HomeMy WebLinkAbout20230569.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #3 TO SERVE AS SINGLE ENTRY POINT
AGENCY FOR LONG-TERM CARE SERVICES AND AUTHORIZE CHAIR TO SIGN
AND SUBMIT ELECTRONICALLY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with Contract Amendment #3 to Serve as a
Single Entry Point Agency for the Long -Term Care 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, Area Agency on Aging, and the Colorado Department of
Health Care Policy and Financing, commencing July 1, 2020, and ending June 30, 2023, with
further terms and conditions being as stated in said contract amendment, and
WHEREAS, after review, the Board deems it advisable to approve said contract
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 Serve as a Single Entry Point Agency
for the Long -Term Care 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, Area Agency on Aging, and the Colorado Department of Health Care Policy and
Financing, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to electronically sign and submit said contract amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 1st day of March, A.D., 2023, nunc pro tunc July 1, 2020.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:d„) .Jk,Gto•,,k,
Weld County Clerk to the Board
BY:
eputy Clerk to the Boa
APPROVED AS TO FOR
rim
ss+.County Attorney
Date of signature: o3/09/23
•
eman, C
Perry L. B
cott K. Jam
�evin D. oss
Lori Sai
cc;1-ISD
03/10 /21
2023-0569
HR0095
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PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: February 14, 2023
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Fiscal Year 2022-2023 Single Entry Point (SEP)
Contract Amendment #3
Please review and indicate if you would like a work session prior to placing this item on the Board's
agenda.
Request Board Approval of the Department's Fiscal Year 2022-2023 Single Entry Point (SEP)
Contract Amendment #3. The Weld County Area Agency on Aging (AAA), Single Entry Point (SEP),
receives funding annually from Health Care Policy and Finance (HCPF) to provide long-term care
information, screening, assessment of need, and service coordination to appropriate long -tern care case
management for disabled and older adults 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.
Amendment #3 modifies requirements related to the new Colorado Single Assessment (CSA) and Person -
Centered Support Plan (PCSP), data entry requirements for the new Care and Case Management (CCM)
system, requirements for the Public Health Emergency (PHE) end and clarifying contract requirements.
The effective date of the amendment will be the date shown on the Signature and Cover Page through
June 30, 2023.
I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair
to sign via electronically DocuSign.
Approve Schedule
Recommendation Work Session
Perry L. Buck, Pro -Tern
Mike Freeman, Chair
Scott K. James
Kevin D. Ross
Lori Saint
Other/Comments:
Pass -Around Memorandum; February 14, 2023 - CMS ID 6693
Page 1
2023-0569
63/0\ /Z3
Cheryl Hoffman
From:
Sent:
To:
Subject:
Yes
Kevin Ross
Kevin Ross
Tuesday, February 14, 2023 12:48 PM
Cheryl Hoffman
Re: PA FOR ROUTING: AAA SEP Contract Amendment #3 (CMS 6693)
From: Cheryl Hoffman <choffman@weld.gov>
Sent: Tuesday, February 14, 2023 2:32:30 PM
To: Kevin Ross <kross@weld.gov>
Subject: FW: PA FOR ROUTING: AAA SEP Contract Amendment #3 (CMS 6693)
Approve?
Cheryl L. Hoffman
Deputy Clerk to the Board
1150 O Street/P.O. Box 758
Greeley, CO 80632
Tel: (970) 400.4227
choffman@weld.gov
From: Lesley Cobb <cobbxxlk@weldgov.com>
Sent: Tuesday, February 14, 2023 12:08 PM
To: Cheryl Hoffman <choffman@weld.gov>
Cc: Karla Ford <kford@weldgov.com>; Bruce Barker <bbarker@weldgov.com>; Cheryl Pattelli <cpattelli@weld.gov>;
Chris D'Ovidio <cdovidio@weld.gov>; Esther Gesick <egesick@weld.gov>; Lennie Bottorff <bottorll@weldgov.com>; HS -
Contract Management <HS-ContractManagement@co.weld.co.us>
Subject: PA FOR ROUTING: AAA SEP Contract Amendment #3 (CMS 6693)
Good morning Cheryl,
Please see the attached PA approved for routing: AAA SEP Contract Amendment #3 (CMS 6693).
Thank you!
Lesley Cobb
Contract Management and Compliance Supervisor
Weld County Dept. of Human Services
315 N. 11th Ave., Bldg A
PO Box A
Greeley, CO 80632
S(970) 400-6512
L4 (970) 353-5212
cobbxxlk@weldgov.com
1
DocuSign Envelope ID: A1252E78-7F13-4ACB-85CA-B82759337FDD
CONTRACT AMENDMENT #3
SIGNATURE AND COVER PAGE
State Agency
Department of Health Care Policy and Financing
Original Contract Number
21-160398
Contractor
Weld County Department of Human Services
Amendment Contract Number
21-160398A3
Current Contract Maximum Amount
No Maximum for any SFY
Contract Performance Beginning Date
July 1, 2020
Current Contract Expiration Date
June 30, 2023
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.
By:
CONTRACTOR
Weld County Department of Human Services
Mike Freema 5d ouS g ntybCommissioners Chair
It t, 4vwist ,
"— E74 B8DB083D41A1...
3/1/2023 I 14:20 PST
Date:
By:
STATE OF COLORADO
Jared S. Polis, Governor
Department o Dtt uSibrtecybyd Financing
Kim B me efer, Executive Direct°
15(14d,
Date:
0B6A84797FA8493
3/1/2023 I 18:54 PST
In accordance with §24-30-202 C.R.S., this Amendment is not valid until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
,-DocuSigned by:
204/1.001 eoywaw
By: `-76F69541272B43A...
3/2/2023 I 06:46 PST
Amendment Effective Date:
Contract Amendment: 21-160398A3 Page 1 of 3
.461/4Z3- o54q
DocuSign Envelope ID: A1252E78-7F13-4ACB-85CA-B82759337FDD
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 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.
B. 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 and shall terminate on the termination of the Contract.
4. PURPOSE
The purpose of this Contract is for Contractor to serve as a Single Entry Point (SEP) Agency within
a local area where a current member or potential long-term care client can obtain long-term care
information, screening, assessment of need, and referral to appropriate long-term care program and
case management services for all Coloradoans within their designated Region/District. The purpose
of this Amendment is to modify requirements related to the new Colorado Single Assessment (CSA)
and Person -Centered Support Plan (PCSP), data entry requirements for the new Care and Case
Management (CCM) system, requirements for the Public Health Emergency (PHE) end,
requirements for HCBS Settings Final Rule , and clarifying contract requirements.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. Exhibit B-2, STATEMENT OF WORK, is hereby deleted in its entirety and replaced with
Exhibit B-3, attached. All references to Exhibit B-2 shall henceforth be a reference to Exhibit
B-3
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
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
Contract Amendment: 21-160398A3 Page 2 of 3
DocuSign Envelope ID: A1252E75-7F13-4ACB-85CA-B82759337FDD
Provisions contained in the Contract to the extent that this Amendment specifically modifies those
Special Provisions.
Contract Amendment: 2I -160398A3 Page 3 of 3
DocuSign Envelope ID: A1252E78-7F13-4ACB-85CA-B82759337FDD
EXHIBIT B-3, STATEMENT OF WORK
1. CASE MANAGEMENT OBLIGATIONS
1.1. Contractor's Obligations
1.1.1.
1.1.1.10.
1.1.1.11.
1.1.1.12.
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:
Colorado Revised Statutes, Title 25.5, Article 6, Sections 104 through and
including 107.
Colorado Department of Health Care Policy and Financing written
communications.
Contractor shall comply with all State Medicaid regulations promulgated by the
Department. These regulations include, but are not limited to:
Long Term Care Single Entry Point System - 10 CCR 2505-10, Sections 8.390
through 8.393 et seq.
Home and Community Based Services Waiver for Persons with Brain Injury
(HCBS-BI) - 10 CCR 2505-10, Section 8.515.
Home and Community Based Services Waiver for Persons who are Elderly, Blind
and Disabled (HCBS-EBD) 10 CCR 2505-10, Sections 8.485 through 8.486.
Community Mental Health Supports Waiver (HCBS-CMHS) 10 CCR 2505-10,
Section 8.509.
Home and Community Based Service Complementary and Integrative Health
Waiver (HCBS-CIH) 10 CCR 2505-10 8.517.5
Waiver for Children with a Life Limiting Illness (HCBS-CLLI) 10 CCR 2505-10,
Section 8.504.
Long -Term Care 10 CCR 2505-10, Sections 8.400 through 8.409.
Program for All -Inclusive Care for the Elderly (PACE) Section 25.5-5-412, Section
6a -b., C.R.S.
Recipient Appeals, 10 CCR 2505-10, Section 8.057.
1.1.2. 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.
1.1.3. The general Business Functions of Contractor shall include, but is not limited to, all of
the following:
1.1.3.1. Providing access to its facilities for Members, inidividuals seeking services, service
providers, and community members. Regular business office hours of operation
shall be posted and made available to the public and accommodations shall be made
available for individuals and Members who need assistance or consultation outside
regular business office hours. Contractor shall provide emergency contact
information to the Department for Key Personnel, when posted hours of operation
do not follow a standard Monday through Friday schedule.
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1.1.3.2. Contractor shall notify and obtain approval from the Department within 10
Business Days of the Effective Date in writing if regular business hours do not
follow a standard Monday through Friday schedule, or if closures are planned
outside of federal, state or local legal holidays.
1.1.3.2.1. Contractor must have documented policies or procedures that
demonstrate to the Department that all required Contract activities and
timelines are being met, individuals and member needs are being fulfilled,
and the schedule does not negatively impact individuals and members.
1.1.3.2.2. Contractor shall make the policies and procedures available to the
Department upon request.
1.1.3.3. Overcoming any geographic barriers within the Region/District, including distance
from the agency office to provide timely assessment and case management services
to individuals and Members.
1.1.3.4. Protecting individuals and Members' rights as they relate to the responsibilities of
SEP agencies as described in this Contract.
1.1.3.5. Providing a person -centered business approach seeking to accommodate Member
requests.
1.1.3.6. Providing access to a telephone system and trained staff to ensure timely response
to messages and telephone calls received after hours.
1.1.3.7. Providing access to telecommunication devices and/or interpreters for the hearing
and vocally impaired and access to foreign language interpreters as needed.
1.1.3.8. Following communication standards set by the Department. The application of
these standards includes but is not limited to Memo Series, technical assistance
documents, Provider Bulletins, training documents, and email correspondence.
1.1.3.9. Contractor shall support the Department's National Core Indicators (NCI) efforts.
1.1.3.10. Contractor shall support the Department's Equity, Diversity, Inclusion, and
Accessibility (EDIA) efforts to include participation in a Department led EDIA
assessment and survey.
1.1.3.11. The Contract shall support the Department and the Department's Contractor in
efforts for transition planning related to case management redesign.
1.1.3.12. Contractor shall consult with the Medical Consultant(s) regarding medical and
diagnostic concerns and long-term home health prior authorizations.
1.2. Collaboration with other Care Coordination Entities or Entry Point and Case
Management Agencies
1.2.1. Contractor shall comply with written communications 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 Department enrollees. As applicable, the
communications shall address partnerships with:
1.3. Regional Accountable Entities (RAE)
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1.3.1. The RAE is responsible for promoting physical and behavioral health. The RAE
promotes the population's health and functioning, coordinates care across disparate
providers, interfaces with LTSS providers, and collaborates social, educational, justice,
recreational, and housing agencies to foster healthy communities and address complex
needs that span multiple agencies and jurisdictions. The RAE manages a network of
primary care physical health providers and behavioral health providers to ensure access
to appropriate care for Medicaid Members.
1.3.2. Contractor shall support the Department's RAE efforts and ensure collaboration occurs
for all shared Members.
1.3.3. Contractor shall work with the RAE when a Member requires assistance in accessing
or coordinating appropriate physical, behavioral, or mental health resources. This shall
include, but is not limited to:
1.3.3.1. Coordinating with the RAE regarding 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.
1.3.3.2. Collaborating with the RAE for shared Members who are being discharged 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.
1.3.3.3. Coordination with RAEs for Members who require complex care coordination
including but not limited to Members with high utilization, disparity to healthcare
access and co-occuring disabilities and behavorial health.
1.3.3.4. Sharing of all information necessary for the RAE to assist Members in accessing
and coordinating physical and behavioral health needs.
1.3.3.5. Contractor shall honor Members' preferences for case management and care
coordination, when applicable, while ensuring collaboration with the RAE occurs.
1.3.3.6. Contractor shall work with the Department to identify a Key Performance Indicator
(KPI) to measure the effectiveness of coordination between Contractor and RAE.
1.4. Entry Point and Case Management Agencies
1.4.1. Community Centered Boards (CCB) are the agencies responsible for determining
eligibility for LTSS programs targeted to Members with intellectual and developmental
disabilities. These programs include four HCBS waivers and three State General
Funded programs. In addition to determining eligibility for these programs, the CCB
also manages the waiting list for one HCBS waiver. The CCB may also act as a Case
Management Agency (CMA) and may also provide direct services. A CMA is
responsible for providing case management services to Members enrolled in a HCBS
waiver targeted to Members with an intellectual or developmental disability. Case
Management includes assessing a Member's needs, developing a Person -Centered
Support Plan, referring for services, and monitoring the receipt of those services, along
with the health and welfare of Members.
1.4.2. Contractor shall collaborate with CCBs and CMAs, this may include, but is not limited
to:
1.4.2.1. Coordinating the transfer of Members switching to or from an HCBS waiver
targeted for Members with an intellectual or developmental disability or specific to
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children with disabilities and connecting individuals or Members to the appropriate
CCB or CMA.
1.4.2.2. Sharing information necessary for the CCB and/or CMA to assist individuals in
accessing LTSS programs targeted for individuals with an intellectual or
developmental disability or children with disabilities.
1.4.2.3. Coordinating the receipt of LTSS when a Member is enrolled in an HCBS waiver
not targeted for Members with an intellectual and developmental disability and a
State General Funded program.
1.5. Qualification and Training Requirements
1.5.1. 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 8.393.1.L et seq.
1.5.2. Contractor shall ensure all newly hired case managers meet the qualification
requirements established in 10 C.C.R. 2505-10, Section 8.393.1.L. et seq.
1.5.3. Contractor shall ensure that all case management staff receive trainings listed below
and any additional Department assigned training within 120 calendar days after the
staff member's hire date and prior to being assigned independent case management
duties. All other case management staff must receive a refresher training as required by
the Department, Department approved vendor, or Contractor. Training must include
the following areas:
1.5.3.1. Long Term Services and Supports Eligibility
1.5.3.2. Intake and Referral
1.5.3.3. Level of Care Screen and Needs Assessment
1.5.3.4. Person -Centered Support Plan Development
1.5.3.5. Notices and Appeals
1.5.3.6. Systems Documentation
1.5.3.7. Long Term Home Health (LTHH)
1.5.3.8. Monitoring
1.5.3.9. Applicable Federal and State laws and regulations for LTSS programs
1.5.3.10. Critical Incident Reporting
1.5.3.11. Waiver requirements and services
1.5.3.12. Mandatory reporting
1.5.3.13. Pre -Admission Screening and Resident Review (PASRR)
1.5.3.14. Nursing Facility admissions
1.5.3.15. Disability and Cultural Competency
1.5.3.16. Participant Directed Training
1.5.4. There will be no exemptions to the above list of required trainings as all case managers
should have a basic knowledge of all case management activities regardless of ongoing
duties.
