enrollee
has never had a SIS-A Assessment. Contractor shall not be reimbursed for an ISLA prior to
the individual being determined eligible for a waiver through the Level of Care Assessment
(ULTC 100.2) and confirmation of financial eligibility.
3.8.3. Contractor shall conduct all initial ISLAs within 60 Calendar days from the date of the Initial
Level of Care Assessment (100.2).
3.8.4. Contractor shall upload the ISLA into the Department's prescribed system within 10 Business
Days of the assessment date.
3.8.5. Contractor shall submit a list of all pilot ISLAs completed on an invoice template prescribed
by the Department.
3.8.5.1. DELIVERABLE: Completed ISLA Invoice
3.8.5.2. DUE: Monthly, by the 15th
3.8.6. Contractor shall complete the ISLA prior to the Prior Authorization Request (PAR) Start
Date.
3.9. HCBS-CES Applications
3.9.1. Contractor shall complete initial and CSR applications for persons applying for the HCBS-
CES waiver as set forth by the Department's prescribed guidelines.
3.9.2. 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.
3.9.3. 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.
3.9.4. Contractor shall maintain all HCBS-CES applications and supporting documentation and
make it available to the Department upon request.
3.10. HCBS-CHRP Support Need Level Assessment
Exhibit B-1, SOW Page 29 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
3.10.1. Contractor shall conduct a Support Need Level Assessment for all HCBS-CHRP enrollments
and re -assessments as set forth by the Department's prescribed guidelines.
3.10.2. Contractor shall conduct an initial Support Need Level Assessment within 45 Calendar Days
from the date of the Initial Level of Care Assessment. Contractor shall conduct all
reassessments as necessary when individual's needs change.
3.10.3. Contractor shall submit a list of all completed HCBS-CHRP Support Need Level
Assessments on a template prescribed by the Department.
3.10.3.1. DELIVERABLE: Completed HCBS-CHRP Support Need Level Assessment List
3.10.3.2. DUE: Monthly, by the 15th
3.10.4. Contractor shall maintain all Support Need Level Assessments and supporting documentation
and make it available to the Department upon request.
3.10.4.1. PERFORMANCE STANDAND: Support Need Level Assessment
3.10.4.2. DUE: Within 10 Business Days of the Department's request
4. STATE GENERAL FUND PROGRAM OBLIGATIONS
4.1. Service and Support Requirements
4.1.1. Contractor shall administer the three State General Fund Programs: State SLS, OBRA-SS,
and FSSP and purchase services and supports for persons determined to be eligible under this
Contract. If Contractor has been determined to be the only willing and qualified provider by
the Department for the Defined Service Area, Contractor must administer the State Programs
and purchase and/or provide services and supports for persons determined to be eligible under
this Contract. Contractor shall not be responsible for guaranteeing services to eligible persons
under this Contract if there are no Providers available to provide services and supports.
Contractor must ensure separation of case management responsibilities and the provision of
services for both State SLS and OBRA-SS.
4.1.2. Contractor shall ensure that written notifications are provided to individuals and Members
informing them of their rights and the potential influence Contractor has on the Service
Planning process, such as exercising free choice of providers.
4.1.3. Contractor shall provide the individual, Members, and/or guardian with written information
about how to file a provider agency complaint as well as how to make a complaint against
Contractor.
4.1.4. Contractor shall have procedures for a dispute resolution process, as described in 10 C.C.R.
2505-10, Section 8.7202.S et seq., when an action to terminate, change, reduce or deny
services is initiated by the provider service agency.
4.2. State General Fund Service Expenditure Reporting
4.2.1. Contractor shall report all State SLS, FSSP, and OBRA-SS direct service expenditures on the
template provided by the Department. All services must be reported and reimbursed within
the fiscal year the service is provided.
4.2.1.1. DELIVERABLE: State General Fund Program Service Expenditure Reports
4.2.1.2. DUE: Monthly, by the 15th of each month or Fiscal Year end close date determined by
the Department for the month of June.
Exhibit B-1, SOW Page 30 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.2.2. Adjustments to direct service expenditures must be added to the next direct service
expenditure report submitted by Contractor at the time of discovery. If the adjustment is
identified after the close of the fiscal year the service is rendered, Contractor must report the
adjustment to the Department within 10 Business Days of discovery and a check must be sent
to the Department with the amount of the overpayment in addition to details about the
overpayment to include member name, program, services, and dollar amount.
4.2.3. Contractor shall verify all services are supported with required documentation as required in
10 C.C.R. 2505-10 Sections 8.7560 et seq., 8.7561 et seq., and 8.7202.V et seq.
4.3. State Supported Living Services (State SLS)
4.3.1. General Requirements
4.3.1.1. Contractor shall operate the State SLS program pursuant to 10 C.C.R. 2505-10 Section
8.7560et seq.
4.3.1.2. Contractor shall not add surcharges to the purchase of covered services for State SLS.
4.3.1.3. Contractor shall provide a list of qualified providers for all services to Members and
families, during the State SLS Individual Support Plan process, and to other interested
parties upon request.
4.3.1.4. Contractor shall provide or coordinate 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 8.7560 et seq.
4.3.1.5. The Department will notify Contractor of the target number of individuals that shall be
served through State SLS prior to the start of each State Fiscal Year (SFY). Contractor
may choose to enroll more individuals in State SLS than authorized, ensuring all
individuals can be served within the funding allocated. Target caseload is calculated using
the unique number of members that receive direct services during the contract period.
4.3.2. State SLS Eligibility
4.3.2.1. Contractor shall determine eligibility for the State SLS program pursuant to 10 C.R.S.
2505-10 Section 8.7560.B et seq.
4.3.2.2. Eligibility for the State SLS program does not guarantee the availability of services and
supports.
4.3.3. State SLS Individual Support Plans
4.3.3.1. Pursuant to 10 C.R.S. 2505-10 Section 8.7560.D et seq. all State SLS Members must have
a State SLS ISP.
4.3.3.2. Contractor shall develop a State SLS Individual Support Plan (State SLS ISP) within 10
Business Days after an initial Individual Support Plan (ISP) meeting for those individuals
not established with Contractor and with a Developmental Disability determination at
time of referral. Contractor shall have up to 10 Business Days to complete additional
meetings and/or assessments that allow for the creation of the State SLS ISP during this
time. Contractor shall ensure the State SLS ISP is signed by all required parties prior to
implementation.
Exhibit B-1, SOW Page 31 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.33.3. The State SLS ISP shall be developed through an in -person meeting that includes, at a
minimum, the individual seeking services and Contractor.
4.3.3.4. Contractor shall utilize the ISP within the Department's prescribed system.
4.33.5. Contractor shall document and finalize all ISP information in the Department's prescribed
system within 10 Business Days of the date of the initial ISP meeting.
4.3.3.5.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the State
SLS ISPs are developed within 10 Business Days of the individual's referral to a State
General Fund program or after the initial ISP meeting.
4.33.6. The State SLS ISP shall be effective for no more than one year and reviewed by
Contractor at least every six months in an in -person monitoring contact.
4.3.3.7. If an individual seeks additional supports or alleges a change in need, Contractor shall
review and update the ISP prior to changing the authorized services and supports.
4.3.4. State SLS Ongoing Case Management
4.3.4.1. Contractor shall utilize appropriated funds to perform Case Management duties in
accordance with 10 C.C.R. 2505-10 Section 8.7560.E et seq.:
4.3.4.1.1. Intake and referral.
4.3.4.1.2. Determining program eligibility.
4.3.4.1.3. Supporting individuals with learning and accessing other community resources.
4.3.4.1.4. Developing a State SLS Individual Support Plan.
4.3.4.1.5. Maintaining the determination of eligibility for services and supports.
4.3.4.1.6. Providing service and support authorization and coordination.
4.3.4.1.7. Program transition coordination.
4.3.4.1.8. Case Management, policy, and regulation training.
4.3.4.1.9. Service records maintenance.
4.3.4.1.10. Utilization review.
4.3.4.2. Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
4.3.4.3. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
4.3.4.4. State SLS Monitoring
4.3.4.4.1. State SLS Monitoring shall be person centered and include at least one in person
contact with the Member and three additional monitoring contacts per year using the
individual's selected modality; in person or virtual and should be discussed and
determined based on Member preference and need.
4.3.4.4.1.1. The Member's selected modality must be documented within the case notes for
each monitoring contact within the Department's prescribed system.
4.3.4.4.2. State SLS Monitoring activities shall include, but not be limited to:
Exhibit B-1, SOW Page 32 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.3.4.4.2.1. Monitoring all services and supports delivered pursuant to the State SLS
Individual Support Plan.
4.3.4.4.2.2. Assessing the effectiveness of the State SLS supports and services.
4.3.4.4.2.3. Assessing if additional State SLS supports and services are needed.
4.3.4.4.2.4. Support in assessing if the individual has become eligible for any other resources
including community resources and other Medicaid resources.
4.3.4.4.2.5. Reviewing health and safety concerns.
4.3.4.4.2.6. Reviewing any Critical Incidents.
4.3.4.4.3. Contractor shall document all monitoring activities in detail in the Department's
prescribed system within 10 Business Days of the activity.
4.3.4.4.3.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the
required quarterly interval.
4.3.4.5. State SLS Transfers
4.3.4.5.1. Contractor shall manage State SLS transfers in accordance with 10 C.R.S 2505-10
Section 8.7560.F et seq.
4.3.4.6. State SLS Direct Services
4.3.4.6.1. 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
8.7560.H.
4.3.4.7. State SLS Records Maintenance
4.3.4.7.1. Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make it available to the Department upon request as required
in 10 C.C.R. 2505-10 Section 8.7560.H 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.
4.3.4.7.3. If Contractor does not maintain supporting documentation in the required format for
all services rendered, the Department may recover these funds pursuant to 10 C.C.R.
2505-10 Section 8.076 et seq.
4.3.4.7.4. Through ongoing monitoring, Contractor shall ensure all services reimbursed by
Contractor are rendered by service providers in accordance with the State SLS
Individual Support Plan.
4.3.4.7.5. Contractor shall attempt to resolve any discrepancies with the service provider
directly.
4.3.4.7.6. Contractor shall notify the Department of any instances of suspected fraud or waste,
and any supporting documentation at the time of discovery.
4.3.4.7.7. Contractor shall notify all service providers that all records and supporting
documentation related to services rendered through State SLS are subject to
Exhibit B-1, SOW Pape 33 of 54
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
inspection and recovery by the Department pursuant to 10 C.C.R. 2505-10 Section
8.076 et seq.
4.4. Omnibus Budget Reconciliation Act of 1987 Specialized Services (OBRA-SS)
4.4.1. Contractor shall provide or arrange for the provision of OBRA-SS to any individual where
the Pre -Admission Screening and Resident Review (PASRR) Level II Evaluation identified
the need for placement into a nursing facility and need for additional specialized services.
Contractor shall ensure the OBRA-SS being provided are listed on the individual's Notice of
Determination (NOD). Contractor shall ensure that OBRA-SS are related to the individual's
intellectual or developmental disability or related condition and individualized to the
resident's needs.
4.4.2. PASRR Level II Evaluation
4.4.2.1. Contractor will review the PASRR Level II Evaluations received from the Skilled
Nursing Facility or State appointed vendor prior to developing an OBRA-SS Individual
Support Plan or providing services.
4.4.3. Maintaining Eligibility and Enrollment
4.4.3.1. Contractor shall enroll individuals into OBRA-SS, if the individual resides in a nursing
facility, demonstrates a need, and agrees to receive services.