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1.5.5. Contractor shall utilize training materials provided by the Department where applicable
related to Section 1.5 of this Exhibit.
1.5.6. Contractor shall participate in Department trainings. Participation can be at the time of
the presented training or following the training using the materials available on the
Department Website or Learning Management System (LMS).
1.5.7. 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.
1.5.8. Contractor may elect to perform additional training not outlined in the Contract but
applicable to the Scope of Work. Contractor may utilize the Department's Case
Management Training Template to identify trainings attended that are not required by
the Department.
1.5.9. 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
1.5.3.1, using the reporting template provided by the Department for review, approval
and payment.
1.5.10. Within one year of implementation of the Department prescribed Level of Care Screen
and Needs Assessment:
1.5.10.1. Case Managers are required to receive oversight reviews of their performance
including their competency with completing the Level of Care Screen and Needs
Assessment. Supervisors, lead workers or a case manager with three years of case
management experience shall perform shadow assessments with one half of
Contractors Case Management staff prior to the end of Contract Fiscal year to
complete the Level of Care Screen and Needs Assessment. Documentation on Case
Manager performance shall be maintained by Contractor and provided to the
Department upon request.
1.5.10.2. Case Managers are required to meet competency requirements determined by the
Department to perform case management tasks including the correct application of
the assessment and person -centered support plan, and applicable waiver benefits.
Case Managers must pass assigned training competency requirements to
independently perform Case Management activities.
1.5.10.2.1. DELIVERABLE: Case Management Training
1.5.10.2.2. DUE: Semi -Annually, trainings held between July 1st and December 31st
are due January 15th, and trainings held between January 1st through June
29th are due June 30th or the Fiscal Year end close date set by the
Department.
1.5.11. Contractor shall maintain supporting documentation demonstrating case managers
attended the required trainings and make the information available to the Department
upon request. Supporting documentation must include the name and description of the
training, date the training was held, case managers in attendance, and trainer sign off
showing the case manager completed the training.
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1.5.11.1. Case Management staff employed by Contractor shall complete Department
prescribed training prior to the launch of the Department's new Care and Case
Management (CCM) Information Technology system.
1.5.11.2. Case managers must meet the competency requirements as outlined in Department
training guidance.
1.5.11.2.1. DELIVERABLE: Completed Case Management Training on the Care and
Case Management (CCM) system.
1.5.11.2.2. DUE: No later than June 30th
1.6. Complaints and Grievances
1.6.1. 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, and case management functions.
1.6.1.1. Complaints received outside of the scope of this Contract shall not be
included.
1.6.1.2. 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.
1.6.2. 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.
1.6.3. Trend analysis shall include an examination of information including, but not limited
to:
1.6.3.1. A comparison of complaint types and number of complaints over a period of time
determined by the Department.
1.6.3.2. Number of type of complaint against Contractor, time, location, individual
involved, staff involved, and/or any additional relevant information.
1.6.3.3. An examination of potential reasons for the increase or decrease in complaints by
total number, subcontractor, individual, or staff.
1.6.3.4. An examination of preventative measures that can be implemented to reduce the
number or frequency of future complaints.
1.6.3.5. Implementation of a plan of action or any future actions to take place.
1.6.3.6. An analysis of whether the plan of action and changes made were effective or if
additional changes need to occur.
1.6.4. As part of the complaint process Contractor shall:
1.6.4.1 Document complaints received.
1.6.4.2. Address substantiated complaints.
1.6.4.3 Respond to complaints received and document actions taken to resolve and/or
mitigate complaints.
1.6.4.4. Conduct a quarterly trend analyses of all complaints received for the full period of
the Contract.
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1.6.4.5. 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. 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.
1.6.6. 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.
1.6.7. Contractor shall submit the Complaint Trends Analysis to the Department for review,
approval, and payment.
1.6.7.1. DELIVERABLE: Complaint Trend Analysis
1.6.7.2. DUE: Quarterly, by October 31st, January 31st, April 30th and June 30th of each
year or the Fiscal Year end close date set by the Department
1.7. Continuous Quality Improvement Plan
1.7.1. Contractor shall provide 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.
1.7.1.2. How Contractor reviews work to determine if the work is being completed in a
correct and high -quality manner.
1.7.1.3. How the Contract identifies and addresses Case Management performance issues.
1.7.2. Contractor shall submit the Continuous Quality Improvement Plan to the Department
for review, approval, and payment.
1.7.2.1. DELIVERABLE: Continuous Quality Improvement Plan
1.7.2.2. DUE: Within 45 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 that changes were not required.
1.7.3.1. DELIVERABLE: Continuous Quality Improvement Plan Update
1.7.3.2. DUE: Annually, by August 15th
1.8. Appeals
1.8.1. Contractor shall represent the Department and defend any adverse action in accordance
with 10 CCR 2505-10, Sections 8.057 et. seq. in all appeals initiated during this
Contract. Contractor shall coordinate with the Department for any adverse actions
necessitating Department attendance at a hearing.
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1.8.2. Contractor shall identify and disclose to the Department immediately, and no later than
45 days prior to a scheduled appeal hearing, any conflict of interest that would interfere
with Contractor's ability to represent the Department in any appeal.
1.8.3. Contractor shall represent its actions at Administrative Law Judge hearings when the
individual or Member appeals a denial or adverse action affecting individuals or
Member's program eligibility or receipt of services.
1.8.4. Contractor shall process appeals in accordance with schedules published by the State
of Colorado Office of Administrative Courts and rules promulgated by the Department.
1.8.5. Contractor shall develop an Appeals Packet which contains all relevant documentation
to support Contractor's denial or adverse action.
1.8.6. Contractor shall develop an Appeals Packet no earlier than 20 Business Days prior to
the date of a scheduled hearing.
1.8.7. Contractor shall submit exceptions when applicable and include all relevant
information.
1.8.8. Contractor shall cooperate with the Office of the State Attorney General for any case
in which it is involved.
1.8.9. Contractor shall document all appeals where Contractor attends any hearing in an
Administrative Law Court.
1.8.10. Contractor shall make the Appeal Packets available to the Department upon request.
1.8.11. Contractor shall document all Appeals Creation of the Packet and Attendance at the
Hearing information, no later than the 10th day of the month following the month when
the packet or hearing was completed, and follow-up in the Department prescribed
system and maintain detailed documentation. The Department will review internal data
reports to verify the number of Appeal Packets completed and number of Hearings
attended for payment purposes.
1.8.11.1. PERFORMANCE STANDARD: 100% of Appeal Packets and Hearings
Attended are added to the Department prescribed system monthly by the 10th day
of the month following the month when the packet or hearing was completed.
1.9. Critical Incident Reporting
1.9.1. 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.
1.9.2. Contractor shall ensure all suspected incidents of abuse, neglect, and exploitation are
immediately reported consistent with current statute; Section 19-10-103 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).
1.9.3. Contractor shall document all CIR follow-up information in accordance with
Department direction in the Department prescribed system and maintain detailed
documentation.
1.9.3.1 PERFORMANCE STANDARD: 100% of CIRs are added to the Department
prescribed system within one Business Day.
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1.10. Critical Incident Quarterly Follow -Up Completion Performance Standard
1.10.1. 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.
1.10.2. 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.
1.10.3. 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 to
48 hours.
1.10.4. 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 3 to 4 Business Days.
1.10.5. 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.
1.10.5.1. PERFORMANCE STANDARD: 90% of all CIRs assigned follow-up is
completed and entered into the Department's prescribed system within the
timelines established by the Department and/or the Department's Quality
Improvement Organization each quarter.
1.11. Corrective Action Plan
1.11.1. When the Department determines that Contractor is not in compliance with any term
of this Contract, Contractor, upon written notification by the Department, shall develop
a corrective action plan. Corrective action plans shall include, but not be limited to:
1.11.1.1. A detailed description of actions to be taken including any supporting
documentation.
1.11.1.2. A detailed time frame specifying the actions to be taken.
1.11.1.3. Contractor's employee(s) responsible for implementing the actions.
1.11.1.4. The implementation time frames and a date for completion.
1.11.2. Contractor shall submit the Corrective Action Plan to the Department within 10
Business Days of the receipt of a written request from the Department.
1.11.2.1. DELIVERABLE: Corrective Action Plan
1.11.2.2. DUE: Within 10 Business Days of receipt of a written request from the Department
1.11.3. Contractor shall notify the Department in writing, within three Business Days, if it will
not be able to present the Corrective Action Plan by the due date. Contractor shall
explain the rationale for the delay and the Department may grant an extension, in
writing, of the deadline for Contractor's compliance.
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1.11.4. Upon receipt of Contractor's Corrective Action Plan, the Department will accept,
modify or reject the proposed Corrective Action Plan. Modifications and rejections
shall be accompanied by a written explanation.
1.11.5. In the event of a rejection of Contractor's Corrective Action Plan Contractor shall re-
write a revised Corrective Action Plan and resubmit it along with requested
documentation to the Department for review.
1.11.5.1. DELIVERABLE: Revised Corrective Action Plan
1.11.5.2. DUE: Within five Business Days of the Department's rejection
1.11.6. Upon acceptance by the Department Contractor shall implement the Corrective Action
Plan.
1.11.7. If corrections are not made by the timeline and/or quality specified by the Department
then funds may be withheld from this Contract. Payments of funds from this Contract
will resume beginning the month that the correction is made and accepted by the
Department.
1.11.8. As part of the Corrective Action Plan, supporting documentation demonstrating that
deficiencies have been remediated may be required. Contractor shall ensure all
supporting documentation is submitted within the timeframes established in the
Corrective Action Plan.
1.11.9. Upon receipt of Contractor's supporting documentation, the Department will accept,
request modifications, or reject the documentation. Modifications and rejections shall
be accompanied by a written explanation.
1.11.10. In the event of a rejection of Contractor's supporting documentation to the Corrective
Action Plan, Contractor shall correct and resubmit the supporting documentation to the
Department for review.
1.11.11. If a Corrective Action Plan or any supporting activities or documentation are required
to correct a deficiency, are not submitted within the requested timeline and/or quality
specified by the Department, funds may be suspended or withheld from this Contract.
1.11.11.1. DELIVERABLE: Revised Supporting Documentation
1.11.11.2. DUE: Within five Business Days of the Department's rejection
1.11.12. If corrections are not made by the timeline and quality specified by the Department
then funds may be withheld from this Contract. Payments of funds from this Contract will
resume beginning the month that the correction is made and accepted by the Department.
1.12. Intake, Screening, and Referral
1.12.1. Contractor shall perform all intake, screening and referral functions/activities for the
operation of a SEP agency in accordance with §25.5-6-104, C.R.S. and 10 CCR 2505-10,
Sections 8.393.2.B. et seq., shall include, but not limited to, the following:
1.12.2. Facilitating the Medicaid application process and responding to all referrals of potentially
eligible individuals and Members within Department prescribed timeframes.
1.12.3. Processing information regarding individual Medicaid eligibility within two Business Days
of receipt from the eligibility site.
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1.12.4. Ask referring agencies to complete and submit an intake and screening form to initiate the
process.
1.12.5. Providing information and referral to other agencies as needed.
1.12.6. Making initial contact with individuals to include a preliminary screening in the following
areas:
1.12.6.1. An individuals need for LTSS.
1.12.6.2. An individuals need for referral to other programs or services.
1.12.6.3. An individuals eligibility for financial and program assistance.
1.12.6.4. The need for a Level of Care Screen.
1.12.6.5. Maintain individual and Member records including documentation of the referrals and
outcome utilizing the Department's prescribed system.
1.12.7. Contractor shall ensure documentation includes the individuals and Member's need for
LTSS and/or the individuals and Member's request for a Level of Care Screen, even though
the screening indicates the individual may not be eligible for LTSS.
1.12.8. Individuals shall be notified at the time of their application for publicly funded LTSS that
they have the right to appeal actions of the SEP agency. The notification shall include the
right to request a fair hearing before an Administrative Law Judge.
1.12.8.1. PERFORMANCE STANDARD: 100% percent of Referrals are entered into the
Department prescribed system monthly by the 10th day of the following month for the
previous month.
1.13. Level of Care Assessment and CCM Tool Screen and Assessment
1.13.1. Contractor shall perform the Functional Eligibility Assessment (100.2) as indicated in
Section 1.14 or the CCM Tool Screen and Assessment as indicated in Section 1.16 for each
Member as directed by the Department. Contractor shall not perform both a Level of Care
Assessment and a new CCM Tool Screen and Assessment for the same Member unless
directed to do so by the Department.
1.14. Level of Care Assessment (100.2)
1.14.1. Contractor shall perform all Initial and Continued Stay Review Level of Care (100.2)
Assessments for the operation of a SEP agency in accordance with §25.5-6-104, C.R.S.,
10 CCR 2505-10, Section 8.401, and 10 CCR 2505-10, Sections 8.393.2 et seq.
1.14.2. Contractor shall conduct Initial and Continued Stay Review (CSR) Level of Care (100.2)
Assessments for the following LTSS programs:
1.14.2.1. HCBS waivers;
1.14.2.2. Program of All -Inclusive Care for the Elderly (PACE);
1.14.2.3. Nursing Facility;
1.14.2.4. Hospital Back -Up (HBU); and
1.14.2.5. Long Term Home Health.
1.14.3. Contractor shall conduct an Initial and CSR Level of Care (100.2) Assessments in
accordance with the following timelines:
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1.14.3.1. Ten Business Days after receiving confirmation that the Medicaid application has been
received by the county Department of Human or Social Services for individuals residing
in the community.
1.14.3.2. Ten Business Days after receiving a referral from a provider for the PACE.
1.14.3.3. Five Business Days after receiving a completed referral from the nursing facility.
1.14.3.4. Five Business Days after receiving a completed approval for the CLLI Waiver.
1.14.3.5. Two Business Days after receiving a completed referral from the hospital.
1.14.4. Initial Functional Eligibility Assessments shall include the following Assessment Event
Types:
1.14.4.1. Initial Review (IR)
1.14.4.2. Deinstitutionalization (DI)
1.14.4.3. Reverse Deinstitutionalization (RDI)
1.14.4.4. Program of All-inclusive Care for the Elderly (PACE)
1.14.4.5. Hospital Back-up Unit (HBU)
1.14.4.6. Nursing Facility (NF)
1.14.4.7. Long Term Home Health (LTHH)
1.14.5. Contractor shall conduct a CSR Level of Care (100.2) Assessment no earlier than 90 days
prior to and no later than the previous Functional Eligibility Assessment end date.
1.14.6. CSR Level of Care (100.2) Assessments shall include the following Assessment Event
Types:
1.14.6.1. Continued Stay Review
1.14.6.2. Nursing Facility Transfers
1.14.6.3. Unscheduled Review
1.14.6.3.1. An Unscheduled Review Assessment Event Type shall be utilized when a Level of
Care (100.2) Assessment is completed due to a change in the Member's functioning
and support needs.
1.14.7. In the event Contractor fails to conduct the CSR Level of Care (100.2) Assessment for
a Member enrolled in a HCBS waiver, Contractor shall be responsible for reimbursing
any providers for services rendered during the gap in eligibility.
1.14.8. In the event Contractor fails to discontinue waiver services for a Member, found
ineligible for a HCBS waiver, Contractor shall be responsible for reimbursing any
providers for services rendered.
1.14.9. Contractor shall conduct an Initial and CSR Level of Care (100.2) Assessments to
include, but not limited to, the following:
1.14.9.1. Verification of Medicaid eligibility or Medicaid application submission.
1.14.9.2. Conduct all Level of Care (100.2) Assessment face-to-face with the individual or
Member, at minimum, and in the place where the individual or Member resides.
1.14.9.3. Receipt and Review of the Professional Medical Information Page (PMIP).
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1.14.10. Contractor shall verify that an indivival or Member needs an institutional level of care
by receiving a PMIP signed by a medical professional and dated no earlier than six
months from the certification start date and no later than 90 days from
the evaluation date of an Initial Level of Care (100.2) Assessment; and within 90
calendar days of the certification start date and before the certification end date for a
CSR for all Clients and Members currently receiving services through an HCBS
waiver.
1.14.11. Review of all supportive information (documentation and interviews) related to the
functional capacity of the individual or Member.
1.14.12. Communicating Level of Care (100.2) Assessmentstatus to the appropriate eligibility
site.
1.14.13. Representing the Department in all appeals relevant to a LTSS program eligibility.
1.14.14. Review of HCBS waiver target criteria for applicant, individuals or Member
participation.
1.14.15. Determine individual or Member Level of Care (100.2) Assessment for enrollment in
an HCBS waiver, PACE, LTHH, HBU, or NF admission.
1.14.16. Provide a notice of action to individuals or Members of all appealable actions related
to their eligibility in a LTSS program.
1.14.17. Maintaining individuals or Member records including all relevant information utilizing
the Department's prescribed system.
1.14.18. Contactor shall document all Initial and CSR Level of Care (100.2) Assessment
information in the Department prescribed system according to assessment timeline
identified at 10 CCR 2505-10, Sections 8.393.2.C et seq.
1.14.18.1. PERFORMANCE STANDARD: 100% percent of Initial Level of Care (100.2)
Assessment and Continued Stay Review Level of Care (100.2)
AssessmentAssessments are completed within required timelines at 10 CCR 2505-
10, Sections 8.393.2.C et seq. and are entered into the Department prescribed
system. Assessments must be verified by the 10th day of the month for the previous
month to be eligible for payment.
1.15. Care and Case Management (CCM) System Implementation
1.15.1. Contractor shall participate in the implementation of the Department's new Care and
Case Management (CCM) Information Technology system and the Colorado Single
Assessment and Person -Centered Support Plan instruments as requested and
determined by the Department.
1.15.2. Contractor shall manage Member records and document case management activities
formally completed in the Benefits Utilization System (BUS) using the CCM.
1.15.3. Contractor will complete either the ULTC 100.2 and Service Plan (formally completed
in the BUS Or the new Colorado Single Assessment and Person -Centered Support Plan
instruments for initial and reassessments as determined by the Department and
document each in the CCM system.
1.15.4. Staff employed by Contractor shall participate in training, as required and outlined by
the Department as outlined in Section 1.5.11.1, on the CCM system automation; the
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1.15.7.1.
1.15.7.2.
1.15.7.3.
1.15.7.4.
1.15.7.5.
1.15.8.
Colorado Single Assessment and Person -Centered Support Plan instruments prior to
performing the LOC Screen, Needs Assessment, or Person -Centered Support Plan.
1.15.5. Contractor shall explain to Members the new assessment and support plan process at
the time of the CSR and at initial enrollment, as directed by the Department.
1.15.6. Contractor shall schedule and conduct new LOC Screen in accordance with the
timelines in Section 1.17 and 1.19 of this Contract.
1.15.7. Contractor shall conduct a Level of Care Assessment for Continued Stay Reviews for
the following Home and Community Based Services (HCBS) Waivers in the CCM
system:
HCBS - BI
HCBS - CMHS
HCBS - EBD
HCBS - CIH
HCBS - CLLI
Contractor shall assess and determine eligibility for HCBS waivers based on each
waiver program targeting criteria and assist the client to select the appropriate waiver
based on the eligibility determination.
1.15.9. Contractor shall manually submit LOC determination, to include the waiver program
selection based on the targeting criteria eligibility determination, to the appropriate
county, using a process as determined by the Department. For initial enrollments, once
confirmation of financial eligibility is determined, if the individual has chosen a waiver
program that is not managed by Contractor, Contractor shall coordinate a transfer to
the appropriate case management agency and assure the transfer is reported to the
Department and is completed.
1.15.10. Contractor shall provide feedback on system automation, system issues and training
materials. as directed by the Department or the Department's designee.
1.15.10.1. DELIVERABLE: Completed Case Management Training on the Colorado Single
Assessment and Person -Centered Support Plan.
1.15.10.2. DUE: No later than June 30th
1.16. CCM Level of Care Screen and Needs Assessment
1.16.1. Level of Care Screen and Needs Assessment
1.16.1.1. Contractor shall perform all Initial and Annual Reassessment Level of Care Screen
and Needs Assessments for the operation of a CMA in accordance with §25.5-6-
104, C.R.S., 10 CCR 2505-10, Section 8.401, and 10 CCR 2505-10, Sections
8.393.2 et seq.
1.16.1.2. The Initial and Reassessment Level of Care Screen shall include and ensure, but
not limited to, the following:
1.16.1.3. A verification of Long -Term Care (LTC) Medicaid Financial eligibility or LTC
Medicaid application submission.
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1.16.1.4. 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.
1.16.1.5. Needs Assessment shall be conducted in person or virtually based on the
individuals or Member's preference.
1.16.1.5.1. Contractor shall verify that a Member needs an institutional level of care by
receiving a PMIP signed by a medical professional and dated no earlier than six
months from the certification start date and no later than 90 days from the
evaluation date of an Initial Level of Care Screen; and within ninety 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), , and Program for All -
Inclusive Care for the Elderly (PACE).
1.16.1.6. A review of all supportive information related to the Level of Care for the Member
to include, but not limited to documentation and interviews.
1.16.1.7. Communicating Level of Care Eligibility status to the appropriate eligibility site.
1.16.1.8. Representing the Department in all appeals relevant to a LTSS program eligibility.
1.16.1.9. A review of HCBS waiver Target Criteria for applicant or Member participation.
1.16.1.10. Determine individual or Member Level of Care Eligibility for enrollment in a BI,
EBD, CIH, CLLI, CMHS, PACE, LTHH, HBU, or Nursing Facility admission.
Analyzing the information obtained to determine the most appropriate responses to
the Level of Care Screen questions.
1.16.1.11. Providing notice of action to Members of all appealable actions related to their
eligibility in a LTSS program.
1.16.1.12. Documenting and maintaining Level of Care Screens and Needs Assessments,
including all relevant information, utilizing the Department's prescribed system
within the timeframes established in 10 CCR 2505-10, Sections 8.393.2.C et seq.
1.17. Level of Care Screen
1.17.1. The Level of Care Screen shall include the following event types:
1.17.1.1. Initial
1.17.1.2. Reassessment
1.17.1.3. Off -Cycle Review
1.17.2. Contractor shall conduct an Initial Level of Care Screen prior to enrolling in the
following programs:
1.17.2.1. BI, EBD, CIH, CLLI, CMHS HCBS Waivers
1.17.2.2. PACE
1.17.2.3. Nursing Facilities
1.17.2.4. Hospital Back -Up
1.17.2.5. LTHH (only)
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1.17.3. Contractor shall conduct an Initial Level of Care Screen in accordance with the
following timelines:
1.17.3.1. Within 10 Business Days after receiving confirmation that the Medicaid application
has been received by the county Department of Human or Social Services for
individuals residing in the community.
1.17.3.2. Within 10 Business Days after receiving a referral from a provider for PACE.
1.17.3.3. Within five Business Days after receiving a completed referral from the nursing
facility.
1.17.3.4. Within five Business Days from the date of referral for individuals residing in a
nursing facility or ICF-IID.
1.17.3.5. Within five Business Days after receiving a completed approval for the CLLI
Waiver.
1.17.3.6. Within two Business Days after receiving a completed referral from the hospital.
1.17.4. The Initial Level of Care Screen shall include, but is not limited to the following:
1.17.4.1. A review of financial eligibility information
1.17.4.2. A review of the Level of Care Screen information
1.17.4.3. A review of relevant medical, educational, social, or other assessment records or
information when applicable.
1.18. Annual Level of Care Screen Reassessment
1.18.1. Contractor shall conduct an Annual Reassessment Level of Care Screen no earlier than
90 days prior to and no later than 30 days prior to the Level of Care Screen certification
end date.
1.18.2. 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.
1.18.3. In the event Contractor fails to conduct the Annual Reassessment Level of Care Screen
for a Member enrolled in a HCBS waiver, Contractor shall be responsible for
reimbursing any providers for services rendered during the gap in eligibility.
1.18.4. Contractor shall follow 10 C.C.R. 2505-10, Section 8.393.6 when transferring a
Member from one county to another county or from one Defined Service Area to
another Defined Service Area.
1.18.5. Contractor shall take action regarding Member Medicaid eligibility within one
Business Day of receipt from the eligibility site.
1.18.6. In the event Contractor fails to discontinue waiver services for a Member found
ineligible for a HCBS waiver, Contractor shall be responsible for reimbursing any
providers for services rendered.
1.18.6.1. PERFORMANCE STANDARD: 100% of Initial Level of Care Screen and
Annual Level of Care Screen assessments are conducted within required timelines
at 10 CCR 2505-10, Sections 8.393.2.C et seq. and are entered into the Department
prescribed system. The Level of Care Screen must be entered into the Department
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prescribed system following the timelines at 10 CCR 2505-10, Sections 8.393.2.C
et seq.
1.18.7. Members shall be notified at the time of the eligibility decision that they have the right
to appeal actions of Contractor to 10 CCR 2505-10 Section 8.519.22 et seq. The
notification shall include the right to request a fair hearing before an Administrative
Law Judge.
1.19. Needs Assessment
1.19.1. Contractor shall conduct an Initial and Annual Needs Assessment for the following
programs:
1.19.1.1. BI, EBD, CIH, CLLI, CMHS HCBS Waivers
1.19.2. Contractor shall conduct a Needs Assessment (Initial) prior to enrollment into a HCBS
waiver, annually (Reassessment) and as needed (off -cycle) by the Member due to a
material change of situation or condition that may reasonably result in a change in the
support needs of the Member. Members who are financially eligible, choose to enroll
in HCBS waiver services, meet the required Level of Care for LTSS and waiver Target
Criteria for one or more HCBS waivers must have a Needs Assessment conducted.
1.19.3. Contractor shall conduct a Needs Assessment with Members to determine the level of
support needed and identify personal preferences and goals.
1.19.4. 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.
1.19.5. Contractor shall conduct and document a Needs Assessment for Members in
accordance with the following timelines:
1.19.5.1. Within 15 Business Days after determination of Level of Care and Financial eligibility
for HCBS Waivers.
1.19.6. 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. They
may also be completed over two or more sessions, if the Member needs or prefers to
do so.
1.19.7. The Needs Assessment shall be conducted at time, modality and location convenient to
the Member and should include people of the Member's identified preference.
1.20. On -Going HCBS Case Management
1.20.1. Case Management services shall include, but is not limited to:
1.20.1.1. A range of deliberate activities to organize and facilitate the appropriate delivery of
Long Term Services and Supports that support the Member's health and well-being.
1.20.1.2. Contractor shall use a Person -Centered Approach to Case Management, which
takes into consideration the preferences and goals of Members and then connects
them to the resources required to address assessed needs, goals, and preferences.
1.20.2. Contractor shall not duplicate Care Coordination provided through the RAEs and other
programs designed for special populations; rather, Contractor shall work to link the
different Care Coordination activities to promote a holistic approach to a Member's
care.
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1.20.3.
1.20.3.1.
1.20.3.2.
1.20.3.3.
1.20.3.4.
1.20.3.5.
Contractor shall ensure that Case Management:
Is accessible to Members.
Is culturally responsive.
Respects Member preferences.
Protects Members' Privacy.
Supports regular communication between service providers, other agencies, and the
Member.
1.20.3.6. Reduces duplication and promotes continuity by collaborating with the Member
and the Member's service providers.
1.20.3.7. The use of mass email communication, robotic and/or automatic voice messages
cannot be used to replace Contractors required individualized case management or
any billable activities.
1.21. Person -Centered Support Planning
1.21.1. Contractor shall develop Person -Centered Support Plans as part of the operations of a
SEP agency in accordance with §25.5-6-104, C.R.S. and 10 CCR 2505-10, Sections
8.393.2.E. et seq.
1.21.2. Contractor shall create and maintain a Person -Centered Support Plan for Members in
accordance with the following timelines:
1.21.3. Within 15 Business Days after determination of Level of Care and Financial eligibility
for HCBS waivers.
1.21.4. Contractor shall provide necessary information and support to ensure that the Member
directs the process to the maximum extent possible and is able to make informed
choices and decisions and create a Person -Centered Support Plan. This Person -
Centered Support Plan shall include, but not be limited to, the following:
1.21.4.1. Ensure the Person -Centered Support Planning occurs at a time and location
convenient to the Member receiving services;
1.21.4.2. Be led by the Member, family members and/or Member's representative with the
case manager support, as needed;
1.21.4.3. Includes people chosen by the Member;
1.21.4.4. Addresses the goals, needs and preferences identified by the Member throughout
the planning process;
1.21.4.5. Addresses the support needs identified in the Needs Assessment;
1.21.4.6. Offers informed choice to the Member regarding the services and supports they
receive and from whom, as well as the documentation of services needed, including
type of service, specific functions to be performed, duration and frequency of
service, type of provider and services needed that may not be available;
1.21.4.7. Include strategies for solving conflict or disagreement within the process, including
clear conflict -of -interest guidelines for all planning participants;
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1.21.4.8.
1.21.4.9.
1.21.4.10.
1.21.4.11.
1.21.4.12.
1.21.4.13.
1.21.4.14.
1.21.5.