4.4.3.2. Upon approval of the nursing facility admission by the State Intellectual Disability
Authority and receipt of the Final Notice of Determination, Contractor shall send referrals
to providers for OBRA-SS within 10 Business Days from the date the PASRR Notice of
Determination is issued and/or received from the Skilled Nursing Facility or State
appointed vendor.
4.4.3.3. Contractor shall maintain Member records within the Department prescribed system. All
changes to OBRA-SS enrollments, shall be entered into the Department prescribed
system within 10 Business Days of the change. The Department may adjust the number
of authorized enrollments based on fluctuating enrollments. If the individual does not
receive OBRA-SS within one calendar month Contractor shall inactivate the individual's
record in the Department prescribed system.
4.4.4. OBRA-SS Individual Support Plans
4.4.4.1. Contractor shall develop an OBRA-SS Individual Support Plan (ISP) within 10 Business
Days after an initial ISP meeting for those individuals not established with Contractor
and with a Developmental Disability determination at time of referral. Contractor shall
have up to 10 Business Days to complete additional meetings and/or assessments that
allow for the creation of the OBRA-SS ISP during this time. Contractor shall ensure the
OBRA-SS ISP is signed by all required parties prior to implementation.
4.4.4.2. The OBRA-SS ISP shall be developed through an in -person meeting that includes, at a
minimum, the individual seeking services and Contractor.
4.4.4.3. Contractor shall utilize the ISP template within the Department's prescribed System.
4.4.4.4. Contractor shall document and finalize all ISP information in the Department's prescribed
system within 10 Business Days of the date of the initial ISP meeting.
Exhibit B-1, SOW Page 34 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.4.4.4.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the OBRA-
SS Individual Support Plans are developed within 10 Business Days of the
individual's referral to a State General Fund program or after the initial ISP meeting.
4.4.4.5. The OBRA ISP shall be effective for no more than one year and reviewed by Contractor
at least every six months in an in -person monitoring contact.
4.4.4.6. If a member seeks additional supports or alleges a change in need, Contractor shall review
and update the ISP prior to changing the authorized services and supports.
4.4.4.7. Contractor shall maintain all OBRA-SS ISPs and supporting documentation and make
them available to the Department upon request.
4.4.5. OBRA-SS Ongoing Case Management
4.4.5.1. Contractor shall utilize appropriated funds to perform Case Management duties to
include:
4.4.5.1.1. Intake and referral.
4.4.5.1.2. Verifying a PASRR Level II Evaluation and Skilled Nursing Facility residency.
4.4.5.1.3. Developing an OBRA-SS Individual Support Plan.
4.4.5.1.4. Maintaining the determination of eligibility for services and supports.
4.4.5.1.5. Providing service and support authorization and coordination.
4.4.5.1.6. Ensuring there is not a duplication of authorized services with the services provided
in the nursing facility.
4.4.5.1.7. Program transition coordination.
4.4.5.1.8. Service records maintenance.
4.4.5.1.9. Case Management, policy, and regulation training.
4.4.5.1.10. Utilization review.
4.4.5.2. Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
4.4.5.3. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
4.4.6. OBRA-SS Monitoring
4.4.6.1.1. Monitoring shall be person centered and include at least one in person contact with
the Member and three additional monitoring contacts per year using the individual's
selected modality; in person or virtual and should be discussed and determined based
on Member preference and need. The Member's selected modality must be
documented within the narrative for each monitoring contact within the Department's
prescribed system.
4.4.6.2. Monitoring activities shall include but not be limited to:
4.4.6.2.1. Monitoring all services and supports delivered pursuant to the OBRA-SS ISP.
4.4.6.2.2. Assessing the effectiveness of the supports and services.
4.4.6.2.3. Assessing if additional supports and services are needed.
Exhibit B-1, SOW Page 35 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.4.6.2.4. Support in assessing if the individual has become eligible for any other resources
including community resources or other Medicaid resources.
4.4.6.2.5. Reviewing health and safety concerns.
4.4.6.2.6. Reviewing any Critical Incidents.
4.4.6.3. Contractor shall document all monitoring activities in detail in the Department's
prescribed system within 10 Business Days of the activity.
4.4.6.3.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the
required quarterly interval.
4.4.7. OBRA-SS Direct Services
4.4.7.1. Contractor shall not utilize OBRA-SS funds to purchase mental health related services.
Contractor shall seek provision of, or payment for, mental health services for those
individuals through the Medicaid -funded mental health system or other local sources of
funding.
4.4.7.2. Contractor shall not utilize or authorize OBRA-SS funds to provide or purchase services
and supports that are covered and provided by the nursing facility.
4.4.7.3. Contractor shall utilize appropriated funds to provide services or coordinate with a
provider to support individuals with intellectual and developmental disabilities living in
a nursing facility. Contractor shall not utilize funding for services that are provided by
the Nursing Facility through Medicaid reimbursement. Services eligible through OBRA
include:
4.4.7.3.1. Assistive Technology
4.4.7.3.2. Behavioral Consultation
4.4.7.3.3. Behavioral Line Services
4.4.7.3.4. Behavioral Counseling
4.4.7.3.5. Behavioral Counseling Group
4.4.7.3.6. Behavioral Plan Assessment
4.4.7.3.7. Day Habilitation - Specialized Habilitation
4.4.7.3.8. Day Habilitation - Supported Community Connections
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
Exhibit B-1, SOW Page 36 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
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 8.7500 et seq.
4.4.8. OBRA-SS Records Maintenance
4.4.8.1 Contractor shall maintain supporting documentation capable of substantiating all
expenditures and shall make it available to the Department upon request as required in 10
C.C.R. 2505-10 Section 8.130.2 et seq.
4.4.8.1.1. Receipts or invoices must contain, at a minimum: Member name, service description,
provider name, first and/or last date of service, service rate, and amount due or paid.
4.4.8.2. If Contractor does not maintain supporting documentation in the required format for all
services rendered, the Department may recover these funds pursuant to 10 C.C.R. 2505-
10 Section 8.076 et seq.
4.4.8.3. Through ongoing monitoring, Contractor shall ensure all services reimbursed by
Contractor are rendered by service providers in accordance with the OBRA-SS Individual
Support Plan.
4.4.8.4. Contractor shall attempt to resolve any discrepancies with the service provider directly.
4.4.8.5. Contractor shall notify the Department of any instances of suspected fraud and any
supporting documentation at the time of discovery.
4.4.8.6. Contractor shall notify all service providers that all records and supporting documentation
related to services rendered through OBRA-SS are subject to inspection and recovery by
the Department pursuant to 10 C.C.R. 2505-10 Section 8.076 et seq.
4.4.8.7. Mental Health Services Prohibited
4.4.8.7.1. Contractor shall not utilize state funds to purchase mental health related services for
individuals with intellectual disabilities who are Medicaid eligible and who also have
a Medicaid covered mental health diagnosis.
4.4.8.7.2. Contractor shall seek provision of, or payment for, mental health services for those
individuals through the Medicaid funded mental health system or other local sources
of funding.
4.5. Family Support Services Program (FSSP)
4.5.1. Contractor shall administer and provide or purchase Family Support Services pursuant to
§25.5-10-305, C.R.S. and 10 C.C.R. 2505-10 Section 8.7561 et seq.
4.5.2. Eligibility, Needs Assessment, and Prioritization of Families
4.5.2.1. Contractor shall determine individual eligibility for the FSSP pursuant to 10 C.R.S 2505-
10 Section 8.7561.C.
4.5.2.2. After FSSP eligibility has been determined, Contractor shall conduct an FSSP Needs
Assessment prior to authorizing services. Contractor shall develop a Needs Assessment
Tool that is, at a minimum, inclusive of all requirements outlined in 10 C.C.R 2505-10
Exhibit B-1, SOW Page 37 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Section 8.7561.F and have documented scoring criteria for the tool. The tool shall be'
included in Contractor's policies and procedures.
4.5.2.2.1. DELIVERABLE: Needs Assessment Tool Template and Scoring Criteria
4.5.2.2.2. DUE: Annually, by August 15th
4.5.2.3. Any revisions to the needs assessment tool template and scoring criteria must be
submitted to the Department within 10 Business Days of the updated tool being
implemented.
4.5.2.4. Contractor shall assess all families, both on the waiting list as "As Soon as Available"
and currently receiving FSSP services, for level of need on an annual basis in accordance
with 10 CCR 2505 Section 8.7561.F et seq.
4.5.2.5. Contractor shall document all completed FSSP Needs Assessments within the
Department's prescribed system within 10 Business Days of completion of the
assessment.
4.5.2.6. Contractor shall maintain all Needs Assessment documentation and make it available to
the Department upon request.
4.5.2.7. The Department will notify Contractor of the target number of individuals that shall be
served through FSSP prior to the start of each State Fiscal Year (SFY). Contractor may
choose to enroll more individuals in FSSP than targeted, ensuring all individuals can be
served within the funding allocated. Target caseload is calculated using the unique
number of members that receive direct services during the contract period.
4.5.3. Family Support Plans (FSP)
4.5.3.1. Contractor shall ensure that individuals and families enrolled in the FSSP have an
individualized Family Support Plan (FSP) which meets the requirements of an
Individualized Plan, as defined in Section 25.5-10-202 et seq. and 25.5-10-211 C.R.S
prior to receiving services.
4.5.3.2. Contractor shall develop the FSP within 10 Business Days after an initial Individualized
Support Plan (ISP) meeting for those individuals not established with Contractor and with
a Developmental Disability or Delay Determination at the time of referral. Contractor
shall ensure the FSP is signed by all required parties prior to implementation.
4.5.3.3. The FSP shall be developed through by, at a minimum, a family representative, and
Contractor.
4.5.3.3.1. Contractor shall ensure that FSPs are developed within 10 Business Days of the Most
in Need Assessment being authorized.
4.5.3.4. The FSP shall be effective for no more than one year.
4.5.3.5. If the Member seeks additional supports or alleges a change in need, Contractor shall
review and update the FSP prior to changing the authorized services and supports.
4.5.3.6. Contractor shall document and finalize all FSP information in the Department's
prescribed system within 10 Business Days of the initial FSP meeting.
4.5.4. FSSP Ongoing Case Management
Exhibit B-1, SOW Page 38 of54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.5.4.1. Pursuant to 10 C.R.S 2505-10 Section 8.7561.G Contractor shall provide case
management for the FSSP, to include coordination of services provided for individuals
with an IDD or Developmental Delay that consists of facilitating enrollment, assessing
needs, locating, coordinating, and monitoring needed FSSP funded services, and
monitoring the effective and efficient provision of services across multiple funding
sources.
4.5.4.2. Contractor shall not charge families to provide direct services and case management for
Family Support Services.
4.5.4.3. Contractor shall provide a list of qualified providers for appropriate services to applicants,
Member(s), and families, during the individualized planning process, and to other
interested parties upon request.
4.5.4.4. Contractor shall utilize appropriated funds to perform case management duties in
accordance with 10 CCR 2505 8.7561.G et seq. to include:
4.5.4.4.1. Development, application assistance, and annual re-evaluation of the Family Support
Plan (FSP) which shall be conducted at least once per year and include making
changes to the FSP as indicated
4.5.4.4.2. Providing service authorization and support coordination to include but not limited to
assessing the effectiveness of FSSP supports and services.
4.5.4.4.3. Ensuring all services and supports are delivered in accordance with the FSP.
4.5.4.4.4. Coordinating with families to obtain required documentation for services.
4.5.4.4.5. Supporting the individual in assessing eligibility for other community and/or
Medicaid resources.
4.5.4.4.6. Program transition coordination.
4.5.4.4.7. Service records maintenance.
4.5.4.4.8. Case Management, policy, and regulation training.
4.5.4.4.9. Utilization review.
4.5.4.5. Contractor shall document all ongoing case management activities in detail in the
Department's prescribed system within 10 Business Days of the activity.
4.5.4.6. The use of mass email communication, robotic and/or automatic voice messages cannot
be used to replace Contractor's required individualized case management activities.
4.5.5. FSSP Direct Services
4.5.5.1. Contractor shall utilize appropriated FSSP funds to purchase services and/or reimburse
or advance funds to families for expenses that are incurred as a result of supporting the
family and/or individual with an intellectual or developmental disability or delay living
in the family home.
4.5.5.2. Contractor shall only authorize and advance or reimburse services that are needed as a
result of the individual's Intellectual and Developmental Disability or Developmental
Delay and shall not be approved if the need is a typical age -related need. The correlation
between the need and the disability must be documented in the FSP.
Exhibit B -1, SOW Page 39 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.5.5.3. Contractor shall ensure that all services are provided in the most cost-effective manner,
meaning the least expensive manner to meet the need.
4.5.5.4. Contractor shall ensure that all services are authorized pursuant to the FSP.
4.5.5.5. Contractor shall utilize FSSP funds to provide funding to families for expenses referenced
in §25.5 -10 -305(a -j), C.R.S and 10 C.R.S. 2505-10 Section 8.7561.D Contractor shall not
authorize or provide any service that is not outlined in these regulations.
4.5.5.6. Contractor shall ensure the authorized services through FSSP are not duplicative of other
resources the family has access to, including HCBS waivers, CFC, third party insurance,
etc.
4.5.5.7. Contractor shall prioritize funding for the FSSP pursuant to 10 C.R.S 2505-10 Section
8.7561.F et seq.
4.5.6. Family Support Council
4.5.6.1. Contractor shall establish and maintain a Family Support Council (FSC) pursuant to
§25.5-10-304 et seq., C.R.S. and 10 C.C.R. 2505-10 Section 8.7561.B et seq.
4.5.6.2. Contractor shall ensure that the FSC is comprised primarily of individuals in services,
family members, and guardians of individuals enrolled in FSSP.
4.5.6.3. Contractor shall submit a list of FSC members annually.
4.5.6.3.1. DELIVERABLE: FSC Member List
4.5.6.3.2. DUE: Annually, by August 15th
4.5.6.4. Contractor shall notify the Department in writing of any changes to the FSC within 10
Business Days.
4.5.6.4.1. DELIVERABLE: FSC Member Updates
4.5.6.4.2. DUE: Within 10 Business Days of the date of change to the FSC members
4.5.6.5. Contractor shall provide orientation and training to all FSC members on the duties and
responsibilities of the FSC. The training and orientation shall be documented with a
record of the date of the training, who provided the training, training topic, and names of
attendees. Contractor shall make the training and orientation materials available to the
Department upon request.
4.5.6.6. Contractor shall ensure the FSC fulfills all duties outlined in 10 C.C.R. 2505-10 Section
8.7561.B et seq. Contractor shall document the meeting minutes and submit them to the
Department. Contractor shall maintain all supporting documentation related to an FSC
meeting and make it available to the Department upon request.
4.5.6.6.1. DELIVERABLE: FSC Meeting Minutes
4.5.6.6.2. DUE: Monthly, by the 15th of each month and by June 30th
4.5.7. FSSP Evaluation
4.5.7.1. In coordination with the FSC, Contractor shall be responsible for evaluating the
effectiveness of the FSSP on an annual basis. Contractor shall ensure the annual program
evaluation addresses all areas required in 10 CCR 2505-10 Section 8.7561.I et seq.
Exhibit B-1, SOW Page 40 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.5.7.2. 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 1�
4.5.8. FSSP Annual Program Report
4.5.8.1. Contractor shall create and submit an FSSP Annual Program Report to the Department.
The FSSP Program Report shall contain all requirements outlined in 10 CCR 2505-10
Section 8.7561.K et seq. Council member signatures approving the report must be
submitted as a separate attachment to the Annual Program Report. Contractor must ensure
the Annual Program Report does not contain Member PHI.
4.5.8.2. Contractor shall provide the FFS Program Report to the Department for review and
approval.
4.5.8.2.1. DELIVERABLE: FSSP Annual Program Report and Council Signature Page
4.5.8.2.2. DUE: Annually, by October 1St
4.5.9. FSSP Records Maintenance
4.5.9.1. Contractor shall maintain supporting documentation capable of substantiating all
expenditures and reimbursements made to providers, Members and/or families.
4.5.9.2. When Contractor purchases services or items directly for Members and/or families,
Contractor shall:
4.5.9.2.1. Maintain receipts or invoices from the service provider and documentation
demonstrating that the provider was paid by Contractor.
4.5.9.2.1.1. Receipts or invoices must contain, at a minimum: Member and/or family name,
provider name, first and/or last date of service, item(s) or service(s) purchased,
item(s) or service(s) cost and amount due or paid.
4.5.9.3. When Contractor reimburses Members and/or families for services or items, Contractor
shall:
4.5.9.3.1. Ensure the Member and/or family provides Contractor with receipts or invoices prior
to reimbursement.
4.5.9.3.1.1. Maintain receipts or invoices from the Member and/or family, and documentation
demonstrating that the individual and/or family was reimbursed by Contractor.
4.5.9.3.2. Ensure all receipts or invoices provided by the Members and/or family contain, at a
minimum: Member and/or family name, provider name, first and/or last date of
service, item(s) or service(s) purchased, items(s) or service(s) cost, and amount paid.
4.5.9.4. When Contractor provides funding to Members and/or families for the purchase of
services or items in advance, Contractor shall include, but is not limited to:
4.5.9.4.1. Establish policies and procedures outlining Contractor's processes for advancing
funds, ensuring supporting documentation is received by the Member and/or family,
and remedial action steps Contractor will take if supporting documentation is not
received. The policies and procedures shall identify timelines and shall be made
available to the Department upon request.
Exhibit B-1, SOW Page 41 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
4.5.9.4.2.
4.5.9.4.3.
4.5.9.4.4.
Notify the Member and/or family that they are required to submit invoices or receipts
to Contractor of all purchases made prior to the close of the State Fiscal Year.
Ensure the Member and/or family provides Contractor with receipts or invoices.
Maintain receipts or invoices from the Members and/or family, and documentation
demonstrating that the Members and/or family was provided with advanced funds by
Contractor.
4.5.9.4.4.1. Ensure all receipts or invoices provided by the Members and/or family contain, at
a minimum: Members and/or family name, provider name, first and/or last date
of service, item(s) or service(s) purchased, items(s) or service(s) cost, and amount
paid.
4.5.9.4.5. Contractor shall ensure the documentation received by the Member and/or family
indicates that the amount was paid.
4.5.9.4.6. If a Member and/or family does not submit invoices or receipts, Contractor shall
document all attempts to obtain receipts or paid invoices and any remedial action
taken. Contractor shall make all supporting documentation available to the
Department upon request.
4.5.9.4.7. If Contractor cannot provide supporting documentation as described in this section,
the Department may recover any unsubstantiated expenditure from Contractor.
4.5.9.5. Contractor shall ensure supporting documentation is recorded for all FSSP dollars for
multiple family services to include a detailed description of the service provided and the
date(s) of service.
4.5.9.5.1. Contractor shall ensure all program expenses related to multiple family expenses can
be substantiated through time tracking, wage costs, benefit costs, or any other
supporting documentation to verify expenses related to proving the services.
5. DATA ENTRY, DATA MONITORING, AND OVERSIGHT
5.1. Individual/Member Records
5.1.1. Contractor shall:
5.1.1.1. Comply with all reporting and billing policies and procedures established by the
Department, document individual and Member records within the Department's
prescribed systems and adhere to the system requirements provided by the Department
for these systems. Systems include, but are not limited to, the Colorado interChange
Medicaid Management Information System (MMIS) and its subsystems: Bridge HCBS
PAR subsystem and the Care and Case Management (CCM) System. Contractor shall
have access to member eligibility, PAR, and claims data through reporting provided
through a COGNOS data query application.
5.1.1.2. Maintain individual and Member records within the Department's prescribed systems for
the purposes of individual and Member information management.
5.1.1.3. Maintain accurate and detailed documentation of all case management and State General
Fund Program activities required through the Contract.
5.1.1.4. Maintain accurate and detailed supporting documentation of all activities required
through this Contract to substantiate reimbursement and make all documentation
Exhibit B-1, SOW Page 42 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
available to the Department upon request if not documented within the Department's
prescribed systems.
5.1.1.5. Correct 100% of data errors discovered by the Department and confirm the accuracy of
the data entered into the Department prescribed system within 10 Business Days of
notification from the Department of an error.
5.1.1.5.1. PERFORMANCE STANDARD: 100% of data errors corrected within 10 Business
Days of notification.
5.1.1.6. Develop and implement a plan to conduct, at minimum, an annual data integrity review.
That includes, but is not limited to, the following:
5.1.1.6.1. Member program records completeness and accuracy as directed by the Department.
5.1.1.6.2. Member demographic information completeness and accuracy.
5.1.1.6.3. Member care team provider and team staff accuracy and completeness, as directed by
the Department.
5.1.1.7. DELIVERABLE: Data Integrity and Data Quality Policies and Procedures
5.1.1.8. DUE: Annually, October l' after the Contract Start Date or within 10 Business Days as
revisions are made.
5.2. Systems Access and Training
5.2.1. Contractor shall develop and implement policies and procedures to internally oversee data
integrity and data quality to include but not limited to how Contractor will:
5.2.1.1. Ensure all staff receive the required systems training as specified in this Contract.
5.2.1.2. Be responsible for management of user access and timely revocation for required systems
to include the CCM, MMIS, Bridge, COGNOS, and PeakPro.
5.2.1.3. Ensure all provision forms are reviewed and submitted accurately and completely within
at least 14 Calendar Days prior to needing access. Any forms submitted without all
necessary information are subject to resubmission and delay.
5.2.1.4. Ensure all revocation forms are submitted immediately upon knowledge of license user's
separation of employment.
5.2.1.5. Conduct an internal audit of all provisioned user licenses monthly or quarterly to ensure
that the list of users is up to date, permissions are accurate, and revocation forms are
submitted in a timely manner.
6. ACCOUNTING
6.1. Contractor's accounting methods shall conform to the standards of Generally Accepted
Accounting Principles (GAAP), and any updates thereto, throughout the Term of the Contract.
6.2. Contractor shall establish and maintain internal control systems and standards that apply to the
operation of the organization.
6.3. Contractor shall assure, all financial documents are filed in a systematic manner to facilitate
audits, all prior years' expenditure documents are maintained for use in the budgeting process
and for audits, and records and source documents are made available to the Department, its
contracted representative, or an independent auditor for inspection, audit, or reproduction.
Exhibit B-1, SOW Page 43 of54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
6.4. Contractor shall establish any necessary cost accounting systems to identify the application of
funds and record the amounts spent.
6.5. Contractor shall document all transactions and funding sources, and this documentation shall be
available for examination by the Department within 10 Business Days of the Department's
request.