1.21.5.1.
Reflect cultural considerations of the Member and be conducted by providing
information in plain language and in a manner, that is accessible to individuals with
disabilities and persons who are limited English proficient;
Formalize the Person -Centered Support Plan, with the informed consent of the
Member in writing, and obtain signatures by all individuals and providers
responsible for its implementation, in accordance with program requirements;
Contain prior authorization for services, in accordance with program directives,
including cost containment requirements;
Include a method for the Member to request updates to the plan as needed;
Include an explanation of complaint procedures to the Member;
Include an explanation of critical incident procedures to the Member; and
Explain the appeals process to the Member.
Contractor shall document and entered all Person -Centered Support Plan information
into the Department's prescribed system(s) within the Department's prescribed
timelines.
PERFORMANCE STANDARD: 100% of Person -Centered Support Plans are
entered into the Department prescribed systems and verified by the required
timeframe.
1.21.5.2. PERFORMANCE STANDARD: 100% of Person -Centered Support Plans are
finalized in the Department prescribed systems by the required timeframe.
1.22. Referral and Related Activities
1.22.1. Contractor shall refer Members for HCBS and other services, as identified through the
Intake Screen and Needs Assessment, and documented in the Person -Centered Support
Plan and entered into the Department's prescribed system.
1.22.2. Contractor shall assist Members in the selection of providers for HCBS waiver services
as desired by the Member. Contractor may use, but is not limited to, the following
methods:
1.22.2.1. Providing a list of qualified provider agencies.
1.22.2.2. Providing the Department's webpage address and information on how to search for
a qualified provider agency.
1.22.2.3. Providing resources for accessing information about provider agency quality, such
as survey information, that is available to the public.
1.22.2.4. Providing information regarding qualified provider agencies based on the
Member's preferences.
1.22.3. Upon the selection of the provider(s) Contractor shall contact the provider(s) to refer
for services.
1.22.4. Upon acceptance from the provider(s) Contractor shall develop the Prior Authorization
Request (PAR).
1.22.5. Contractor shall ensure authorized services are connected to a personal goal and/or
identified need.
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1.22.6. Contractor shall ensure the scope, frequency, and duration of services authorized
correlate to an assessed need and/or personal goal and are within the limitations set
forth in each of the current federally approved waivers.
1.22.7.
1.22.7.1.
1.22.7.2.
1.22.7.3.
1.22.7.4.
1.22.7.5.
1.22.8.
Contractor shall ensure the services authorized are not duplicative of another service,
including but not limited to:
State plan benefits.
Third party resources.
Natural supports.
Charitable organizations.
Other public assistance programs.
Contractor shall ensure the Department or its Contractor's approval is received prior to
services beginning for PARs exceeding cost -containment.
1.22.9. Upon final PAR approval, Contractor shall ensure all providers identified in the Person -
Centered Support Plan receive the approved Prior Authorization (PA) number and
necessary information from the Person -Centered Support Plan to provide services.
1.22.10. Contractor shall create or revise the PAR no less than annually, when the Member
experiences a change in needs warranting a change in HCBS waiver services and when
required by the Department.
1.22.11. The PAR shall be entered into the Department's prescribed system, no later than five
Business Days from finalization of the Person -Centered Support Plan and provider
selection and acceptance.
1.22.11.1. PERFORMANCE STANDARD: 100% of PARs shall be entered into the
Department's prescribed system by the required timeframe.
1.23. Monitoring
1.23.1. Contractor shall conduct monitoring for each Member enrolled in an HCBS waiver.
1.23.2. Monitoring shall be conducted in accordance with 10 CCR 2505-10, Section
8.393.2.G.4 and pursuant to the specific waiver requirements.
1.23.3. Monitoring shall occur at the frequency and in the method identified in the HCBS
waiver and Department regulations for which the Member is enrolled.
1.23.4. At minimum, monitoring includes, but is not limited to the following:
1.23.4.1. Review of the Person -Centered Support Plan.
1.23.4.2. Review of the Member's satisfaction with services.
1.23.4.3. Review of the receipt of services to ensure services are provided in accordance with
the approved Person -Centered Support Plan and Prior Authorization.
1.23.5. Contractor shall conduct a review of service utilization to ensure each Member is
receiving at least one HCBS waiver service every (30) calendar days and to detect
overutilization and/or underutilization of authorized HCBS waiver services, which may
result in a revision to the Person -Centered Support Plan and Prior Authorization.
1.23.6. Contractor shall review health and safety concerns.
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1.23.7. Contractor shall conduct a review of any Critical Incidents.
1.23.8. Contractor shall contact providers, as necessary, but no less than every six months.
1.23.9. Referrals to other agencies or services as needed; to include contacting and
collaborating with the RAE when the Monitoring indicates the Member's needs for
physical and/or behavioral health care; and obtaining collateral information as needed.
1.23.10. Contractor shall obtain collateral information as needed.
1.23.10.1. Results of the Monitoring may lead to the need for Contractor to revise the Person -
Centered Support Plan and Prior Authorization. When this occurs, Contractor shall
comply with Department regulations and this Contract.
1.23.11. Contractor shall conduct an In -Person Monitoring visit at least one time during the
Person -Centered Support Plan year.
1.23.12. Contractor shall ensure one required monitoring visit is conducted in -person with the
Member, in the Member's place of residence.
1.23.13. The Department will reimburse Contractor for up to one additional Virtual or In -Person
Monitoring visit during the Person -Centered Support Plan year. The additional Virtual
or In -Person Monitoring visit shall be determined by the Member's needs and agreed
upon by the Member or at the direction of the Department. The additional In -Person
Monitoring may occur, but is not limited to the following:
1.23.13.1. Following a Critical Incident:
1.23.13.1.1. Upon change in residential setting or following release from short-term
incarceration, discharge from a hospital, nursing facility, or other institutional
setting that did not require a Level of Care Screen.
1.23.13.1.2. Due to a reported change in need that may necessitate a Person -Centered
Support Plan revision.
1.23.13.1.3. As an outcome of a monthly monitoring contact requiring additional follow
up with the Member.
1.23.13.1.4. Following a Member complaint or a request for assistance to resolve an
ongoing issue that presents a health and safety risk;
1.23.13.2. For transition planning purposes:
1.23.13.2.1. Virtual monitoring is defined as the use of electronic video whereby the
member and the case manager can view one another on screen, in real-time
while speaking/meeting.
1.23.13.2.2. The additional Virtual or In -Person Monitoring visit may occur in a setting of
the Member's choosing.
1.23.13.3. Contractor shall conduct additional monitoring as needed by the Member and in a
method as needed or as agreed to by the Member.
1.23.13.4. Contractor shall document all In -Person Monitoring activities in the Department's
prescribed system and maintain detailed documentation. The Department will
review internal data reports to verify the number of In -Person Monitoring activities
for payment purposes.
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1.23.13.4.1.
1.23.13.4.2.
PERFORMANCE STANDARD: 100% of In -Person Monitoring activities shall
occur at the frequency specified in the HCBS waiver for which the Member is
enrolled.
PERFORMANCE STANDARD: 100% of In -Person Monitoring activities shall
be documented in the Department's prescribed system within the required
timeframe.
1.24. Committee Updates
1.24.1. Contractor shall perform all necessary business functions for the operation of a SEP
Agency as defined in the state statutes and regulations including, but not limited to the
following:
1.24.1.1. Establishing a community advisory committee for the purpose of providing public
input and guidance for SEP Agency operation. The committee shall meet at least
twice a year or more often as necessary.
1.24.1.2. Establishing a Resource Development committee to facilitate the development of
local resources to meet the LTSS needs of individuals and Members who reside
within the SEP Region/District.
1.24.2. Bi-annually, Contractor shall provide written Committee Updates to the Department.
Active, on -going participation by key management or administrative staff in other
provider or interest group meetings to discuss Resource Development issues are an
acceptable substitute as long as complete documentation of the discussions and
progress made in developing relevant solutions is incorporated into the committee
updates.
1.24.3. Contractor shall submit the Committee Updates on the Department prescribed template
for the Department's review, approval, and payment
1.24.3.1. DELIVERABLE: Committee Updates
1.24.3.2. DUE: Bi-Annually, for meetings held between July 1st and December 31st,
Committee Updates are due January 15th, and for meetings held between January
1st through June 29th, Committee Updates, are due June 30th of each year or the
Fiscal Year end close date determined by the Department
1.25. HCBS Settings Final Rule Transition Workbook
1.25.1. Contractor shall abide by and perform its duties and obligations in conformity with the
HCBS Settings Final Rule.
1.25.2. Contractor shall document, track, and provide on -going status updates as it relates to
administrative work to support individual transitions under the HCBS Settings Final
Rule. Documentation shall include a HCBS Final Rule Settings Workbook that
includes summarizing efforts at Contractor level and documenting at the individual
Member level steps taken to support, and status of transitions from noncompliant
settings.
1.25.3. The HCBS Settings Final Rule Transition Workbook shall include information
including, but not limited to:
1.25.3.1. Summarizing Contractor's administrative processes and steps to facilitate
Member's transitions from both residential and nonresidential settings, including:
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1.25.3.2. Initially identifying Members affected by provisional and/or final notices of
noncompliance, including individuals who may not have been included in any files
shared by the Department;
1.25.3.3. Explaining Contractor's steps taken to reach out to and provide each identified
Member with the information included in the provisional and/or final notices of
noncompliance; and
1.25.3.4. Identifying areas in which Contractors needs or still needs assistance from the
Department.
1.25.4. Documenting and tracking Members receiving services at residential settings subject
to a provisional and/or final notice of noncompliance, to include, but not be limited to:
1.25.4.1. Member identification information (first name, last name, Medicaid ID);
1.25.4.2. Member's provider at noncompliant setting and the location of this setting;
1.25.4.3. Dates of initial communications with Member and provider based on the
provisional notice of noncompliance; and
1.25.4.4. If the setting was subject to a final notice of noncompliance, the following
additional information:
1.25.4.4.1. Current status of transition, and if not on track, a summary of the situation;
1.25.4.4.2. Case manager, transition team identified, and supervisor assigned;
1.25.4.4.3. Date of initial individual transition planning conversation based on final notice of
noncompliance;
1.25.4.4.4. Member RFP details (dates, agencies, etc.);
1.25.4.4.5. Monitoring activity (health and safety);
1.25.4.4.6. Progress updates/summaries; and
1.25.4.4.7. Post -transition check -in dates.
1.25.5. Documenting and tracking Members receiving services at nonresidential settings
subject to a provisional and/or final notice of noncompliance, to include, but not be
limited to, the same categories of information as specified above in Section 1.25.4.
1.25.6. Contractor shall submit the HCBS Settings Final Rule Transition Workbook to the
Department for review, approval, and payment. the Department's prescribed
workbook template
1.25.6.1. DELIVERABLE: Final HCBS Settings Final Rule Transition Workbook
1.25.6.2. DUE: No later than June 1st
1.26. COVID-19 Public Health Emergency Ending Activities
1.26.1. Contractor shall review all currently served Members to identify which members no
longer meet the programmatic requirements to maintain their eligibility.
1.26.2. Contractor shall perform a minimum of two attempts to reach and/or located the
member or their representative using their preferred method of communication.
1.26.3. Contractor shall document all contact with Members using the Department Prescribed
System.
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1.26.4. Contractor shall work with their County Office related to functional and financial
eligibility.
1.26.5. Contractor shall outreach all currently served Members to inform them of the end of
the Public Health Emergency including, but not limited to:
1.26.5.1. Outreach Members to identify if Member meets programmatic requirements by
conducting an Assessment if the Member has not received their required level of
care assessment and/or did not meet level of care requirements during their last
continued stay review assessment.
1.26.5.2. Change Program
1.26.5.3. Additional Service Coordination
1.26.5.4. Issue Notice of Actions (LTC -803)
1.26.6. Contractor shall follow all Department guidance for service changes related to the end
of the Public Health Emergency.
1.26.7. Contractor shall be compensated with a one-time payment for performing case
management administrative activities related to the end of the Public Health
Emergency.
1.26.7.1. PERFORMANCE STANDARD: 100% of all impacted members are outreached
and assessed to determine if members continue to meet programmatic requirements
and/or financial eligibility.
1.27. Certification
1.27.1. The Department or a designee shall review the performance of Contractor.
1.27.2. Performance monitoring may include a review of log notes, support plans, assessments,
and other documentation relevant to the long-term care services provided the Member.
Contractor shall be notified within 30 days of the outcome of a review that may result
in approval, provisional approval, denial or termination of certification. The
Department may appoint a designee to monitor and/or make certification
recommendations.
1.27.3. The Department, in accordance with state statutes and regulations, shall certify
Contractor. Certification shall be based upon, but not limited to:
1.27.3.1. Results of on -site visits.
1.27.3.2. Evaluation results of the quality of service provided.
1.27.3.3. Compliance with Program requirements.
1.27.3.4. Service timeliness.
1.27.3.5. Performance of administrative functions.
1.27.3.6. Costs per Member.
1.27.3.7. Communications with Members.
1.27.3.8. Member monitoring.
1.27.3.9. Targeting populations served.
1.27.3.10. Community coordination.
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1.27.3.11. Outreach and financial accountability.
1.28. Accounting
1.28.1. 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.
1.28.2. Contractor shall establish and maintain internal control systems and standards that
apply to the operation of the organization.
1.28.3. 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.
1.28.4. Contractor shall establish any necessary cost accounting systems to identify the
application of funds and record the amounts spent.
1.28.5. 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.
1.28.5.1.
1.28.5.2.
DELIVERABLE: Transaction and Funds Documentation
DUE: Within 10 Business Days of the Department's Request
1.29. Subrecipient Status and Requirements
1.29.1. 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.
1.29.2. Single Audits
1.29.2.1. Under the Final Rule, all Non -Federal Entities, as defined in the Final Rule,
expending $750,000.00 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.
1.29.2.2. Contractor shall notify the State when expected or actual expenditures of federal
assistance from all sources equal or exceed $750,000.00.
1.29.2.3. If the expected or actual expenditures of federal assistance from all sources do not
equal or exceed $750,000.00 Contractor shall provide an attestation to the State that
they do not qualify for a Single Audit.
1.29.2.4. 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.
1.29.2.4.1. DELIVERABLE: Single Audit
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1.29.3.1.
1.29.3.2.
1.29.2.4.2. 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
1.29.3. 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.
DELIVERABLE: Attestation Form
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
1.29.4. The audit period shall be Contractor's fiscal year.
1.30. Treatment of Funds
1.30.1. All funding identified as a subaward with matching federal dollars received through
this Contract is subject to the requirements within Uniform Guidance.
1.30.2. All subawards must be used on allowable expenses associated with performing the
activities outlined in this Contract and on allowable expenses per Uniform Guidance.
1.30.3. 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.
2. COMPENSATION AND INVOICING
2.1. Administrative Compensation
2.1.1. The compensation under the Contract shall consist of rates -based reimbursement
intended to cover the cost of activities provided through this Contract.
2.1.2. Contractor will receive payment as specified in Section 2.2 and 2.4.
2.1.3. The rates shown in the following table upon the Department's approval of all
deliverables and services:
2.2. Administrative Rate Table
SEP ADMINISTRATIVE RATE TABLE
DELIVERABLE DESCRIPTION
PAYMENT FREQUENCY
RATE
Operations Guide
One Time Payment per
Initial Guide
$7,683.58
Operations Guide Update and Summary
Each Annual Update
$1,382.11
Complaint Trend Analysis
Per Quarterly Deliverable
$3,748.73
Critical Incident Reporting
Per Month Per Enrollment
$1.56
Critical Incident Follow -Up Completion
Performance Standard
Per Quarter
$2,384.99
Case Management Training
Per Bi-Annual Deliverable
$630.53
Committee Updates
Per Bi-Annual Deliverable
$1,041.64
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Appeals — Creation of Packet
Per Appeal Packet
$516.68
Appeals — Attendance at Hearing
Per Appeal Hearing
Attended
$477.18
Initial Level of Care Screening and
Assessment
Payment per Assessment
$275.66
Continued Stay Review — Level of Care
Screening and Assessment
Payment per Assessment
$191.61
Monitoring
Payment per Monitoring
Visit
(Up to 2 Visits per Year)
$101.80
On -Going Case Management
Tier One (1-700)
Monthly, Payment per
Member per Activity
$93.35
On -Going Case Management
Tier Two (701-2750)
Monthly, Payment per
Member per Activity
$88.82
On -Going Case Management
Tier Three (2751+)
Monthly, Payment per
Member per Activity
$76.42
Rural Travel Add -On (Initial, CSR, In -Person
Monitoring) for Rural and Frontier Counties
Payment per Activity
$36.41
Initial Level of Care Screen
Per Screen
$204.37
Annual Reassessment — Level of Care Screen
Per Screen
$190.13
Initial Needs Assessment — Required
Questions Only
Per Assessment
$258.03
Annual Reassessment Needs Assessment —
Required Questions Only
Per Assessment
$242.19
Initial Needs Assessment — Voluntary
Questions Included
Per Assessment
$322.54
Annual Reassessment Needs Assessment —
Voluntary Questions Included
Per Assessment
$308.24
Completed Training on Colorado Single
Assessment and Person -Centered Support
Plan Instruments Training on the Care and
Case Management Information Technology
System (CCM), Assessment, and Support Plan
Instruments
Upon Training Completion
Calculated
Allocation
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Completed Case Management Training on the
Care and Case Management (CCM)
Information Technology system,
Upon Training Completion
Calculated
Allocation
Continuous Quality Improvement Plan
Per Plan
$492.49
HCBS Settngs Final Rule Transition
Workbook
Per Deliverable
Calculated
Allocation
COVID-19 Public Health Emergency Ending
Activities
Calculated Allocation
Calculated
Allocation
2.3. The rates shown above 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 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 authorized by the Colorado legislature or due to an
administrative error. In the event that the Department does modify these rates, the
Department may modify them through the use of an Option Letter.
2.4. Billing and Payment Procedures
2.4.1. Unless otherwise provided, and where appropriate, the Department shall establish
billing procedures and pay Contractor for Administrative Functions at a rate determined
by the Department, performed and accepted pursuant to the terms of this Contract.
2.4.2. Contractor shall be reimbursed for Administrative Functions and on -going case
management at the frequency and criteria identified in Section 2.5 of this Exhibit,
Invoicing and Payment Procedures.
2.5. Invoicing and Payment Procedures
2.5.1. Appeals — Creation of Packet and Hearing Attendance
2.5.1.1. Contractor shall ensure that all Appeals Packet and Hearing Attendance
information is entered into the Department prescribed system within the required
timeframe. The Department will pay for all Appeals Packet and Hearing
Attendances from data pulled from the Department prescribed system on the 11th
day of the month for Appeal Packets and Hearing Attendance form the previous
month. Contractor shall maintain all supporting documentation and packets related
to all Appeals.
2.5.2. Complaint Log and Trends Analysis
2.5.2.1. Contractor shall submit quarterly Complaint Log and Trends Analysis deliverable.
Contractor shall 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.
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2.53. Completed Case Management Training on the Care and Case Management
(CCM) Information Technology system
2.5.3.1. Contractor shall receive payment once all case managers complete the Case
Management Training on the CCM 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 employed by
Contractor.
2.5.4. Completed Training on the Colorado Single Assessment and Person -Centered
Support Plan Instruments
2.5.4.1. Contractor shall receive payment once participating case managers complete the
training on the Colorado Single Assessment and Person -Centered Support Plan 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.
2.5.5. Continuous Quality Improvement Plan
2.5.5.1. Contractor shall submit the Continuous Quality Improvement Plan deliverable.
Contractor shall 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.
2.5.6. COVID-19 Public Health Emergency Ending Activities
2.5.6.1. Contractor shall outreach all impacted Members and determine if Members
continue to meet programmatic requirements and/or financial eligibility. Contractor
shall be compensated with a one-time payment for performing case management
administrative activities related to the end of the Public Health Emergency.
2.5.7. Critical Incident Reports (CIRs)
2.5.7.1. 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 11th day of the month for enrollments from
the previous month.
2.5.8. Critical Incident Quarterly Follow -Up Completion Performance Standard
2.5.8.1. Contractor is eligible to receive a quarterly performance -based payment for timely
completion of requested CIR follow-up action. To receive the quarterly
performance -based payment, Contractor must have 90% of all CIRs assigned
follow- up completed and entered into the Department prescribed system within
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 the Contactor will be awarded the performance
based -payment.
2.5.9. Level of Care Screen (100.2): Initial and CSR
2.5.9.1. Contractor shall conduct and enter all Initial and CSR Level of Care Screen into the
Departments prescribed system within the Department's prescribed timeframe. The
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Department will pay for Initial and CSR Level of Care Screen from data pulled
from the Department prescribed system on the eleventh (11th) day of the month for
assessments from the previous month. Contractor shall only be reimbursed for a
Level of Care Screen (100.2) or a Colorado Single Assessment Level of Care
Screen per Member as directed by the Department.
2.5.10. Level of Care Screen (CCM) Initial and Reassessment
2.5.10.1. Contractor shall submit HCBS Final Rule Transition Workbook 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.
2.5.11. HCBS Final Rule Transition Workbook
2.5.11.1. Contractor shall submit HCBS Final Rule Transition Workbook 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.
2.5.12. Monitoring
2.5.12.1. Contractor shall conduct member's first Case Management Monitoring In -Person,
and one additional Monitoring visit, based on Member's need, either an In -Person
or Virtually during the Support Plan year and adhere to all requirements. The
Department will pay for Case Management Monitoring based on data pulled from
the Department prescribed system on the 11th day of the month for Case
Management Monitoring from the previous month.
2.5.13. Needs Assessment (CCM): Initial and Reassessment
2.5.13.1. Contractor shall conduct and enter all Initial and Reassessment Needs Assessments
into the Department's prescribed system within the required timelines. The
Department will pay for Initial and Reassessment Needs Assessments based on data
pulled from the Department's prescribed system on the 11th day of the month for
assessments conducted in the previous month.
2.5.14. On -Going Case Management
2.5.14.1. Contractor shall conduct and enter all allowable ongoing case management
activities into the Department's prescribed system within the required timeframes.
The Department will pay On -Going Case Management activities each month based
on data pulled from the Department prescribed system on the 11th day of the month
for activities completed in the previous month.
2.5.15. Operations Guide
2.5.15.1. Contractor shall submit the Operations Guide and all required components.
Contractor shall receive payment for the Operations Guide only after the
Department has received, reviewed, and accepted the Deliverable.
2.5.16. Operations Guide Update and Summary
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2.5.16.1. Contractor shall review the Operations Guide for years two, three, four, and five of
this Contract, and determine if any modifications are required to account for any
changes in the Work, in the Department's processes and procedures, or in
Contractor's processes and procedures and update the Operations Guide as
appropriate to account for any changes. Contractor shall submit an Operations
Guide Update, as well as a Summary of all changes to the Department or an
explanation demonstrating that the Operations Guide Update was reviewed, and
Contractor determined that no edits were needed. The Department shall review the
update summary and determine whether significant modifications to the Operations
Guide Update were completed. Contractor shall receive payment for an Operations
Guide Update only after the Department has determined that significant changes
were made and accepted. 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. Significant changes would include, but are not limited to, an
update to Contractor's current practices or procedures.
2.5.17. Rural Travel Add -On (Initial, CSR, In -Person Monitoring) for Rural and
Frontier Counties
2.5.17.1. Contractor shall receive an additional payment for Rural Travel Add -On for Rural
and Frontier Counties for the following activities only: Level of Care Screen
(100.2): Initial and CSR, Level of Care Screen (CCM): Initial and Reassessment;
Needs Assessment (CCM) Initial and Reassessment, and In -Person Monitoring
based on data pulled from the Department prescribed system on the 11th day of the
month for activities from the previous month. The due dates identified shall be
adhered to, and requested information shall be entered in the Department's
prescribed systems and/or submitted to the Department by the 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.
2.6. Payment and Billing Errors
2.6.1. Contractor shall review all payments made by the Department to ensure accuracy
within 10 Business Days of receiving a payment summary.
2.6.2. Contractor shall notify the Department of any errors in billing or payment within 10
Business Days of receiving a payment summary on the Department's prescribed
template to ensure over and under payments are adjusted
2.6.2.1. DELIVERABLE: Payment Correction Form
2.6.2.2. DUE: Within 10 Business Days of receiving a payment summary from the
Department
2.6.3. The Department shall notify Contractor of any overpayment or underpayment
identified through an internal review process.
2.6.4. If an overpayment is confirmed by the Department, the overpayment amount will be
withheld from the next monthly reimbursement to Contractor and, if necessary, from
each monthly payment thereafter to Contractor, until all overpayment of funds is
recovered.
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2.6.5. If an underpayment is confirmed, the amount will be included on the next monthly
reimbursement to Contractor.
2.7. Unexpended Funds
2.7.1. Contractor shall remit any funds disbursed under this Contract that are not expended
by the close of the Period of Performance.
2.8. Closeout Payments
2.8.1. Notwithstanding anything to the contrary in this Contract, all payments for the final
month of this Contract shall be paid to Contractor no sooner than 10 days after the
Department has determined that Contractor has completed all of the requirements of
the Closeout Period
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EXHIBIT B, TERMINOLOGY
1 TERMINOLOGY
1.1 In addition to the terms defined in §3 of the original Contract, acronyms and abbreviations
are defined at their first occurrence in this Exhibit A-3, Statement of Work. The following
list of terms shall be construed and interpreted as follows:
1.2 Appeal — The process a case manager participates in when an individual or Member appeals
an adverse action made by the case manager.
1.3 Benefits Utilization System (BUS) — the online data system maintained by the Department
for recording case management activities associated with Long Term Services and
Supports.
1.4 Bridge — the online data system maintained by the Department for authorization of member
services.
1.5 Business Day - Any day in which the State is open and conducting business, but shall not
include Saturday, Sunday, or any day which the State observes one of the holidays listed in
C.R.S. §24-11-101(1).
1.6 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, Pandemic, power
outage, strike, loss of necessary personnel or computer virus.
1.7 Care and Case Management System (CCM) — The Department's future case management
Information Technology (IT) platform.
1.8 Case Management - The assessment of an individual receiving long-term services and
supports' needs, the development and implementation of a support plan for such individual,
referral and related activities, the coordination and monitoring of long-term service
delivery, the evaluation of service effectiveness, and the periodic reassessment of such
individual's needs. Case Management under this Contract is for the State General Funded
programs only and is funded with State General Funds.
1.9 Case Management Agency (CMA) — a public or private not -for-profit or for-profit
organization contracted with the state of Colorado to provide case management services and
activities pursuant to C.R.S. 25.5-6-1702.
1.10 Case Management Redesign — the evaluation and redesign of the entry point and case
management structure for LTSS in Colorado.
1.11 Case Manager — A person who provides case management services and meets all regulatory
requirements for case manager.
1.12 Closeout Period - The period beginning on the earlier of 90 days prior to the end of the last
Extension Term or notice by the Department of its decision to not exercise its option for an
Extension Term, and ending on the day that the Department has accepted the final
deliverable for the Closeout Period, as determined in the Department -approved and updated
Closeout Plan, and has determined that the closeout is complete.
1.13 Colorado Revised Statutes (C.R.S.) — The legal code of Colorado; the legal codified general
and permanent statutes of the Colorado General Assembly.
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1.14 Community Centered Board (CCB) - A private corporation, for-profit or not -for profit, that
is designated pursuant to section 25.5-10-209.
1.15 Complaints and Grievances — 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, transparency, State SLS and OBRA-SS program requirements,
State SLS and OBRA-SS program subcontractors, administrative case management
functions. Complaints received outside of the scope of this Contract shall not be included.
1.16 Contractor — The individual, entity or subrecipient selected to complete the Work contained
in the Contract. Contractor and subrecipient will be used interchangeably throughout this
contract
1.17 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.
1.18 Critical Incident — an actual or alleged event that creates the risk of serious harm to the
health or welfare of an individual receiving services; and it may endanger or negatively
impact the mental and/ or physical well-being of an individual.
1.19 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.
1.20 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
1.21 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.
1.22 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.
1.23 Department — The Colorado Department of Health Care Policy and Financing, a
Department of the government of the State of Colorado.
1.24 Disaster - An event that makes it impossible for Contractor to perform the Work out of its
regular facility, and may include, but is not limited to, natural disasters, fire, Pandemic, or
terrorist attacks.
1.25 District — a Department defined distinct geographic county -based service area. Each District
is served by a single SEP Agency.
1.26 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.
1.27 Eligibility Determination — determination of eligibility for Long Term Services and
Supports (LTSS) programs.
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1.28 Financial Eligibility - The eligibility criteria for a publicly funded program, based on the
individual's financial circumstances, including income and resources, if applicable.
1.29 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.
1.30 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.
1.31 Health First Colorado — Colorado's Medicaid Program.
1.32 HIPAA - The Health Insurance Portability and Accountability Act of 1996, as amended.
1.33 Home and Community Based Services (HCBS) Settings Final Rule - Released by the
Centers for Medicare & Medicaid Services (CMS) in January 2014. This rule ensures that
participants in Medicaid -funded HCBS programs have full access to the benefits of
community living. The federal rule is codified at 42 C.F.R. § 441.301(c)(4). The state
version of the federal rule is codified at 10 CCR 2505-10 section 8.484.
1.34 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
an individual 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). Human Rights Committee — A third party mechanism to adequately
safeguard the legal rights of persons receiving services by participating in the granting of
informed consent, monitoring the suspensions of rights, monitoring behavioral
developmental programs, monitoring of psychotropic medications, and reviewing
investigations of allegations of mistreatment of persons with intellectual and developmental
disabilities.