6.5.1. DELIVERABLE: Transaction and Funds Documentation
6.5.2. DUE: Within 10 Business Days of the Department's Request
7. SUBRECIPIENT STATUS AND REQUIREMENTS
7.1. Contractor has been determined to be a Subrecipient under 2 CFR Chapter I, Chapter II, Part 200
et al. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards (Uniform Guidance); Final Rule (the "Final Rule"), released December 26, 2013,
and subsequently updated, and thus shall be required to follow all requirements and guidance
contained in the Final Rule.
7.2. Single Audits
7.2.1. Under the Final Rule, all Non -Federal Entities, as defined in the Final Rule, expending
$1,000,000.00 or more from all federal sources (direct or from pass -through entities) must
have a single or program -specific audit conducted for that year in accordance with Subpart F
of the Final Rule.
7.2.2. Contractor shall notify the State when expected or actual expenditures of federal assistance
from all sources equal or exceed $1,000,000.00.
7.2.3. If the expected or actual expenditures of federal assistance from all sources do not equal or
exceed $1,00,000.00 Contractor shall provide an attestation to the State that they do not
qualify for a Single Audit.
7.2.4. Pursuant to the Final Rule §200.512 (a)(1) the Single Audit must be completed and submitted
to the Department within the earlier of 30 Calendar Days after receipt of the auditor's
report(s), or nine months after the end of the audit period. If the due date falls on a Saturday,
Sunday, or federal holiday, the reporting package is due the next Business Day.
7.2.4.1. DELIVERABLE: Single Audit
7.2.4.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or
nine months after the end of the audit period
7.2.5. If Contractor did not receive enough federal funds to require a Single Audit, Contractor shall
submit an attestation form stating a Single Audit was not required utilizing the Department's
template.
7.2.5.1. DELIVERABLE: Attestation Form
7.2.5.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or
nine months after the end of the audit period
7.2.6. The audit period shall be Contractor's fiscal year.
7.3. Treatment of Funds
7.3.1. All funding identified as a subaward with matching federal dollars received through this
Contract is subject to the requirements within Uniform Guidance.
Exhibit B-1, SOW Page 44 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
7.3.1.1. All subawards must be used on allowable expenses associated with performing the
activities outlined in this Contract and on allowable expenses per Uniform Guidance.
7.3.1.2. Any subawards not used on the activities outlined in this Contract is subject to recovery
at the end of the Period of Performance as identified by the Department.
7.4. Subcontracting Subawards
7.4.1. Contractor shall ensure any Subcontractors performing activities outlined in this Contract on
behalf of the Contractor fulfill all obligations outlined within this Contract and all obligations
of a subrecipient.
8. FINANCIAL TRANSPARENCY
8.1. Contractor shall comply with all transparency requirements pursuant to C.R.S. Title 25.5-6-1708.
8.2. Contractor shall ensure all documents are available on Contractor's website in an easily accessible
location and format. Board of Director or Governing Body Changes
8.2.1. Contractor shall notify the Department in writing of any changes to the Board of Directors or
Governing Body within 10 Business Days.
8.2.1.1. DELIVERABLE: Written notification of changes to Board of Director or Governing
Body membership
8.2.1.2. DUE: Within 10 Business Days of the effective date
9. COMPENSATION AND INVOICING
9.1. State General Fund Program Allocations
9.1.1. The Department will notify Contractor in writing of Contractor's individual allocation for
State SLS, OBRA-SS, and FSSP for each State Fiscal Year.
9.1.2. Reimbursement for activities and services performed by Contractor shall not exceed the
maximum amount identified in Contractor's individual allocation. Activities and services
must be rendered during the State Fiscal Year.
9.1.3. The Department, in its sole discretion, may increase or decrease Contractor's individual
allocations under this Contract by notifying Contractor's Representative. Increases or
decreases in the amount of State funding during the term of this Contract may be made by
written notice by the Department to Contractor or by amendment of the Contract. The
circumstances may include but shall not be limited to:
9.1.3.1. If necessary to fully utilize program appropriations.
9.1.3.2. Adjustments to reflect prior year final contract utilization and current year expenditures.
9.1.3.3. Supplemental appropriation changes resulting in an increase or decrease in the amounts
originally appropriated and available for the purposes of this program.
9.1.3.4. Closure of programs and/or termination of related contracts.
9.1.3.5. Delay or difficulty in implementing new programs or services.
9.1.3.6. Other special circumstances as deemed necessary by the Department.
9.1.3.7. Changes in Member utilization due to changing needs, new enrollments, terminations,
and/or delays in services.
Exhibit B -1, SOW Page 45 of 54
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
9.1.3.8. Target caseloads not being met.
9.2. State General Fund Program Target Caseloads
9.2.1. The Department will notify Contractor in writing of the target number of individuals that
shall be served in State SLS, OBRA-SS, and FSSP prior to the start of each State Fiscal Year.
9.2.2. Contractor may choose to enroll more individuals in State SLS, OBRA-SS, and FSSP than
authorized, ensuring all individuals can be served within the funding allocated.
9.2.3. Target caseload is calculated by the Department using the unique number of members that
receive direct services during the contract period.
9.2.4. Contractor shall enroll members into OBRA-SS if the need for services is identified through
the PASRR Level II and shall notify the Department if sufficient funding is not available in
Contractor's individual allocation to support the individual's needs or to enroll a Member
into the program.
9.2.5. Contractor shall redirect unallocated funding from one State General Fund program to
another to fully utilize funding allocated and best serve member needs within the Defined
Service Area. Contractor shall notify the Department if Contractor cannot use all of the
funding allocated for State General Fund programs or if Contractor has additional funding
needs that could support Members with unmet needs during the Fiscal Year.
9.3. State General Fund Program Compensation
9.3.1. The compensation under this Contract shall consist of rates -based reimbursement intended to
cover the costs of all State General Fund activities provided through this Contract. The
Department shall pay Contractor for the State SLS and OBRA-SS activities at the rates
specified in Exhibit C, Rates. Direct services for State SLS and OBRA-SS shall be
reimbursed at the rates posted and distributed on the Department's website on the Provider
Rates and Fee Schedule. The Department shall pay Contractor for FSSP activities at the rates
specified in Exhibit C, Rates. Direct services for FSSP shall be reimbursed at one dollar per
unit.
9.3.2. The liability of the State, at any time, for such payment shall be limited to the unexpended
amount remaining of such funds available to the Department.
9.3.3. Payments shall be made in accordance with rates as specified in Exhibit C, Rates of this
Contract as determined by the Department and may be amended during the term of the
contract using an Option Letter. When Contractor's maximum allocation of State funding has
been paid to Contractor, no additional funds shall be provided under this Contract.
9.3.4. Payment pursuant to this Contract is contingent upon Contractor, or subcontractor(s),
securing and properly maintaining all necessary licenses, certifications, approvals, etc.,
required to properly provide the services or goods covered by the contract.
9.3.5. The rates specified in Exhibit C; Rates are determined by the approved appropriation from
the Colorado General Assembly. The Department, at its discretion, shall have the option to
increase or decrease these rates as the Department determines is necessary based on its
approved appropriation or to correct an administrative error in rate calculations. To exercise
this option, the Department shall provide written notice to Contractor in a form substantially
similar to the Sample Option Letter in the original Contract, and any new rates table or exhibit
shall be effective as of the effective date of that notice unless the notice provides for a
different date. The Department may modify the rates shown in this section based on the
Exhibit B-1, SOW Page 46 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Medicaid Provider rate increases or decreases authorized by the Colorado legislature or due
to an administrative error. If the Department does modify these rates, the Department may
modify them using an Option Letter.
9.3.6. The rates for State SLS and OBRA-SS direct services will be posted on the Department's
website on the Provider Rates and Fee Schedule. Contractor shall bill all FSSP direct services
at one dollar per unit.
9.4. Adjustments to Fund Disbursement Amounts
9.4.1. The Department reserves the right to adjust during the Contract period and post -period
adjustment to disbursements following the end of the Contract period, or an adjustment to the
Fiscal Year contract if:
9.4.2. Contractor does not achieve the Performance Standards identified for each program.
9.5. Case Management Agency Compensation
9.5.1. The compensation under this Contract shall consist of rates -based reimbursement intended to
cover the costs of all activities provided through this Contract.
9.5.2. Contractor will receive payment as specified in Exhibit C, Rates.
9.5.2.1. The rates specified in Exhibit C are determined by the approved appropriation from the
Colorado General Assembly. The Department, at its discretion, shall have the option to
increase or decrease these rates as the Department determines necessary based on its
approved appropriation or to correct an administrative error in rate calculations. To
exercise this option, the Department shall provide written notice to Contractor in a form
substantially similar to the Sample Option Letter in the original Contract, and any new
rates table or exhibit shall be effective as of the effective date of that notice unless the
notice provides for a different date. The Department may modify the rates shown in this
section based on the Medicaid Provider rate increases or decreases authorized by the
Colorado legislature or due to an administrative error. If the Department does modify
these rates, the Department may modify them through the use of an Option Letter.
9.6. Rural or Urban Designation
9.6.1. The Department shall determine whether Contractor is a Rural and Frontier or an Urban
agency.
9.7. Detailed Invoicing and Payment Procedures
9.7.1. Applications — HCBS-CES
9.7.1.1. Contractor shall submit all HCBS-CES applications to the Department's vendor for
review and approval, as directed by the Department. The Department will pay for initial
application per person applying for HCBS-CES per year, as well as CSR HCBS-CES
application each year thereafter. The Department will not pay for initial or CSR
applications that were denied due to being incomplete. Incomplete applications include
any application that did not contain: a signature page, a completed Level of Care, DD or
Delay Determination date, dates of service, or partial application (missing pages) which
are required from Contractor necessary to process the application. An incomplete
application denial is different than a denial for the client not meeting nighttime and/or
daytime criteria. The Department will pay for HCBS-CES applications from reports
Exhibit B-1, SOW Page 47 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
received by the Department's vendor on the 11th of the month for assessments from the
previous month.
9.7.2. Appeal Packets and Hearing Attendance
9.7.2.1. Contractor shall ensure that all Appeal Packets and Hearing Attendance information is
entered into the Department prescribed system within the required timeframe. The
Department will pay for all Appeal Packets and Hearing Attendances from data pulled
from the Department prescribed system on the 15th day of the month for Appeal Packets
and Hearing Attendance from the previous month. Contractor shall maintain all
supporting documentation and packets related to all Appeals.
9.7.3. At -Risk Diversion
9.7.3.1. Contractor shall complete all At -Risk Diversion activities as required by the Department
and shall invoice the Department for all completed contacts by the 15th day of the month
for all contacts completed in the previous month. The Department will pay for contacts
once the invoice and supporting documentation is reviewed and accepted.
9.7.4. Case Management Training
9.7.4.1. Contractor shall submit the Case Management Training deliverable. Contractor will
receive payment once the Department has reviewed and accepted the Deliverable. If the
original submission is rejected by the Department, Contractor shall not receive payment
until a revised deliverable has been received and accepted by the Department. If a case
manager did not receive one or more of the required trainings prior to being assigned
independent duties, Contractor shall not receive payment for the Deliverable until all
trainings have been provided. Contractor shall have 30 Calendar Days to provide any
outstanding trainings and resubmit the Deliverable.
9.7.5. Community Advisory Committee Updates
9.7.5.1. Contractor shall submit the Committee Updates Deliverable. Contractor shall receive
payment once the Department has reviewed and accepted the Deliverable. If the
Deliverable shows that no committee meeting updates have been included, Contractor
shall not receive payment for the Deliverable.