1.35 Hospital Back Up — an LTSS program for Members who have complex wound care and/or
are ventilator -dependent or medically complex.
1.36 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: an
individuals need for long term services and supports; an individuals need for referral to
other programs or services; an individuals' eligibility for financial and program assistance;
and the need for a Level of Care Screen and Needs Assessment of the Client seeking
services.
1.37 Key Personnel - The position or positions that are specifically designated as such in this
Contract.
1.38 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.
1.39 Level of Care Assessment - Determining eligibility of an individual for a Long -Term
Services and Supports (LTSS) program and determined by a Community Centered Board.
A comprehensive evaluation with the individual seeking services and others chosen by the
individual to participate and an evaluation by the case manager utilizing the Department
prescribed tool, with supporting diagnostic information from the individual's medical
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provider, and to determine the individual's level of functioning for admission or continued
stay in certain Long -Term Services and Supports (LTSS) programs.
1.40 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.
1.41 Long Term Care Notice of Action — the form required to be sent to individuals by
Contractor within 11 business days regarding their appeal rights in accordance with 10
CCR 2505-10 8.507 et seq.
1.42 Long -Term Services and Supports (LTSS) - the services and supports used by Members of
all ages with functional limitations and chronic illnesses who need assistance to perform
routine daily activities such as bathing, dressing, preparing meals, and administering
medications.
1.43 Long Term Services and Supports (LTSS) Programs - Any of the following publicly funded
programs: HCBS — BI, HCBS -CIH, HCBS -CLLI, HCBS -CMHS, HCBS — EBD, PACE,
LTHH, HBU, and NF.
1.44 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.
1.45 Member - Any individual enrolled in the Colorado Medicaid program, State General Fund
programs, Colorado's CHP+ program or the Colorado Indigent Care Program, as
determined by the Department.
1.46 Monitoring — A role of Case Managers to ensure that members get the authorized services
in accordance with their support plan, to include, but not limited to monitoring quality of
services and supports provided to Members enrolled in a State General Funded program.
1.47 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 state's long term services and supports (LTSS) systems and service
recipient outcomes, helping states prioritize quality improvement initiatives, engage in
thoughtful decision making, and conduct futures planning with valid and reliable LTSS
data.
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1.48 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 (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.
1.49 Operational Start Date — When the Department authorizes Contractor to begin fulfilling its
obligations under the Contract.
1.50 Other Personnel - Individuals and Subcontractors, in addition to Key Personnel, assigned to
positions to complete tasks associated with the Work.
1.51 Pandemic — Refers to an epidemic that has spread over several countries or continents,
usually affecting a large number of people.
1.52 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.
1.53 Person -Centered Appoach - respecting and valuing individuals' and Members' preferences,
strengths, and contributions.
1.54 Person -Centered Support Plan - A document, using the Department -prescribed instrument,
that identifies approved services, regardless of funding source, necessary to assist a member
to remain safely in the community and developed 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.
1.55 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.
1.56 Pre -Admission Screening and Resident Review (PASRR) - The review that occurs for all
Members seeking admission to a Medicaid nursing facility to screen the Member for
evidence of serious mental illness and/or intellectual and developmental disabilities or
related conditions. The review determines whether the Member's needs the level of services
that a nursing facility provides and whether Members who need nursing facility services
also need specialized services.
1.57 Professional Medical Information Page (PMIP) - The medical information document signed
by a licensed medical professional used as a component of the Level of Care assessment to
determine the client's need for LTSS program.
1.58 Program - a publicly funded program including, but not limited to: Home and Community
Based Services Waivers, Medicaid Nursing Facility, Hospital Back -Up, Program for All -
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Inclusive Care for the Elderly (PACE), Long Term Home Health (LTHH), and State
General Funded (SGF) Programs.
1.59 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.
1.60 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.
1.61 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 C.F.R.
Sections 441.301 and 441.302.
1.62 Quarter - Four (4) distinct time periods during the State Fiscal Year. Quarter one begins on
July 1 and ends September 30. Quarter two begins on October 1 and ends December 31.
Quarter three begins on January 1 and ends March 31. Quarter four begins on April 1 and
ends on June 30.
1.63 Region — a distinct geographic area, determined by the Department, which is comprised of
one or more Districts.
1.64 Regional Accountable Entity (RAE) - A single regional entity responsible for duties
previously performed by Regional Care Collaborate Organizations and Behavioral Health
Organizations (BHO).
1.65 Resource Development — the study, establishment and implementation of additional
resources or services that extend the capabilities of community based LTSS systems to
better serve LTSS individuals and Members and those likely to need community based
LTSS in the future.
1.66 Rural — Defined Service Areas that are eligible for rural travel add-on reimbursement for
required in -person activities reimbursed through this Contract.
1.67 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
1.68 Single Entry Point Agency (SEP Agency) - The organization selected to provide intake,
screening, referral, Level of Care Screening and Assessment, and case management
functions for person in need of receiving LTSS within Single Entry Point District.
1.69 Soft Launch - Implementation of a phased roll -out of the Care and Case Management
Information Technology System (CCM) and the new Assessment and Support Plan
instruments with limited functionality, on a small scale.
1.70 State — The State of Colorado, acting by and through any State agency.
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1.71 State Fiscal Rules - The fiscal rules promulgated by the Colorado State Controller pursuant
to C.R.S. §24-30-202(13)(a).
1.72 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.
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 CFR — Code of Federal Regulations
2.1.2 CHP+—Child Health Plan Plus
2.1.3 CMS — the Federal Centers for Medicare and Medicaid Services
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 HIPAA — Health Insurance Portability and Accountability Act of 1996, as amended.
2.1.7 MFCU — the Colorado Medicaid Fraud Control Unit in the Colorado Department of
Law
2.1.8 PHI — Protected Health Information
2.1.9 PII — Personally Identifiable Information
2.1.10 SFY — State Fiscal Year
2.1.11 U.S.C. — United States Code
2.1.12 VARA — Visual Rights Act of 1990
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EXHIBIT C-3, CONTRACTOR'S GENERAL REQUIREMENTS
1. CONTRACTOR'S GENERAL REQUIREMENTS
1.1.The Department will contract with only one organization, Contractor, and will work solely
with that organization with respect to all tasks and deliverables to be completed, services to be
rendered and performance standards to be met under this Contract.
1.2.Single Entry Point Agency
1.2.1. Contractor shall serve as the Single Entry Point Agency for the following counties:
1.2.1.1. Weld County.
1.2.2. Contractor may be privy to internal policy discussions, contractual issues, price
negotiations, confidential medical information, Department financial information, advance
knowledge of legislation and other Confidential Information. In addition to all other
confidentiality requirements of the Contract, Contractor shall also consider and treat any such
information as Confidential Information and shall only disclose it in accordance with the terms
of the Contract.
1.2.3. Contractor shall work cooperatively with Department staff and, if applicable, the staff of
other State contractors to ensure the completion of the Work. The Department may, in its sole
discretion, use other contractors to perform activities related to the Work that are not contained
in the Contract or to perform any of the Department's responsibilities. In the event of a conflict
between Contractor and any other State contractor, the State will resolve the conflict and
Contractor shall abide by the resolution provided by the State.
1.2.4. Contractor shall inform the Department on current trends and issues in the healthcare
marketplace and provide information on new technologies in use that may impact Contractor's
responsibilities under this Contract.
1.2.5. Contractor shall maintain complete and detailed records of all meetings, system
development life cycle documents, presentations, project artifacts, and any other interactions
or Deliverables related to the Work described in the Contract. Contractor shall make such
records available to the Department upon request throughout the term of the Contract.
1.3.Deliverables
1.3.1. All Deliverables shall meet Department -approved format and content requirements. The
Department will specify the number of copies and media for each Deliverable.
1.3.2. All Deliverables shall be submitted to the Department by close of business on the due date
determined by the Department.
1.3.2.1.Contractor shall submit each Deliverable to the Department for review and approval and
shall adhere to the following Deliverable process such for any documentation creation,
review, and acceptable cycle, Contractor shall:
1.3.2.1.1. Gather and document requirements for the Deliverable.
1.3.2.1.2. Create a draft in the Department -approved format for the individual Deliverable.
1.3.2.1.3. Perform internal quality control review(s) of the Deliverable, including, but not limited
to:
1.3.2.1.3.1. Readability.
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1.3.2.1.3.2. Spelling.
1.3.2.1.3.3. Grammar.
1.3.2.1.3.4. Completion.
1.3.2.1.4. Adhere to all required templates or development of templates.
1.3.2.2.The Department will review the Deliverable and may direct Contractor to make changes to
the Deliverable. Contractor shall make all changes within five Business Days following the
Department's direction to make the change unless the Department provides a longer period
in writing.
1.3.2.2.1. Changes the Department direct include, but are not limited to, modifying portions of
the Deliverable, requiring new pages or portions of the Deliverable, requiring resubmission
of the Deliverable or requiring inclusion of information or components that were left out
of the Deliverable.
1.3.2.2.2. The Department may also direct Contractor to provide clarification or provide a
walkthrough of any Deliverable to assist the Department in its review. Contractor shall
provide the clarification or walkthrough as directed by the Department.
1.3.2.3.Once the Department has received an acceptable version of the Deliverable, including all
changes directed by the Department, the Department will notify Contractor of its
acceptance of the Deliverable in writing. A Deliverable shall not be deemed accepted prior
to the Department's notice to Contractor of its acceptance of that Deliverable. Contractor
shall not receive payment for a Deliverable until it has been received and accepted by the
Department. Deliverables requiring correction shall not be paid until receipt of a revised
and accepted Deliverable by the Department.
1.3.3. Contractor shall employ an internal quality control process to ensure that all Deliverables
are complete, accurate, easy to understand and of high quality, as described herein.
Contractor shall provide Deliverables that, at a minimum, are responsive to the specific
requirements for that Deliverable, organized into a logical order, contain accurate spelling
and grammar, are formatted uniformly, and contain accurate information and correct
calculations. Contractor shall retain all draft and marked -up documents and checklists
utilized in reviewing Deliverables for reference as directed by the Department.
1.3.4. In the event any due date for a Deliverable falls on a day that is not a Business Day, the
due date shall be automatically extended to the next Business Day, unless otherwise
directed by the Department.
1.3.5. All due dates or timelines that reference a period of days, months or quarters shall be
measured in calendar days, months and quarters unless specifically stated as being
measured in Business Days or otherwise. All times stated in the Contract shall be
considered to be in Mountain Time, adjusted for Daylight Saving Time as appropriate,
unless specifically stated otherwise.
1.3.6. No Deliverable, report, data, procedure or system created by Contractor for the Department
that is necessary to fulfilling Contractor's responsibilities under the Contract, as determined
by the Department, shall be considered proprietary.
1.3.6.1.If any Deliverable contains ongoing responsibilities or requirements for Contractor, such
as Deliverables that are plans, policies or procedures, then Contractor shall comply with
all requirements of the most recently approved version of that Deliverable. Contractor shall
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not implement any version of any such Deliverable prior to receipt of the Department's
written approval of that version of that Deliverable. Once a version of any Deliverable
described in this subsection is approved by the Department, all requirements, milestones
and other Deliverables contained within that Deliverable shall be considered to be
requirements, milestones and Deliverables of this Contract.
1.3.6.2.Any Deliverable described as an update of another Deliverable shall be considered a
version of the original Deliverable for the purposes of this subsection.
1.4.Stated Deliverables and Performance Standards
1.4.1. Any section within this Statement of Work headed with or including the term
"DELIVERABLE" or "PERFORMANCE STANDARD" is intended to highlight a
Deliverable or performance standard contained in this Statement of Work and provide a
clear due date for the Deliverables. The sections with these headings are for ease of
reference trot intended to expand or limit the requirements or responsibilities related to any
Deliverable or performance standard, except to provide the due date for the Deliverables.
1.5.Communication with the Department
1.5.1. Contractor shall enable all Contractor staff to exchange documents and electronic files
with the Department staff in formats compatible with the Department's systems. The
Department currently uses Microsoft Office 2016 and/or Microsoft Office 365 for PC. If
Contractor uses a compatible program, then Contractor shall ensure that all documents or
files delivered to the Department are completely transferrable and reviewable, without
error, on the Department's systems.
1.5.2. The Department will use a transmittal process to provide Contractor with official direction
within the scope of the Contract. Contractor shall comply with all direction contained
within a completed transmittal. For a transmittal to be considered complete, it must
include, at a minimum, all of the following:
1.5.2.1. The date the transmittal will be effective.
1.5.2.2. Direction to Contractor regarding performance under the Contract.
1.5.2.3. A due date or timeline by which Contractor shall comply with the direction contained in
the transmittal.
1.5.2.4. The signature of the Department employee who has been designated to sign transmittals.
1.5.2.5. The Department will provide Contractor with the name of the person it has designated to
sign transmittals on behalf of the Department, who will be the Department's primary
designee. The Department will also provide Contractor with a list of backups who may
sign a transmittal on behalf of the Department if the primary designee is unavailable. The
Department may change any of its designees from time to time by providing notice to
Contractor through a transmittal.
1.5.3. The Department may deliver a completed transmittal to Contractor in hard copy, as a
scanned attachment to an email or through a dedicated communication system, if such a
system is available.
1.5.3.1. If a transmittal is delivered through a dedicated communication system or other electronic
system, then the Department may use an electronic signature to sign that transmittal.
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1.5.4. If Contractor receives conflicting transmittals, Contractor shall contact the Department's
primary designee, or backup designees if the primary designee is unavailable, to obtain
direction. If the Department does not provide direction otherwise, then the transmittal with
the latest effective date shall control.
1.5.5. In the event that Contractor receives direction from the Department outside of the
transmittal process, it shall contact the Department's primary designee, or backup
designees if the primary designee is unavailable, and have the Department confirm that
direction through a transmittal prior to complying with that direction.
1.5.6. Transmittals may not be used in place of an amendment, and may not, under any
circumstances be used to modify the term of the Contract or any compensation under the
Contract. Transmittals are not intended to be the sole means of communication between
the Department and Contractor, and the Department may provide day-to-day
communication to Contractor without using a transmittal.
1.5.7. Contractor shall retain all transmittals for reference and shall provide copies of any
received transmittals upon request by the Department.
1.6.Member Engagement
1.6.1. Person- and Family -Centered Approach
1.6.1.1. Contractor shall actively engage Members in their health and well-being by demonstrating
the following:
1.6.1.1.1. Responsiveness to Member and family/caregiver needs by incorporating best practices
in communication and cultural responsiveness in service delivery.
1.6.1.1.2. Utilization of various tools to communicate clearly and concisely.
1.6.1.1.3. Contractor shall align Member engagement activities with the Department's person -
and family -centered approach that respects and values individual preferences, strengths,
and contributions.
1.6.2. Cultural Responsiveness
1.6.2.1. Contractor shall provide and facilitate the delivery of services in a culturally competent
manner to all individuals and Members, including those with limited English proficiency
and diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual
orientation or gender identity.
1.6.2.2. Contractor shall provide all information for individuals and Members in a manner and
format that may be easily understood and is readily accessible by individuals and
Members.
1.6.2.2.1. Readily accessible is defined as electronic information and services that comply with
modern accessibility standards, such as Section 508 of the Americans with Disabilities
Act, Section 504 of the Rehabilitation Act.
1.6.3. Language Assistance Services
1.6.3.1. Contractor shall provide language assistance services including bilingual staff and/or
interpreter services, at no cost to any individuals or Member. Language assistance shall
be provided at all points of contact, in a timely manner and during all hours of operation.
1.6.3.2. Contractor shall make oral interpretation available in all languages.
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1.6.3.3. Contractor shall assure the competence of language assistance provided by interpreters
and bilingual staff.
1.6.3.4. Contractor shall not use family and friends to provide interpretation services except by
request of the individuals or Member.
1.6.3.5. Contractor shall provide interpreter services for all interactions with individuals and
Members when there is no Contractor staff person available who speaks a language
understood by an individuals or Member.
1.6.3.6. Contractor shall notify individuals and Members verbally regarding the individuals or
Member's right to receive the following language assistance services, as well as how to
access the following language assistance services.
1.6.3.6.1. Oral interpretation for any language. Oral interpretation requirements apply to all non-
English languages, not just those that the state identifies as prevalent.
1.6.3.6.2. Contractor shall ensure that language assistance services shall include, but are not
limited to, the use of auxiliary aids such as TTY/TDY and American Sign Language.
1.6.3.6.3. Contractor shall ensure that customer service telephone functions easily access
interpreter or bilingual services.
1.6.4. Written Materials for Individuals and Members
1.6.4.1.Contractor shall ensure that all written materials it creates for distribution to individuals
and Members meet all noticing requirements of 45 C.F.R. Part 92.
1.6.4.2.Contractor shall ensure that all written materials it creates for distribution to individuals
and Members are culturally and linguistically appropriate to the recipient.
1.6.4.3.Contractor shall write all materials in easy to understand language.
1.6.5. Individual and Member Communications
1.6.5.1.Contractor shall maintain consistent communication, both proactive and responsive, with
individuals and Members.
1.6.5.2.Contractor shall assist any individuals or Member who contacts Contractor, including
individuals and Members not in Contractor's Region/District who need assistance with
contacting his/her SEP, CCB, RAE, or other agencies.
1.6.6. Individual and Member Rights
1.6.6.1.Contractor shall have written policies guaranteeing each individual and Member's right to
be treated with respect and due consideration for his or her dignity and privacy.
1.6.6.2.Contractor shall provide information to individuals and Members regarding their rights that
include, but are not limited to:
1.6.6.2.1. The right to be treated with respect and due consideration for their dignity and privacy.
1.6.6.2.2. The right to participate in decisions regarding their services.
1.6.6.2.3. The right to be free from any form of restraint or seclusion used as a means of coercion,
discipline, convenience or retaliation.
1.6.6.2.4. The right to request and receive a copy of their records.
1.6.6.2.5. The right to obtain available and accessible services under the Contract.
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1.6.6.3.Contractor shall post and distribute rights to individuals, including but not limited to:
1.6.6.3.1. Individuals /Members.
1.6.6.3.2. Individuals /Member's families.
1.6.6.3.3. Providers.
1.6.6.3.4. Case Workers.
1.6.6.3.5. Stakeholders.
1.7.Operations Guide
1.7.1. Contractor shall not engage in any Work under the Contract, prior to the Operational Start
Date. The Department shall not be liable to Contractor for, and Contractor shall not
receive, any payment for any period prior to the Operational Start Date under this Contract.
1.7.2. Contractor shall create and implement an Operations Guide. The Operations Guide shall
include the creation and management of the following:
1.7.2.1. Communication Plan.
1.7.2.2. Business Continuity Plan.
1.7.2.3. Start -Up Plan.
1.7.2.4. Closeout Plan.
1.7.3. Contractor shall submit the Operations Guide to the Department for review approval, and
payment.
1.7.3.1. DELIVERABLE: Operations Guide
1.7.3.2. DUE: Within 45 Business Days after the Effective Date
1.7.4. Contractor shall review its Operations Guide on an annual basis and determine if any
modifications are required to account for any changes in the Work, in the Department's
processes and procedures or in Contractor's processes and procedures and update the
Guide as appropriate to account for any changes. Contractor shall submit an Annual
Operations Guide Update that contains all changes from the most recently approved prior
Operations Guide or Annual Operations Guide Update or shall note that there were no
changes. If changes were made to the Operations Guide, Contractor shall also compile
and submit a summary of all changes to the Department.
1.7.5. Contractor shall submit the Annual Operations Guide Update and Summary to the
Department for review, approval, and payment.
1.7.5.1. DELIVERABLE: Annual Operations Guide Update and Summary
1.7.5.2. DUE: Annually, by August 15th
1.7.6. The Operational Start Date shall not occur until Contractor has completed all requirements
of the Operations Guide, unless the Department provides written approval otherwise.
1.8.Communication with Members, Providers, and Other Entities
1.8.1. Contractor shall create a Communication Plan that includes, but is not limited to, all of the
following:
1.8.1.1.A description of how Contractor will communicate to Members any changes to the services
those Members will receive or how those Members will receive the services.
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1.8.1.2.A description of the communication methods, including things such as email lists,
newsletters and other methods, that Contractor will use to communicate with Providers and
Subcontractors.
1.8.1.3.The specific means of immediate communication with Members and a method for
accelerating the internal approval and communication process to address urgent
communications or crisis situations.
1.8.1.4.A general plan for how Contractor will address communication deficiencies or crisis
situations, including how Contractor will increase staff, contact hours or other steps
Contractor will take if existing communication methods for Members or Providers are
insufficient.
1.8.1.5.A listing of the following individuals within Contractor's organization, including cell
phone numbers and email addresses:
1.8.1.5.1. An individual who is authorized to speak on the record regarding the Work, the
Contract or any issues that arise that are related to the Work.
1.8.1.5.2. An individual who is responsible for any website or marketing related to the Work.
1.8.1.5.3. Back-up communication staff that can respond in the event that the other individuals
listed are unavailable.
1.8.1.5.3.1. An outline of the process for Contractor's communication, timely responses and
emergency protocols in the event there is a natural disaster or Pandemic.
1.8.1.5.3.1.1. Communication Plan shall include steps for responding to the Department, provider
agencies, members and community organizations in the event there is a natural disaster or
Pandemic.
1.9.Business Continuity Plan
1.9.1. Contractor shall create a Business Continuity Plan that Contractor will follow in order to
continue operations during and after a Business Interruption to include but not limited to a
Disaster, Pandemic, power outage, strike, loss of necessary personnel, or computer virus.
The Business Continuity Plan shall include, but is not limited to, all of the following:
1.9.1.1.The essential services and functions provided by Contractor.
1.9.1.2.The lead person and response team responsible for implementing the business continuity
plan, individual/team roles, and contact information.
1.9.1.3.How emergency responses procedures will be implemented and who will activate the
business continuity plan.
1.9.1.4.How Contractor will implement a flexible work plan that includes social distancing,
hygiene etiquette, cancellation of non -essential activities, closure of buildings, and/or
relocation to alternative facilities.
1.9.1.5.How Contractor will address training personnel, preparing equipment, and backup systems.
1.9.1.6.How Contractor will address budget and finance mechanisms to ensure financing of
essential services.
1.9.1.7.How Contractor will ensure necessary supplies and equipment are available to maintain
essential services.
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1.9.1.8.How Contractor will replace staff that are lost or unavailable during or after a Business
Interruption so that the Work is performed in accordance with the Contract.
1.9.1.9.How Contractor will manage employees who are exposed to a Pandemic related illness or
are suspected to be ill or become ill at a worksite, such as infection control response and
immediate mandatory sick leave.
1.9.1.10. How Contractor will ensure or enhance communication and information technology
infrastructure to support tele-commuting.
1.9.1.11. How Contractor will back-up all information necessary to continue performing the
Work remotely, so that no information is lost because of a Business Interruption.
1.9.1.11.1. In the event of a Disaster, the plan shall also include how Contractor will make all
information available at its back-up facilities.
1.9.1.12. How Contractor will maintain complete back-up copies of all data, databases, operating
programs, files, systems, and software pertaining to enrollment information at a
Department -approved, off -site location.
1.9.1.13. How Contractor will minimize the effects on Members of any Business Interruption to
include how Contractor will notify members of closures and cancellations.
1.9.1.14. How Contractor will communicate with the Department during the Business
Interruption and points of contact within Contractor's organization the Department can
contact in the event of a Business Interruption.
1.9.1.15. How Contractor will transition from in person meetings to conference calls or other
virtual platforms or cancel or delay meetings as necessary.
1.9.1.16. Planned long-term back-up facilities out of which Contractor can continue operations
after a Disaster.
1.9.1.17. The time period it will take to transition all activities from Contractor's regular facilities
to the back-up facilities after a Disaster.
1.9.1.18. How Contractor will prepare necessary internal staff for implementing the business
continuity plan, which may include tests, drills, or training annually and revising the plan
based on lessons learned.
1.9.1.19. How Contractor will identify and engage with external organizations to help the
community, such as sharing best practices and sharing timely and accurate information
about a Business Interruption.
1.9.1.20. How Contractor will implement steps to return to normal after a Business Interruption.
1.10. Closeout Plan
1.10.1. Contractor shall create a Closeout Plan that describes all requirements, steps, timelines,
milestones, and Deliverables necessary to fully transition the services described in the
Contract from Contractor to the Department or to another contractor selected by the
Department to be Contractor after the termination of the Contract.
1.10.1.1. The Closeout Plan shall include, but is not limited to:
1.10.1.1.1. Transfer of Individuals and Members
1.10.1.1.2. Transfer of documentation to include all electronic and physical documentation.
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1.10.1.1.3. Transfer of all Individuals and Member records through the Department Case
Management Systems.
1.10.1.1.4. Transfer of services
1.10.1.1.4.1. Transfer of Case Management Services
1.10.1.2. The Closeout Plan shall also designate an individual to act as a closeout coordinator
who will ensure that all requirements, steps, timelines, milestones, and deliverables
contained in the Closeout Plan are completed and work with the Department and any other
contractor to minimize the impact of the transition on individuals and Members and the
Department.
1.10.1.2.1. Contractor shall ensure all policy, procedures, training, and appeals information are
transferred to the Department.
1.10.1.3. Contractor shall deliver the Closeout Plan to the Department for review and approval.
1.10.2. Contractor shall be ready to perform all Work by the Operational Start Date.
1.10.3. In the event Contractor is required to implement their Closeout Plan, Contractor shall
provide weekly updates to the Department demonstrating compliance and progression to
toward meeting the milestones described herein and in the approved Closeout Plan.
1.11. Closeout Period
1.11.1. During the Closeout Period, Contractor shall complete all of the following:
1.11.1.1. Implement the most recent Closeout Plan or Closeout Plan Update as approved by the
Department in the Operations Guide, as described herein and complete all steps,
Deliverables and milestones contained in the most recent Closeout Plan or Closeout Plan
Update that has been approved by the Department.
1.11.1.2. Provide to the Department, or any other contractor at the Department's direction, all
reports, data, systems, Deliverables and other information reasonably necessary for a
transition as determined by the Department or included in the most recent Closeout Plan
or Closeout Plan Update that has been approved by the Department.
1.11.1.3. Ensure that all responsibilities under the Contract have been transferred to the
Department, or to another contractor at the Department's direction, without significant
interruption.
1.11.1.4. Notify any Subcontractors of the termination of the Contract, as directed by the
Department.
1.11.1.5. Notify all Members that Contractor will no longer be the SEP as directed by the
Department. Contractor shall create these notifications and deliver them to the Department
for approval. Once the Department has approved the notifications, Contractor shall deliver
these notifications to all Members, but in no event shall Contractor deliver any such
notification prior to approval of that notification by the Department.
1.11.1.5.1. DELIVERABLE: Member Notifications
1.11.1.5.2. DUE: 90 days prior to termination of the Contract
1.11.1.6. Continue meeting each requirement of the Contract as described in the Department -
approved and updated Closeout Plan, or until the Department determines that specific
requirement is being performed by the Department or another contractor, whichever is
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sooner. The Department will determine when any specific requirement is being performed
by the Department or another contractor, and will notify Contractor of this determination
for that requirement.
1.11.1.7. The Closeout Period may extend past the termination of the Contract. The Department
will perform a closeout review to ensure that Contractor has completed all requirements of
the Closeout Period. If Contractor has not completed all of the requirements of the Closeout
Period by the date of the termination of the Contract, then any incomplete requirements
shall survive termination of the Contract.
1.12. Performance Reviews
1.12.1. The Department may conduct desk reviews and/or on -site performance reviews or
evaluations of Contractor in relation to the Work performed under the Contract.
1.12.2. The Department may work with Contractor in the completion of any performance reviews
or evaluations or the Department may complete any or all performance reviews or
evaluations independently, at the Department's sole discretion.
1.12.3. Contractor shall provide all information necessary for the Department to complete all
performance reviews or evaluations, as determined by the Department, upon the
Department's request. Contractor shall provide this information regardless of whether the
Department decides to work with Contractor on any aspect of the performance review or
evaluation.
1.12.4. Contractor shall provide all documentation requested by the Department to complete the
performance review using the Departments identified process within ten (10) Business
Days of the Department request. All documentation must be complied in the Departments
prescribed manner to ensure a time efficient review.
1.12.5. The Department may conduct these performance reviews or evaluations at any point during
the term of the Contract, or after termination of the Contract for any reason.
1.12.6. The Department may make the results of any performance reviews or evaluations available
to the public, or may publicly post the results of any performance reviews or evaluations.
1.12.7. The Department may recoup funding as a result of any performance review or evaluation
where payment was rendered for services not complete or not in alignment with federal
and/or state regulations or this Contract.
1.13. Renewal Options and Extensions
1.13.1. The Department may, within its sole discretion, choose to not exercise any renewal option
in the Contract for any reason. If the Department chooses to not exercise an option, it may
reprocure the performance of the Work in its sole discretion.
1.13.2. The Parties may amend the Contract to extend beyond five years, in accordance with the
Colorado Procurement Code and its implementing rules, in the event that the Department
determines the extension is necessary to align the Contract with other Department
contracts, to address state or federal programmatic or policy changes related to the
Contract, or to provide sufficient time to transition the Work.
1.14. Department System Access
1.14.1. In the event that Contractor requires access to any Department computer system to
complete the Work, Contractor shall have and maintain all hardware, software, and
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interfaces necessary to access the system without requiring any modification to the
Department's system. Contractor shall follow all Department policies, processes, and
procedures necessary to gain access to the Department's systems.