9.7.6. Complaint Log and Trend Analysis
9.7.6.1. Contractor shall submit a quarterly Complaint Log and Trend Analysis deliverable.
Contractor will receive payment once the Department has reviewed and accepted the
Deliverable. If the original submission is rejected by the Department, Contractor shall not
receive payment until a revised deliverable has been received and accepted by the
Department.
9.7.7. Community First Choice Training
9.7.7.1. Contractor shall receive a one-time payment for completing Community First Choice
trainings as directed by the Department. The payment will be based on an allocation
calculated by the Department based on funding availability, the time required for training
completion, and the average number of case managers participating.
9.7.8. Continuous Quality Improvement Plan
9.7.8.1. Contractor shall submit the Continuous Quality Improvement Plan deliverable and
updates. Contractor shall receive payment once the Department has reviewed and
Exhibit B-1, SOW Page 48 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
accepted the Deliverable. If the original submission is rejected by the Department,
Contractor shall not receive payment until a revised deliverable has been received and
accepted by the Department.
9.7.9. Critical Incident Quarterly Follow -Up Completion and Entry Performance Standard
9.7.9.1. Contractor is eligible to receive a quarterly performance -based payment for timely
completion of the requested HCBS CIR follow-up action. To receive this quarterly
performance -based payment, Contractor must have 90% of all CIRs assigned follow-up
completed and entered into the Department's prescribed system within the timelines
assigned by the Department and/or Department Quality Improvement Organization. The
Department will calculate Contractor's performance at the close of each quarter to
determine if Contractor will be awarded the performance -based payment. HCBS and SGF
CIRs will be calculated and paid separately.
9.7.10. Critical Incident Reports and Critical Incident Report Administrative Review: HCBS IDD
Waivers
9.7.10.1. Contractor shall ensure all CIRs have been entered in the Department prescribed system
within the required timeframe. The Department will pay per Member enrolled each month
based on actively enrolled Members pulled from the Department prescribed system on
the 15th day of the month for HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS
enrollments from the previous month.
9.7.11. Critical Incident Reports: HCBS LTSS Waivers
9.7.11.1. Contractor shall ensure all CIRs have been entered in the Department prescribed system
within the required timeframe. The Department will pay per Member enrolled each month
based on actively enrolled Members pulled from the Department prescribed system on
the 15th day of the month for CHCBS, HCBS-BI, HCBS-CIH, HCBS-CLLI, HCBS-
CMHS, and HCBS-EBD.
9.7.12. Critical Incident Reporting and Critical Incident Report Administrative Review State SLS,
OBRA-SS, FSSP
9.7.12.1. Contractor shall ensure all CIRs have been entered in the Department prescribed system
within the required timeframe. The Department will pay for all State SLS, OBRA-SS,
and FSSP CIRs MANE and CIRs non -MANE based on data pulled from the
Department's prescribed system on the 15th day of the month for CIRS from the previous
month.
9.7.13.
9.7.13.1.
9.7.14.
9.7.14.1.
Developmental Disability and Delay Determinations
Contractor shall input all disability determinations into the Department prescribed system
within the required timeframes. The Department will pay disability determinations, based
on data pulled from the Department prescribed system on the 15th day of the month for
determinations from the previous month.
Direct Services: State SLS, OBRA-SS, FSSP
Contractor shall submit the State General Fund program direct service expenditure report
invoice for all direct service expenditures for State SLS, OBRA-SS, and FSSP by the 15th
of each month. The Contract shall receive reimbursement for allowable direct services
not to exceed maximum for State General Fund programs for all reimbursable activities
for the fiscal year.
Exhibit B -I, SOW Page 49 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
9.7.15.
9.7.15.1.
9.7.16.
9.7.16.1.
9.7.17.
9.7.17.1.
9.7.18.
9.7.18.1.
9.7.19.
9.7.19.1.
Testing for IDD Determinations
Contractor shall obtain prior approval from the Department for IDD Determination
Testing funding by invoicing the Department each month for the costs of IDD
Determination testing by the 15th day of the month. If approved, the Department will pay
for the actual cost of testing once the request has been approved and the invoice has been
reviewed and accepted. All invoices shall be submitted in the format prescribed by the
Department.
Family Support Council Meetings
Contractor shall submit meeting minutes to the Department for FSC meetings attended
by the 15th day of the month for meetings attended in the previous month, and by June
30th or the Fiscal Year end close date determined by the Department for all meetings
attended in June. The Department will pay for up to six FSC meetings for the Designated
Service Areas attended within the Fiscal Year once the invoice has been reviewed and
accepted. Contractor shall maintain all supporting documentation related to an FSC
meeting and make it available to the Department upon request.
FSSP Annual Report
Contractor shall submit an FSSP Report on an annual basis to the Department. Contractor
shall receive payment for the Annual FSSP Report after it has been reviewed and accepted
by the Department.
FSSP Evaluation Report
Contractor shall submit an FSSP Evaluation Report on an annual basis to the Department.
Contractor shall receive payment for the FSSP Evaluation Report after it has been
reviewed and accepted by the Department.
HCBS-DD Waiting List Enrollment Capacity Building
The Department will pay Contractor for each new member enrolled into the HCBS-DD
waiver from the waiting list as authorized by the Department and as funding is
appropriated and earmarked by the General Assembly. The Department will determine
which HCBS-DD enrollments from the waiting list qualify for capacity building funding
as defined in this Contract.
9.7.20. Human Rights Committee: HCBS IDD Waivers
9.7.20.1. Contractor shall create all HRC packets in accordance with Department requirements and
timeframes. 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 15th day of the month for
HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous
month.
9.7.21.
9.7.21.1.
Human Rights Committee Packet Creation: State SLS, OBRA-SS, FSSP
Contractor shall invoice the Department for all State SLS, OBRA-SS, and FSSP member
packets created during a Human Rights Committee meeting by the 15th day of the month
for all meetings held in the previous month. The Department will pay for each packet
Exhibit B-1, SOW Page 50 of 54
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
created once the invoice has been reviewed and accepted. All invoices shall be submitted
in the format prescribed by the Department.
9.7.22. Interim Support Level Assessments
9.7.22.1. Contractor shall maintain all supporting documentation related to the Interim Support
Level Assessment and make it available to the Department upon request. Contractor shall
invoice the Department 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 are reviewed and accepted.
9.7.23. Level of Care Screen: Initial and Reassessments
9.7.23.1. Contractor shall conduct and enter all initial and reassessment Level of Care Screens into
the Department's prescribed system within the required timeframes. The Department will
pay for initial and reassessment Level of Care Screens based on data pulled from the
Department's prescribed system on the 15th day of the month for Screens conducted in
the previous month.
9.7.24. Long -Range Plan
9.7.24.1. Contractor shall submit a Long -Range Plan on an annual basis and present it to the
Department. Contractor shall receive payment for the Long -Range Plan after it has been
reviewed and accepted by the Department.
9.7.25. Monitoring Contacts: State SLS and OBRA-SS
9.7.25.1. Contractor shall conduct and enter all monitoring contacts for State SLS and OBRA-SS
into the Department's prescribed system within the required timeframe. Contractor shall
receive payment for the four required monitoring contacts per service plan year. The
Department will pay for monitoring contacts based on data pulled from the Department's
prescribed system on the 15th day of the month for contacts conducted in the previous
month.
9.7.26. Most in Need Assessment: FSSP
9.7.26.1. Contractor shall conduct and enter all completed Needs Assessments into the
Department's prescribed system within the required timeframe. Contractor shall receive
payment for one Needs Assessment for members enrolled or on the FSSP ASAA waiting
list per fiscal year. The Department will pay for Needs Assessments each month based
on data pulled from the Department's prescribed system on the 15th day of the month for
assessments conducted in the previous month.
9.7.27. Needs Assessment: Initial and Reassessment
9.7.27.1. Contractor shall conduct and enter all initial and reassessment Needs Assessments into
the Department's prescribed system within the required timeframes. The Department will
pay for initial and reassessment Needs Assessments based on data pulled from the
Department's prescribed system on the 15th day of the month for assessments conducted
in the previous month.
9.7.28. Ongoing Case Management: State SLS, OBRA-SS, FSSP
9.7.28.1. Contractor shall conduct and enter all ongoing case management activities for State SLS,
OBRA-SS, and FSSP into the Department's prescribed system within the required
timeframe. Contractor shall receive one ongoing case management payment each month
Exhibit B-1, SOW Page 51 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
per member for allowable activities completed. The Department will pay for ongoing case
management activities based on data pulled from the Department's prescribed system on
the 15th day of the month for activities conducted in the previous month.
9.7.29. Operations Guide
9.7.29.1. Contractor shall develop an Operations Guide that meets all requirements outlined in this
Contract for year one. Contractor shall receive payment for the Operations Guide once
the deliverable has been reviewed and accepted by the Department.
9.7.30. Operations Guide Updates
9.7.30.1. Contractor shall review the Operations Guide for years two, three, four, and five of this
Contract, and determine if any modifications are required. Updates shall include but not
be limited to any changes in the Work, in the Department's processes and procedures, or
in Contractor's processes and procedures. Contractor shall submit the Annual Operations
Guide Update as well as a summary of all changes to the Department or an explanation
demonstrating that the Operations Guide was reviewed, and Contractor determined that
no edits were necessary. The Department shall review the Operations Guide Update and
the summary to determine whether significant modifications were completed. Contractor
shall receive payment for the updated Operations Guide only after the Department has
determined that significant changes were made, and the Department has accepted the
Deliverable. If minor changes or no changes were completed Contractor shall not receive
payment for this deliverable. The Department does not consider changes such as updating
dates, contact information or locations to be significant changes.
9.7.31. Rapid Reintegration
9.7.31.1. Contractor shall conduct and enter all Rapid Reintegration activities at the Level of Care
Assessment into the Department's prescribed system within the required timeframes. The
Department will pay for Rapid Reintegration based on an invoice template provided by
the Department or data pulled from the Department's prescribed system on the 15th day
of the month for Rapid Reintegration completed in the previous month. Rapid
Reintegration shall include reimbursement for completing Rapid Reintegration barrier
questions, assessment and support, and post survey questions.
9.7.32. Rural Travel Add -On for Rural and Frontier Counties
9.7.32.1. Contractor shall receive an additional payment for Rural Travel Add -On for Rural and
Frontier Counties for the following activities only: initial and Reassessment Level of Care
Screen, initial and Reassessment Needs Assessment, At -Risk Diversion, State SLS and
OBRA-SS In -Person Monitoring, and State SLS and OBRA-SS In -Person Individualized
Support Plans. Payment shall be based on approved invoices or data pulled from the
Department prescribed system on the 15th day of the month for activities from the
previous month.
9.7.33. SIS-A Assessments
9.7.33.1. Contractor shall enter all SIS assessments into SIS Online by the last day of the month.
The Department will pay for all SIS-A Assessments from data pulled from the
Department prescribed system on the 15th day of the month for assessments from the
previous month. Reassessment requests must be reviewed and accepted by the
Department prior to completion, entry, and payment.
Exhibit B-1, SOW Page 52 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-0CE0473D383F
9.7.34. Support Need Level Assessment - HCBS-CHRP
9.7.34.1. Contractor shall maintain all supporting documentation related to the Support Need Level
Assessment and make it available to the Department upon request. Contractor shall
invoice the Department for all completed assessments by the 15th day of the month for
all assessments completed in the previous month. The Department will pay for
assessments once the invoice and supporting documentation is reviewed and accepted.