1.14.2. Contractor shall be responsible for any costs associated with obtaining and maintaining
access to systems needed to perform the Work under this solicitation, as determined by the
Department. The Department will not reimburse Contractor for any costs associated with
obtaining and maintaining access to Department systems.
1.15. Provider Fraud
1.15.1. Contractor shall notify the Department and the Colorado Medicaid Fraud Control Unit of
the Colorado Department of Law (MFCU) if it identifies or suspects possible Provider
Fraud as a result of any activities in its performance of this Contract.
1.15.2. Upon identification or suspicion of possible Provider Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.15.3. For each incident of identified or suspected Provider Fraud, Contractor shall provide all
of the following, at a minimum:
1.15.3.1. Written documentation of the findings.
1.15.3.2. Information on any verbal or written reports.
1.15.3.3. All details of the findings and concerns, including a chronology of Contractor actions
which resulted in the reports, in a format agreed to by the Department.
1.15.3.4. Information on the identification of any affected claims that have been discovered.
1.15.3.5. Any claims data associated with its report (in a mutually agreed upon format, if
possible).
1.15.3.6. Any additional information as required by the Department.
1.15.4. For each incident of identified or suspected Provider Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department and the
MFCU.
1.15.4.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.15.4.2. DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.15.5. Contractor shall revise or provide additional information related to Contractor Suspected
Fraud Written Notice Form as requested by the Department or the MFCU.
1.15.5.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and
Additional Information
1.15.5.2. DUE: Within three Business Days following the Department's or the MFCU's request,
unless the Department or MFCU provides for a different period in its request.
1.16. Member Fraud
1.16.1. Contractor shall notify the Department if it identifies or suspects possible Member Fraud
as a result of any activities in its performance of this Contract.
1.16.2. Upon identification or suspicion of possible Member Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
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1.16.3. For each incident of identified or suspected Member Fraud, Contractor shall provide all
of the following, at a minimum:
1.16.3.1. All verbal and written reports related to the suspected fraud.
1.16.3.2. All details of the findings and concerns, including a chronology of Contractor actions
which resulted in the reports, and the Member's State ID number, and Member's date of
birth if applicable.
1.16.3.3. Information on the identification of any affected claims that have been discovered.
1.16.3.4. Any claims data associated with its report in a format agreed to by the Department.
1.16.3.5. Any additional information as required by the Department.
1.16.4. For each incident of identified or suspected Member Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department at
report.clientfraud(c6state.co.us, or at such other email address as provided by the
Department from time to time.
1.16.4.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.16.4.2. DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.16.5. Contractor shall revise or provide additional information related to Contractor Suspected
Fraud Written Notice Form as requested by the Department.
1.16.5.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and
Additional Information
1.16.5.2. DUE: Within three Business Days following the Department's request, unless the
Department provides for a different period in its request.
2. CONTRACTOR PERSONNEL
2.1.Personnel General Requirements
2.1.1. Contractor shall provide qualified Key Personnel and Other Personnel as necessary to
perform the Work throughout the term of the Contract.
2.1.2. Contractor shall designate the following Key Personnel positions
2.1.2.1. Administrator
2.1.2.1.1. The Administrator shall be responsible for all of the following:
2.1.2.1.2. Serving as Contractor's primary point of contact for the Department.
2.1.2.1.3. Ensuring the completion of all Work in accordance with the Contract's requirements.
This includes, but is not limited to, ensuring the accuracy, timeliness and completeness of
all work.
2.1.2.1.4. Ensuring the timely submission and accuracy of all Deliverables submitted to the
Department.
2.1.2.1.5. Overseeing all other Key Personnel and Other Personnel and ensuring proper staffing
levels throughout the term of the Contract.
2.1.2.2. Case Management Supervisor(s)
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2.1.2.2.1. Contractor's Case Management Supervisor(s) shall meet all of the qualifications listed
in 10 C.C.R. 2505-10, Section 8.393.1.L.l.d et seq.
2.1.2.3. Other Personnel
2.1.2.4. Contractor shall have at least one Case Manager and one receptionist/clerical. Contractor
shall have additional Case Manager(s) and Support Staff as necessary to complete the
Work.
2.1.2.5. Contractor's Case Manager(s) shall meet all of the qualifications listed in 10 C.C.R. 2505-
10, Section 8.393.1.L.l.d et seq.
2.1.3. Contractor shall provide the Department with a final list of Key Personnel assigned to the
Contract and appropriate contact information for those individuals.
2.1.3.1. DELIVERABLE: Key Personnel assigned to the Contract
2.1.3.2. DUE: Within five Business Days after the Effective Date
2.1.4. Contractor shall provide the Department with a final list of individuals assigned to the
Contract and appropriate contact information for those individuals.
2.1.4.1. DELIVERABLE: Final list of names of the individuals assigned to the Contract
2.1.4.2. DUE: Within five Business Days after the Effective Date
2.1.5. Contractor shall update this list as needed to account for changes in the individuals
assigned to the Contract.
2.1.5.1. DELIVERABLE: Updated list of names of the individuals assigned to the Contract
2.1.5.2. DUE: Within five Business Days after changes to the individuals assigned to the Contract
are identified by Contractor.
2.2.Background Checks
2.2.1. Contractor shall conduct background checks on all new applicants for positions in which
direct care, as defined in section §26.3.1.101(3.5), C.R.S. will be provided to an at -risk
adult, as defined in section §26-3.1-101 (1.5), C.R.S to include at a minimum a Colorado
Bureau of Investigation check. On and after January 1, 2019, prior to employment, a Single
Entry Point agency shall submit the name of a person who will be providing direct care, to
an at -risk adult, as well as any other required identifying information, to the Colorado
Department of Human Services for a check of the Colorado Adult Protective Services data
system pursuant to section §26-3.1-111, C.R.S. to determine if the person is substantiated
in a case of mistreatment of an at -risk adult.
2.2.2. Contractor shall not permit any individual proposed for assignment to Key Personnel
positions to perform any Work prior to the Department's approval of that individual to be
assigned as Key Personnel.
2.2.3. If any of Contractor's Key Personnel or Other Personnel are required to have and maintain
any professional licensure or certification issued by any federal, state or local government
agency, then Contractor shall submit copies of such current licenses and certifications to
the Department.
2.2.3.1.DELIVERABLE: A copy of all current professional licensure and certification
documentation as specified for Key Personnel or Other Personnel
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2.2.3.2.DUE: Within five Business Days of receipt of updated licensure or upon request by the
Department
2.3.Personnel Availability
2.3.1. Contractor shall ensure Key Personnel and Other Personnel assigned to the Contract are
available for meetings with the Department during the Department's normal business
hours, as determined by the Department. Contractor shall also make these personnel
available outside of the Department's normal business hours and on weekends with prior
notice from the Department.
2.3.2. Contractor's Key Personnel and Other Personnel shall be available for all regularly
scheduled meetings between Contractor and the Department, unless the Department has
granted prior written approval otherwise.
2.3.3. Contractor shall ensure that the Key Personnel and Other Personnel attending all meetings
between the Department and Contractor have the authority to represent and commit
Contractor regarding work planning, problem resolution and program development.
2.3.4. At the Department's direction, Contractor shall make its Key Personnel and Other
Personnel available to attend meetings as subject matter experts with stakeholders both
within the State government and external private stakeholders.
2.3.5. All of Contractor's Key Personnel and Other Personnel that attend any meeting with the
Department or other Department stakeholders shall be physically present at the location of
the meeting, unless the Department provides telephone or video conferencing capabilities.
If Contractor has any personnel attend by telephone or video conference, Contractor shall
provide all additional equipment necessary for attendance, including any virtual meeting
space or telephone conference lines.
2.3.6. Contractor shall respond to all telephone calls, voicemails, and emails two Business Days
of receipt by Contractor, unless the situation is identified as urgent by the Department For
situations identified as urgent by the Department, Contractor must respond to the
Department the same business day but no later than 24 hours following the request.
2.4.Other Personnel Responsibilities
2.4.1. Contractor shall use its discretion to determine the number of Other Personnel necessary
to perform the Work in accordance with the requirements of this Contract. If the
Department determines that Contractor has not provided sufficient Other Personnel to
perform the Work in accordance with the requirements of this Contract, Contractor shall
provide all additional Other Personnel necessary to perform the Work in accordance with
the requirements of this Contract at no additional cost to the Department.
2.4.2. Contractor shall ensure that all Other Personnel have sufficient training and experience to
complete all portions of the Work assigned to them. Contractor shall provide all necessary
training to its Other Personnel, except for Department provided training specifically
described in this Contract.
2.4.3. Contractor shall employe or contract with a licensed medical professional who will be
available for consultation regarding Long Term Home Health (LTHH) PARs for Members.
2.4.4. Contractor may subcontract to complete a portion of the Work required by the Contract.
The conditions for using a Subcontractor or Subcontractors are as follows:
Page 53 a56
DocuSign Envelope ID: A1252E78-7F13-4ACB-85CA-B82759337FDD
2.4.4.1.Contractor shall not subcontract more than 40% percent of the Work. In this instance this
requirement shall not apply to any Subcontractor that is substantially owned by Contractor.
2.4.4.2.Contractor shall provide the organizational name of each Subcontractor and all items to be
worked on by each Subcontractor to the Department.
2.4.4.2.1. DELIVERABLE: Name of each Subcontractor and items on which each
Subcontractor will work
2.4.4.2.2. DUE: Within five Business Days after the Effective Date. The later of 30 days prior
to the subcontractor beginning work or the Effective Date.
2.4.5. Contractor shall obtain prior consent and written approval for any use of Subcontractor(s).
EXHIBIT END
Page 54 of 56
DocuSign Envelope ID: A1252E78-7F13-4ACB-85CA-B82759337FDD
EXHIBIT D, SUPPLEMENTAL PROVISIONS FOR FEDERAL AWARDS
For the purposes of this Exhibit only, Contractor is also identified as "Subrecipient." This
Contract has been funded, in whole or part, with an award of Federal Funds. In the event of a
conflict between the provisions of these Supplemental Provisions for Federal Awards, the
Special Provisions, the Contract or any attachments or exhibits incorporated into and made a part
of the Contract, the Supplemental Provisions for Federal Awards shall control. In the event of a
conflict between the Supplemental Provisions for Federal Award and the FFATA Supplemental
Provisions (if any), the FFATA Supplemental Provisions shall control.
1 Federal Award Identification
A. Subrecipient: Weld County Department of Human Services;
B. Subrecipient Data Universal Numbering System (DUNS) Number: 075757955;
C. The Federal Award Identification Number (FAIN): 1805CO5ADM;
D. The Federal Award date is: July 1, 2022;
E.The subaward period of performance start date is July 1, 2022 and the end date is June 30,
2024;
F. Federal Funds:
Contract or
Fiscal Year
Amount of Federal
Funds obligated by this
Contract
Total amount of Federal
Funds obligated to the
Subrecipient
Total amount of the
Federal Award
FY2022-23
To Be Determined,
Dependent on Caseload
To Be Determined,
Dependent on Caseload
To Be Determined,
Dependent on Caseload
G. Federal Award project description: To secure case management, associated utilization
review services, and other administrative activities for applicants and individuals of the Home
and Community Based Services Waiver for Persons with Brain Injury (HCBS-BI), Home and
Community Based Services Waiver for Persons who are Elderly, Blind and Disabled (HCBS-
EBD), Community Mental Health Supports Waiver (HCBS-CMHS), Home and Community
Based Service Complementary and Integrative Health Waiver (HCBS-CIH)), Waiver for
Children with a Life Limiting Illness (HCBS-CLLI), Program for All -Inclusive Care for the
Elderly (PACE).
H. Contractor was selected by the State in accordance with Colorado Revised Statute
(C.R.S.) Title 25.5, Article 10.
I. The name of the Federal awarding agency is the United States Centers for Medicare &
Medicaid Services (CMS); the name of the pass -through entity is the Colorado Department of
Health Care Policy & Financing (HCPF); and the contact information for the awarding official
is Sarah McDonnell, SEP Contract Manager, Office of Community Living, 1570 Grant Street,
Denver, CO 80203, Sarah.McDonnell55istate.co.us, 303-866-3615.
Page 55 of 56
DocuSign Envelope ID: A1252E78-7F13-4ACB-85CA-B82759337FDD
J. The Catalog of Federal Domestic Assistance (CFDA) number is 93.778, the name is Medical
Assistance Program, and the dollar amount is To Be Determined, Dependent on Caseload.
K. This award is not for research & development.
L.The indirect cost rate for the Federal Award (including if the de minimis rate is charged per 2
CFR 200.414 Indirect (F&A) costs) is pre -determined based upon the State of Colorado and
HCPF cost allocation plan.
EXHIBIT END
Page 56 of 56
Contract Form
New Contract Request
Entity Information
Entity Name*
COLORADO DEFT OF HEALTH CARE
POLICY & FINANCING
Entity ID*
#O0007174
Contract Name*
DEPARTMENT OF HEALTH CARE POLICY & FINANCING
(2022-23 SINGLE ENTRY POINT AMENDMENT 3)
Contract Status
CTB REVIEW
Contract ID
6693
Contract Lead*
COR6XXLK
❑ New Entity?
Parent Contract ID
20201636
Requires Board Approval
YES
Contract Lead Email Department Project #
cobbxxlk#co.weld.co.us
Contract Description*
FISCAL YEAR 2022-2023 SINGLE ENTRY POINT (SEP) CONTRACT AMENDMENT #3. TERM 7 )2022-6332023. (REFERENCE:
ALSO ASSOCIATED WITH SEP CONTRACT TYLER ID 2020-1636, CONTRACT AMEND #1 -TYLER ID 2021-1459 AND AMEND
#2 - TYLER ID 2021-3087)
Contract Description 2
PA ROUTING THROUGH NORMAL APPROVAL PROCESS. ETA TO C:TR 02,16:23.
Contract Type*
AMENDMENT
Amount*
$0.00
Renewable*
NO
Automatic Renewal
Grant
Department
HUMAN SERVICES
Department Email
CM-
HumanServicesc0weldgov.co
rn
Department Head Email
CM-HumanServices-
DeptHead yweldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COU NTYATTO RN EYS1/ELDG
OV,COM
Requested BOCC Agenda
Date*
02,2212023
Due Date
02/1812023
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 NSA enter NSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in
OnRase
Contract Dates
Effective Date
Review Date.
04/28i202.3
Renewal Date
Termination Notice Period
Contact Information
Contact Info
Contact Name
Purchasing
Committed Delivery Date
Contact Type Contact Email
Expiration Date*
06/30/2023
Contact Phone 1 Contact Phone 2
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
02,?24,/2023
Final Approval
l3OCC Approved
11OCC Signed Date
MCC Agenda Date
03/01,2023
Originator
COBB CLK
Finance Approver
CHERYL PATTELLI
Legal Counsel
BYRON HOWELL
Finance Approved Date Legal Counsel Approved Date
02,,27,"2023 02:27,?2023
Tyler Ref
AG 030123
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