9.7.35. Training on the Colorado Single Assessment, and Person -Centered Support Plan Instruments
and Streamlined Eligibility
9.7.35.1. Contractor shall receive a one-time payment for the training and oversight of Contractor's
staff in performing the Colorado Single Assessment, and Person -Centered Support Plan.
Payment will be made calculated based on the average number of staff as specified by the
Department. This funding is subject to recovery if the number of staff trained is below
the average number of staff as specified by the Department. Waiting List Management
9.7.36. Contractor shall enter all waiting list management contacts with individuals and families into
the Department prescribed system within the required timeframe. The Department will pay
for required waiting list contacts from data pulled from the Department prescribed system on
the 15th of the month for contacts from the previous month or using an invoice developed by
the Department. The Department shall not pay for more than one contact per individual (18
and older) on the HCBS-DD ASAA, See Date and Safety Net waiting list and State SLS,
OBRA-SS, or FSSP ASAA waiting list per year. Contractor shall only be reimbursed for one
waiting list contact for the HCBS-DD, State SLS or FSSP waiting list when the event occurs
during the same contact.
9.7.37. Year End Close Deadlines
9.7.37.1. The due dates identified in this section shall be adhered to, and information entered into
the Department's prescribed systems and/or submitted to the Department by a date
identified in this Contract. For the month of June, the Department will notify Contractor
of the modified due date to account for year-end closing. Any submission past the
assigned year end close date will not be reimbursed.
9.8. Payment and Billing Errors
9.8.1. Contractor shall review all payments made by the Department to ensure all activities are
appropriately reimbursed.
9.8.2. Contractor shall notify the Department of any errors in billing or payment by the 15th of the
month for the prior month's payment on the Department's prescribed template to ensure over
and under payments are adjusted.
9.8.2.1. DELIVERABLE: Payment Correction Form
9.8.2.2. DUE: On the 15th of each month for corrections on the prior month's payment, with
exception of June payments which must meet year-end close deadlines established by the
Department. Contractor shall specify on the form if corrections have not been identified
for the prior month's payment.
9.9. Unexpended Funds
9.9.1. Contractor shall remit any Subawards disbursed under this Contract that are not expended by
the close of the Period of Performance.
Exhibit B-1, SOW Page 53 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
9.10. Closeout Payments
9.10.1. 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 Business Days after the
Department has determined that Contractor has completed all the requirements of the
Closeout Period.
Exhibit B-1, SOW Page 54 of 54
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
EXHIBIT C-3, 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
Initial Level of Care Screen
$210.27
Per Screen
Report
Federal/State
Funded
Exhibit C-3, Rates
Page l of 4
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Annual Reassessment —
Level of Care Screen
$195.63
Per Screen
Report
Federal/State
Funded
Initial Needs Assessment —
Required Questions Only
$265.49
Per
Assessment
Report
Federal/State
Funded
Annual Reassessment Needs
Assessment — Required
Questions Only
$249.20
Per
Assessment
Report
Federal/State
Funded
Initial Needs Assessment —
Voluntary Questions
Included
$331.87
Per
Assessment
Report
Federal/State
Funded
Annual Reassessment Needs
Assessment — Voluntary
Questions Included
$317.15
Per
Assessment
Report
Federal/State
Funded
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
SIS Assessment
$357.09
Per
Assessment
Report
Federal/State
Funded
Interim Support Level
Assessment -Pilot
$294.17
Per
Assessment
Report
Federal/State
Funded
Initial At -Risk Diversion —
In Person
$104.70
Monthly
Invoice or
Report
Federal/State
Funded
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
Exhibit C-3, Rates
Page 2 of 4
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Completed Training Plan for
Calculated
One -Time
Deliverable
Federal/State
the Colorado Single
Assessment and Person-
Allocation Based
on Funding
Payment
Funded
Centered Support Plan
Availability
Completed Training on
Calculated Based
One -Time
Deliverable
Federal/State
Community First Choice
on Funding
Payment
Funded
Availability
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 & Investigation:
MANE
$349.18
Per Incident
Report
State Funded
State SLS, OBRA-SS, and
FSSP Critical Incident
Reporting & Investigation:
Non -MANE
$46.71
Per Incident
Report
State Funded
State SLS, OBRA-SS, and
FSSP Human Rights
Committee
$125.73
Per Member
Reviewed
Invoice
State Funded
State SLS and OBRA-SS
Complaints Trend Analysis
$220.69
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS, and
FSSP CIR Follow -Up
Performance Standard
$51.81
Quarterly
Deliverable
State Funded
State SLS, OBRA-SS, and
FSSP Ongoing Case
Management
$91.67
Monthly, Per
Activity
Report
State Funded
State SLS and OBRA-SS
Monitoring — In Person
$104.70
Per Contact
Report
State Funded
State SLS and OBRA-SS
Monitoring - Virtual
$87.45
Per Contact
Report
State Funded
State SLS Expenditure
Report
$625.76
Monthly
Invoice
State Funded
OBRA-SS Expenditure
Report
$369.56
Monthly
Invoice
State Funded
Exhibit C-3, Rates
Page 3 of 4
Docusign Envelope ID: 69A10C9A-A1 B5-4052-956A-6CE0473D383F
FSSP Needs Assessment
$33.25
Per
Assessment
Report
State Funded
FSSP Expenditure Report
$556.57
Monthly
Invoice
State Funded
Family Support Council
Meetings
$418.29
Per Meeting
Invoice
State Funded
FSSP Annual Report
$621.79
Annually
Deliverable
State Funded
FSSP Program Evaluation
$529.19
Annually
Deliverable
State Funded
Exhibit C-3, Rates Page 4 of 4
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
EXHIBIT D-3, TERMINOLOGY
1. TERMINOLOGY
1.1. In addition to the terms defined in 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. At Risk Diversion — is a Person -Centered process through which services are arranged or
provided to enable a Member of an At -Risk Population to avoid admission to a nursing
facility and live, instead, in a setting of their choice.
1.1.5. Behavioral Health Authorities (BHA) — The behavioral health administration established in
Part 200 of Article 50 of Title 27, C.R.S.
1.1.6. 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).
1.1.7. Business Interruption — Any event that disrupts 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.
1.1.8. Care and Case Management System (CCM) — The Department's case management
Information Technology (IT) platform.
1.1.9. 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.
1.1.10. 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.
1.1.11. 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.
1.1.12. 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.
1.1.13. Client — Any individual applying for or seeking information for LTSS.
Exhibit D-3, Terminology Page 1 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.1.14. Closeout Period — The period beginning on the earlier of 90 Calendar 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.
1.1.15. Colorado Revised Statutes (C.R.S.) — The legal code of Colorado; the legal codified general
and permanent statutes of the Colorado General Assembly.
1.1.16. 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.
1.1.17. Community First Choice (CFC) - Services and supports authorized through the section
1915(k) of the Social Security Act and provided in community settings to an individual who
requires an institutional level of care that would otherwise be provided in a Hospital, Nursing
Facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID),
an institution providing inpatient psychiatric services for individuals under age 21, or an
institution for mental diseases for individuals age 65 or over.
1.1.18. Complaints — Any complaint received by Contractor as it relates to the services provided
through this Contract to include, but not limited to general business functions, administration,
State General Fund program functions, and case management functions. Excludes any
complaints regarding activities outside the scope of this Contract.
1.1.19. 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.
1.1.20. Contract — The agreement, including all attached Exhibits, all documents incorporated by
reference, all referenced statutes, rules and cited authorities, and any future modifications
thereto, that is entered into as a result of this solicitation.
1.1.21. 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.
1.1.22. Contractor — The individual or entity selected as a result of this solicitation to complete the
Work contained in the Contract.
1.1.23. 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.
1.1.24. 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.
1.1.25. 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.
Exhibit D-3, Terminology Page 2 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.1.26. 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.
1.1.27. 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.
1.1.28. Data — State Confidential Information and other State information resources transferred to
Contractor for the purpose of completing a task or project assigned in the Statement of Work.
1.1.29. 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.
1.1.30. Department — The Colorado Department of Health Care Policy and Financing, a department
of the government of the State of Colorado.
1.1.31. 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.
1.1.32. 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.
1.1.33. 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.
1.1.34. 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,
including Level of Care Determination and financial eligibility.
1.1.35. 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.
1.1.36. 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.
1.1.37. Health First Colorado — Colorado's Medicaid program.
1.1.38. Health Insurance Portability and Accountability Act (HIPAA) — The Health Insurance
Portability and Accountability Act of 1996, as amended.
1.1.39. 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: Children's Home and Conununity Based Services
Waiver (CHCBS), 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
Exhibit D-3, Terminology Page 3 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
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).
1.1.40. Hospital Back -Up - A LTSS program for Members who have complex wound care and/or
are ventilator -dependent or medically complex.
1.1.41. 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.
1.1.42. 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.
1.1.43. 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. Intake, Screening and
Referral — The initial contact between the individual and 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.
1.1.44. Key Personnel — The position or positions that are specifically designated as such in the
Contract.
1.1.45. Learning Management System (LMS) - An online software application for the
administration, delivery and tracking of case management training programs and materials.
1.1.46. 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.
1.1.47. 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.
1.1.48. Long Term Care notice of action — The form required to be sent to Clients by Contractor
within 11 Business Days regarding their appeal rights in accordance with 10 CCR 2505-10
8.507 et seq.
1.1.49. 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.
Exhibit D-3, Terminology Page 4 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.1.50. Long Term Services and Supports (LTSS) Programs - Any of the following publicly funded
programs: CHCBS, FSSP, HCBS-BI, HCBS-CES, HCBS-CHRP, HCBS-CLLUCwCHN,
HCBS-CMHS, HCBS-DD, HCBS-EBD, HCBS-CIH, HCBS-SLS, CFC, HBU, LTHH,
Medicaid Nursing Facilities, OBRA-SS, PACE, State SLS.
1.1.51. 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
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.
1.1.52. 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.
1.1.53. 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.
1.1.54. 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 pluming with valid and reliable LTSS data.
1.1.55. 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.
1.1.56. 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.
1.1.57. Offeror — Any individual or entity that submits a proposal, or intends to submit a proposal,
in response to this solicitation.
Exhibit D-3, Terminology Page 5 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.1.58. Operational Start Date — When the Department authorizes Contractor to begin fulfilling its
obligations under the Contract.
1.1.59. Organized Health Care Delivery System - A Case Management Agency that contracts with
other qualified providers to furnish services authorized in the CHCBS, HCBS-BI, HCBS-
CLLI, HCBS-CES, HCBS-C1H, 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.
1.1.60. Other Personnel — Individuals and Subcontractors, in addition to Key Personnel, assigned to
positions to complete tasks associated with the Work.
1.1.61. Pandemic — Refers to an epidemic that has spread over several countries or continents, usually
affecting a large number of people.
1.1.62. 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.
1.1.63. Person -Centered Approach — Respecting and valuing individuals' and Members' preferences,
strengths, and contributions.
1.1.64. Person -Centered Support Plan - A document, using the State -prescribed instrument, that
identifies 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
plan 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.
1.1.65. 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.
1.1.66. 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
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 §24-72-501 C.R.S.
1.1.67. Pre -Admission Screening and Resident Review (PASRR) — The review that occurs for all
Clients 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
Exhibit D-3, Terminology Page 6 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
provides and whether Clients who need nursing facility services also need specialized
services.
1.1.68. 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 an LTSS program.
1.1.69. Program — A publicly funded program including, but not limited to: Home and Community
Based Services Waivers, CFC, 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.
1.1.70. 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.
1.1.71. 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.
1.1.72. 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.
1.1.73. 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.
1.1.74. Rapid Referral — The Person -Centered process that occurs when a member, who is seeking
admission to a nursing facility, does not oppose living in the Community, and is experiencing
Unstable Housing, is rapidly referred to a Transition Coordinator to receive Transition
Coordination Services.
1.1.75. Rapid Reintegration — the Person -Centered process that occurs when a member, who will be
admitting into a nursing facility, does not oppose living in the Community, and is not
experiencing Unstable Housing and receives services as described in the member's Rapid
Reintegration Plan.
1.1.76. Rapid Reintegration Plan — a written Person -Centered plan developed for the purpose of
rapidly transitioning a member(s) from a nursing facility and safely into the Community.
1.1.77. Regional Accountable Entity (RAE) — A single regional entity responsible for duties
previously performed by Regional Care Collaborate Organizations and Behavioral Health
Organizations (BHO).
1.1.78. Resource Development — The study, establishment and implementation of additional
resources or services that extend the capabilities of community based LTSS systems to better
Exhibit D-3, Terminology Page 7 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
serve LTSS Clients and Members and those likely to need community based LTSS in the
future.
1.1.79. Rural and Frontier — Defined Service Areas that are eligible for rural travel add-on
reimbursement for required in -person activities reimbursed through this Contract.
1.1.80. Services — The services and activities to be performed by Contractor as set forth in this
Contract and shall include any services and activities to be rendered by 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.
1.1.81. Start —Up Period — The period starting on the Effective Date and ending on the Operational
Start Date.
1.1.82. State — The State of Colorado, acting by and through any State agency.
1.1.83. State Fiscal Rules — The fiscal rules promulgated by the Colorado State Controller pursuant
to C.R.S. §24-30-202(13)(a).
1.1.84. 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.
1.1.85. 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
individuals with intellectual and developmental disabilities. SIDA issues the Letter of
Determination to the nursing facility.
1.1.86. 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).
1.1.87. State Records — Any and all State data, information, and records, regardless of physical form,
including, but not limited to, information subject to disclosure under CORA.
1.1.88. Subcontractor — Third parties, if any, engaged by Contractor to aid in performance of the
Work.
1.1.89. Support Need Level Assessment - The standardized assessment tool to identify and measure
the practical support requirements for HCBS-CHRP waiver participants.
1.1.90. Surcharge - Any additional amount added by Contractor, over and above the rate charged by
the subcontractor to Contractor, which would be shown on an individual's service plan or on
encounter data service rates submitted to the Department.
1.1.91. Target Criteria — Department defined criteria based on Member needs to access services
under a HCBS waiver.
1.1.92. 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.
Exhibit D-3, Terminology Page 8 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1.1.93. 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.
1.1.94. Work — The delivery of the Goods and performance of the Services described in the Contract.
1.1.95. 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. CFC — Community First Choice
2.1.2. CFR — Code of Federal Regulations
2.1.3. CHP+ —Child Health Plan Plus
2.1.4. CORA — Colorado Open Records Act, C.R.S. §24-72-200.1, et. seq.
2.1.5. C.R.S. — Colorado Revised Statutes
2.1.6. CPI — Consumer Price Index
2.1.7. CPI -U - CPI for all urban consumers
2.1.8. HIPAA — Health Insurance Portability and Accountability Act of 1996, as amended.
2.1.9. MFCU — the Colorado Medicaid Fraud Control Unit in the Colorado Department of Law
2.1.10. PCI — Payment Card Information
2.1.11. PHI — Protected Health Information
2.1.12. PII — Personally Identifiable Information
2.1.13. SFY — State Fiscal Year
2.1.14. U.S.C. — United States Code
2.1.15. VARA — Visual Rights Act of 1990
Exhibit D-3, Terminology Page 9 of 9
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Executive Director Contract Summary and Checklist — New Contract
Contract
Manager
Sarah McDonnell, CMA Contract
Manager, OCL
Contract
Manager
Email
Sarah.McDonnell(#state.co.us
ELT Member
Yasmin Gardner, Operations and
Administration Division Director
Contact
Phone #
303-866-5668
SET Member
Bonnie Silva, Office of Community
Living Director
Type of
Document
Contract
Contractor Name
1. Adult Care Management, Inc., dba A&I Avenues DSA #8
2. Community Connections, Inc. for DSA #20
3. Developmental Pathways, Inc. for DSA #5
4. Foothills Gateway Inc. DSA #10
5. Garfield County Department of Human Services DSA #15
6. Jefferson County Human Services DSA #7
7. Las Animas County Department of Human Services DSA #4
8. Montrose County Human Services DSA #19
9. Northeastern Colorado Association of Local Governments' Area
Agency on Aging DSA #1
10. Otero County Department of Human Services for DSA #3
11. Prowers County Public Health and Environment for DSA #2
12. Rocky Mountain Health Organization dba Rocky Mountain Health
Plans DSA #13, #14, #16, #17, #18
13. Rocky Mountain Human Services for DSA #6
14. The Resource Exchange, Inc for DSA a #11, #12
15. Weld County Department of Human Services DSA #9
Summary of Services
Provided
OCL is contracting with not -for-profit and county -based agencies
throughout the state for the following activities:
• Administrative case management functions for the following
programs:
o HCBS Children with a Life Limiting Illness Waiver (HCBS-
CLLI)
o HCBS Children's Extensive Supports Waiver (HCBS-CES)
o HCBS Children's Habilitation Residential Program Waiver
(HCBS-CHRP)
o HCBS Community Mental Health Supports Waiver (HCBS-
CMHS)
o HCBS Complimentary and Integrative Health Waiver
(HCBS-CIH)
o HCBS Developmental Disabilities Waiver (HCBS-DD)
o HCBS Persons who are Elderly, Blind and Disabled Waiver
(HCBS-EBD)
o HCBS Persons with Brain Injury Waiver (HCBS-BI)
o HCBS Supported Living Services Waiver (HCBS-SLS)
o Hospital Back -Up Program (HBU)
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
o Intermediate Care Facilities -Intellectual and
Developmental Disabilities (ICF-IDD)
o Long Term Home Health (LTHH)
o Nursing Facilities (NF)
o Program for All -Inclusive Care for the Elderly (PACE)
Activities include but are not limited to:
o Intake and Referral
o Developmental Disability Determination
o Level of Care Assessment
o Human Rights Committee
o Critical Incident Reporting, Investigations
o Supports Intensity Scale Assessment
o Support Need Level Assessment
o Waiting List Management
Case management, administration, and direct service provision for
the three State General Funded programs including the:
o Family Support Services Program (FSSP)
o State Supported Living Services Program (State SLS)
o Omnibus Reconciliation Act of 1987 Specialized Services
Program (OBRA-SS)
Activities include but are not limited to:
o Intake and Referral
o Developmental Disability and Delay Determination
o Ongoing Case Management
o Assessment
o Service Plan Development
o Monitoring
o Waiting List Management
o Direct Service Provision
The CMA January Amendment will include the following changes:
• Community First Choice 100.2 Assessment Requirements
• Pilot Interim Support Level Assessment Requirements
Total Contract Amount FY2024-25 GAE for CMAs:
(Include each SFY and Medicaid Admin: No Contract Maximum, Estimate $32,133,091
the total) SGF Programs: $21,688,981
Grand Estimate Total: $53,822,072
Contract Reference or
(If not applicable, describe
why)
Idition
Criteria
nfurmat,on, please review the
iIable on the Procurement dra€ting request page
Performance Metrics
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Performance metrics can be
found throughout Exhibit B-1,
Statement of Work on pages
1 through 54 and within
Exhibit E-1, Contractor's
Administrative Requirements
on pages 1 through 25. The
contract outlines specific
performance standards,
deliverables, and timelines
that must be met by the
contractor.
What sections of the contract describe performance metrics for the Contractor?
Program expectations can be
found throughout Exhibit B-1,
Statement of Work on pages
1 through 54 and within
Exhibit E-1, Contractor's
Administrative Requirements
on pages 1 through 25. The
contract outlines specific
performance standards,
deliverables, and timelines
Where are HCPF Program staff and their management program expectations
that must be met by the
contractor. Each waiver and
program have specific actions
required to include how the
activity must be completed,
the timeframe, and
requirements for data entry
into the Care and Case
clearly included in the contract?
Management system or
submissions to HCPF.
Exhibit 0-1, Statement of
Work:
Section 9, Compensation and
Invoicing on pages 45 through
47. Reductions to the State
General Fund program
allocation if performance
measures at not met, if
enrollments decrease, or
funding is not utilized.
Section 9.7, Detailed Invoicing
Which performance metrics have financial repercussions for failing to meet the
and Payment Procedures on
pages 47 through 53. Specific
payment criteria to ensure
the work is complete,
documented, and approved
as required prior to payment.
metric?
Section 1.9, Critical Incidents
on pages 11 through 12.
Performance -based payments
that are only received if the
specific performance
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
standards are met each
quarter.
Section 4, State General Fund
Program Obligations on pages
30 - 42. Include specific
requirement for collecting
and maintaining service
documentation. Services
without required
documentation are subject to
recovery.
Specific Provisions
Boilerplate, Section 11,
Breach of Contract on pages
14 through 16.
Exhibit E-1, Contractor's
Administrative Requirements,
Section L26, Corrective
Action Plan on pages 15
through 16.
What sections of the contract contain requirements that would allow the
Department to readily terminate and replace this contractor if they fail to
perform?
Yes, Exhibit E-1, Contractor's
Administrative Requirements,
Section 3 Information
Technology Related
Requirements on pages 22
through 25.
Does the contract include the appropriate cybersecurity clauses for the risk level
of the contract? If "yes", what sections are these in? If "no", why not?
Payment
Exhibit 5-1, Statement of
Work, Section 9.7, Detailed
Invoicing and Payment
Procedures on pages 47
through 53. The contract has
specific payment criteria to
ensure the work is complete,
documented, and approved
as required prior to payment.
All payments are tied to an
activity, performance
standard, or deliverable being
completed prior to payment.
Describe how payments are tied to one of the following:
1. Meeting specific performance standards;
2. Completing deliverables; or
3. Recovering funds for the Department?
The Fee for Service Rates
Division developed the rates
for this Contract. This
included considering caseload
size, activities completed, the
time it takes to complete said
activities, the staff who
completes those activities,
etc.
How were the rates and payments for this contract determined? How do we
know they are competitive and that we are getting a good price for the services
provided?
Partnership
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
Yes, OCL meets with CMAs to
walk through the contract to
review and discuss to ensure
all CMAs understand all
requirements.
Additionally, OCL holds
quarterly CFO/Contract calls
to discuss contract
requirements, deliverable
expectations, payments,
financial review results, and
subrecipient requirements.
OCL also holds quarterly Case
Management Agency
meetings with case managers,
supervisors, and directors to
discuss contract
requirements, changes to
case management
requirements, outcomes of
performance and quality
reviews, and other impacts to
their agencies. Additionally,
staff from OCL provide
ongoing technical assistance,
training, and guidance
individual and across all
agencies as needed.
Yes, the CMA Contracts have
been accounted for within
the PACAP. All payments are
tracked by program within
the GAE for CMS 64 reporting.
OCL has worked closely with
Jerrod and Gabriela within
the Accounting Division on
this project.
How has the contract manager ensured that the contractor understands the
expectations of the Department's business owner?
Federal and State Compliance
Has the contract manager verified with Accounting that the contract is
documented in the Public Assistance Cost Allocation Plan (PACAP) or Medicaid
Administrative Claiming (MAC) plan and this documentation includes a description
of the administrative costs, the associated cost allocation (i.e., direct or indirect)
methodology, the federal financial participation rate, and the benefitting federal
and/or State programs?
The Program Contact, ELT Member, and SET Member listed above document their approval of this form
by approving the eClearance folder containing it.
Docusign Envelope ID: 69A10C9A-A1 B5.4052-956A-6CE0473D383F
1/JV/LJ� G.JV r Ivl
FY24-25 CMAApriI Amendment
(/)
Member Contact Center: (800) 221-3943
* Colorado Department of Health Care Policy & Financing-(/SitePages/Colorado-Department-of-Health-Care-Policy-&-Financing,.p2S). / eClearance
eClearanceDocuments
(https://cohcpf.sharepoint.com/eClearance/eClearanceDocuments)
FY24-25 CMA April Amendment
https://cohcpf.sharepoint.com/eClearance/eClearanceDocuments/Forms/Approver?/docsethomepage.aspx?ID=77749&FolderCTID=Ox0120D52000F2EAE615C1 FF98408E5B0B05C6F9E3BCOOCE615... 1/5
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1/JV/LJ, L.JV r�ri
FY24-25 CMA April
Amendment
FY24-25 CMA April Amendment
Instructions
1. Open and review documents - use Ctrl + click to open each document in a new browser
2. Click on "Edit Properties" on the left side of this page to approve or not approve w/comments
3. Save
Requesting approval for the 15 Case
Management Agency (CMA) Contract
Amendments for April 1, 2025. This amendment Workflow History
will add the Community First Choice (CFC)
Assessments and Interim Support Level Modified
Assessment (ISLA) Pilot. The CFC assessments Title Activity Comments ModifiedM
will allow assessments to begin April 1st, which is
necessary for CFC cost savings to begin in July. FY24-25 CMA April Amendment Sent to Wed Jan McDonnell,
The ISLA pilot will allow HCPF to gather (https://cohcpf.sharepoint.com/eClearance/Lists/eClearanceApprover 15 2025 Sarah
necessary data needed for a July transition from Workflow Log/DispForm.aspx?ID=167818) 1: Lofgren,
Amanda
the Sup
port Intensity Scale (SIS) assessment to
the ISLA. Once approved, procurement will FY24-25 CMA April Amendment Approved Thu Jan Lofgren,
complete the individual CMA mail merger using (https://cohcpfsharepoint.com/eClearance/Lists/eClearance 16 2025 Amanda
the unique information for each agency within Workflow Log/DispForm.aspx?I D=168009)
the mail merge spreadsheet. FY24-25 CMA April Amendment Sent to Thu Jan Lofgren,
(https://cohcpfsharepoint.com/eClearance/Lists/eClearanceApprover 16 2025 Amanda
ClearanceType Contrails (Program A Workflow Log/DispForm.aspx?ID=168010) 2: Gardner,
( g Approvals After P&C Req
(https://cohcpfsharepoint.com/eClearance/_It Yasmin
PageType=4&Listld={58d5a54a ff6d 4998 a`FY24-25 CMA April Amendment Approved Fri Jan Gardner,
5cf993a436ec}&ID=15&RootFolder=') (https://cohcptsharepoint.corn/eClearance/Lists/eClearance 172025 Yasmin
Originating DivisionOperations and Administration Division Workflow Log/DispForm.aspx?ID=168035)
Primary Contact McDonnell, Sarah (/eClearance/_layouts/15/u�24 25 CMA April Amendment Sent to Fri Jan Gardner,
eClearance5tatus Complete (https://cohcpf.sharepoint.com/eClearance/Lists/eClearanceApprover 172025 Yasmin
Workflow Log/DispForm.aspx?ID=168036) 3: Laughlin,
Colin
FY24-25 CMA April Amendment Approved Tue Jan Laughlin,
(https://cohcpf.sherepoint.com/eClearance/Lists/eClearance 212025 Colin
Workflow Log/DispForm.aspx?ID-168152)
FY24-25 CMA April Amendment Sent to Tue Jan Laughlin,
(https://cohcpf.sharepoint.com/eClearance/Lists/eClearanceApprover 212025 Colin
Workflow Log/DispForm.aspx?ID=168154) 4:
Donahoo,
Jeffre...
FY24-25 CMA April Amendment Approved Wed Jan Donahoo,
(https://cohcpf.sharepoint.com/eClearance/Lists/eClearance 222025 Jeffrey
Workflow Log/DispForm.aspx?ID=168281)
FY24-25 CMA April Amendment Sent to Wed Jan Donahoo,
(https://cohcpf.sharepoint.com/eClearance/Lists/eClearanceApprover 222025 Jeffrey
Workflow Log/DispForm.aspx?ID=168282) 5:
Schneider,
Bett...
View All Properties
Edit Properties
https://cohcpf.sharepoint.com/eClearance/eClearanceDocuments/Fomis/Approver?/docsethomepage.aspx?ID=77749&FolderCTID=0x0120D52000F2EAE615C1 FF98408E5BOB05C6F9E3BCOOCE615... 2/5
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1/JV/LJ, G.JV r IYI
FY24-25 CMAApril Amendment
Title Activity Comments ModifiedByodified
FY24-25 CMA April Amendment Approved This Thu Jan Schneider,
(https://cohcpf.sharepoint.com/eClearance/Lists/eClearance amendment 302025 Bettina
Workflow Log/DispForm.aspx?ID=168854) is adding
Interim
Support
Level
Assessments
(ISLA) pilot,
replacing
the existing
SIS
assessments
and the
increase in
funding is
resulting
from an
anticipated
increases in
the number
of
assessments
conducted.
Costs are
about$27k
GF, funded
from an
OCL-specific
line item.
This
amendment
is also
adding
Community
First Choice
(CFC) 100.2
Assessments
which is
budget
neutral.
FY24-25 CMA April Amendment Sent to
(https://cohcpf.sharepoi nt.com/eClearance/Lists/eClearanceApprover
Workflow Log/DispForm.aspx?ID=168855) 6:
Bimestefer,
Kim
Thu Jan Schneider,
302025 Bettina
https://cohcpf.sharepoint.com/eClearance/eClearanceDocu ments/Forms/Approver?/docsethomepage.aspx?ID=77749&FolderCTl D=0x0120D52000F2EAE615C 1 FF98408E5B0B05C6F9E3BCOOCE615... 3/5
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1/JU/GJ, G.JU r /r,
FY24-25 CMA April Amendment
Title Activity Comments ModifiedByodified
FY24-25 CMA April Amendment Approved Thu Jan Bimestefer,
(https://cohcpfsharepoint.com/eClearance/Lists/eClearance 302025 Kim
Workflow Log/DispForm.aspx?ID=168877)
FY24-25 CMA April Amendment Sent to Thu Jan Bimestefer,
(https://cohcpfsharepoint.com/eClearance/Lists/eClearanceApprover 302025 Kim
Workflow Log/DispForm.aspx?ID=168878) 7: Rowley,
Rebecca
FY24-25 CMA April Amendment Approved Thu Jan Rowley,
(https://cohcpf.sharepoint.com/eClearance/Lists/eClearance 30 2025 Rebecca
Workflow Log/DispForm.aspx?ID=168886)
FY24-25 CMA April Amendment All Thu Jan Rowley,
(https://cohcpf.sharepoint.com/eClearance/Lists/eClearanceapprovals 30 2025 Rebecca
Workflow Log/DispForm.aspx?ID=168888) complete
ONew ± Upload ri Sync O Share More v
Find a file
Name
Modified Modified By
FOCAS FY24-25 CMA April Amendment January 22 Donahoo, Jeffrey (/eClearance%layouts/15/userdisp.aspx?ID=2168)
(/eClearance/eClearanceDocuments/FY24-25
CMA April Amendment/FOCAS FY24-25 CMA
April Amendment.docx)
FY2024-25 CMA Contract Amendment 3 CFC ISLA January 15 McDonnell, Sarah (/eClearance/ layouts/15/userdisp.aspx?ID=2891)
1.15.2025
(/eClearance/eClearanceDocuments/FY24-25
CMA April Amendment1FY2024-25 CMA Contract
Amendment 3 CFC ISLA 1.15.2025.docx)
FY24-25 BAT CMA January 15 McDonnell, Sarah (/eClearance/ layouts/15/userdisp.aspx?ID=2891)
(/eClearance%Clears nceDocuments/FY24-25
CMA April Amendment/FY24-25 BAT CMA.docx)
FY24-25 Executive Director Contract Summary January 15 McDonnell, Sarah (/eClearance/layouts/15/userdisp.aspx?ID=2891)
and Checklist - CMA$
(/eClearance%ClearanceDocuments/FY24-25
CMA April Amendment/FY24-25 Executive
Director Contract Summary and Checklist -
CMAs.docx)
Drag files here to upload
https://cohcpf.sharepoint.com/eClearance/eClearanceDocuments/Forms/Approver7/docsethomepage.aspx?ID=77749&FolderCTID=0x0120D52000F2EAE615C1 FF98408E5B0B05C6F9E3BCOOCE615... 4/5
Docusign Envelope ID: 69A10C9A-A1B5-4052-956A-6CE0473D383F
1/JV/GJ� L.JV r1V1
FY24-25 CMA April Amendment
DEPARTMENT VALUES
Person-Centeredness • Accountability • Continuous Improvement • Employee Engagement • Integrity • Transparency
https://cohcpf.sharepoint.com/eClearance/eClearanceDocuments/Forms/Approver7/docsethomepage.aspx7ID=777498FolderCTID=Ox0120D52000F2EAE615C1 FF98408E5B0B05C6F9E3BCOOCE615... 5/5
Contract Form
Entity Information
Entity Name* Entity ID*
DEPARTMENT OF HEALTH CARE @00023890
POLICIES & FINANCIAL
Contract Name* Contract ID
DEPARTMENT OF HEALTH CARE POLICIES & FINANCIAL 9117
AMENDMENT #3 TO THE INTERGOVERNMENTAL
AGREEMENT C24-188034
Contract Status
CTB REVIEW
Contract Lead *
SADAMS
❑ New Entity?
Parent Contract ID
20240121
Requires Board Approval
YES
Contract Lead Email Department Project #
sadams@weld.gov;cobbx
xlk@weld.gov
Contract Description *
AMEND #3 TO THE IGA FOR WCDHS TO SERVE AS A CASE MANAGEMENT AGENCY TO PERFORM CASE
MANAGEMENT ACTIVITIES FOR THE AAA PROGRAM. THE CMA RFP AND AWARD (TYLER# 2023-0543),
AGREEMENT (2024-0121) AMEND #1(2024-1535); AMEND #2 (2024-3344)
Contract Description 2
PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB IS 2/18/2025.
Contract Type *
AMENDMENT
Amount*
$0.00
Renewable *
NO
Automatic Renewal
Grant
IGA
Department
HUMAN SERVICES
Department Email
CM-
HumanServices@weld.gov
Department Head Email
CM-HumanServices-
DeptHead@weld.gov
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
Requested BOCC Agenda
Date*
02/26/2025
Due Date
02/22/2025
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"
04/30/2025
Committed Delivery Date
Renewal Date
Expiration Date"
06/30/2025
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 CHERYL PATTELLI BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
02/20/2025 02/20/2025 02/20/2025
Final Approval
BOCC Approved Tyler Ref #
AG 022625
BOCC Signed Date Originator
SADAMS
BOCC Agenda Date
02/26/2025
Hello